Gonarthrosis or arthrosis of the knee is a serious degenerative-dystrophic pathology of the knee joint, which causes the destruction of the cartilage tissue structure of the joints, which, in turn, leads to their deformation and loss of their functions.Pathology often leads to human disability.
Deformative gonarthrosis of the knee occupies a leading place among all arthrosis, and if at first only a small part of the joint is affected, then in the absence of adequate treatment, when the disease reaches a late stage of development, the entire joint is involved in the pathological process.
Most often, the disease develops in people over 40 years old, but in athletes it can also appear at a young age (after receiving serious joint injuries).
Women are more susceptible to the process of joint deformation, but it often occurs in men and even in young children.In order not to worsen the situation, you must be able to recognize the first signs of this disease.
varieties
The classification of gonarthrosis depends on its etiology and location.Each of the varieties has its own development characteristics, which are always taken into account by the doctor when prescribing treatment.But in terms of the nature of their manifestation, they are almost identical.
Thus, the types of acute arthrosis of the knee joint, depending on the etiology of the disease, are as follows:
- Primary gonarthrosis.This disease develops without any prerequisites.The risk group includes the elderly, women and patients suffering from obesity.Gonarthrosis of the knee joint of the primary type can develop for years without appearing.But the sooner it is detected, the more favorable the prognosis will be for its treatment.
- Secondary gonarthrosisKnee pain occurs due to previous injuries, but it can also be a consequence of various infectious pathologies.If the damaged joints are treated in time, the patient has every chance to avoid this disease.
There are types of osteoarthritis according to location:
- Gonarthrosis of the right side, which develops in the articular tissues of the right knee.It often occurs in athletes, as well as in people whose work requires frequent physical activity.
- Gonarthrosis of the left sideinvolves the left knee in the pathological process.It occurs in people who are professionally engaged in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritisit has a destructive effect on the tissues of the knee joints of both legs.This type of disease is considered more serious, both in terms of symptoms and therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in elderly people, that is, it is idiopathic in nature.
Anatomy and pathological changes
The knee joint is formed by the articular surfaces of the tibia and femur.In its front part is the patella, which during movements slides smoothly along the depression located between the condyle of the femoral joint.
The femur and tibia together with the knee cap are covered with elastic glialine cartilage, which is 5-6 mm thick.It helps to reduce friction when a person performs physical activity and in case of a fall performs the function of shock absorption.
Pathological changes in joints: gradual disorders
In the first stage of the development of gonarthrosis of the knee joint, blood circulation is mainly affected.Small intraosseous vessels that supply blood to the hyaline joint are interrupted, which leads to gradual drying of its surface.It becomes less elastic and cracks begin to form on its surface.
As a result, instead of sliding smoothly, these cartilages touch each other.Inflammation gradually begins to develop, and the diseased cartilages, moving slightly, prevent each other from fully performing their functions.Due to the formation of a large number of microcracks in the area of the tissues that make up the cartilage, they gradually lose their shock-absorbing properties.
In the second stage of gonarthrosis progression, compensatory changes begin to occur in the bone area.Under the influence of increased loads, the articular platform gradually begins to flatten, this leads to compression of the subchondral area (the area of the bone located under the cartilage).
The joint surfaces along the edges begin to grow with bony processes, which on an x-ray look like sharp spikes.
As the lubricating fluid in the joint becomes thicker, it loses much of its function.This leads to accelerated cartilage degeneration.For this reason, it appears as a thin thread on an x-ray, or becomes completely invisible.
If this is observed, it means that the disease smoothly (or quickly - it all depends on the situation) proceeds to the third stage of development.
In the third stage of gonarthrosis of the knee joint, visible deformation of the bones occurs.They seem to be squeezed into each other, which leads to reduced mobility of the joints.Cartilage tissue is almost completely depleted.
Causes and predisposing factors
The causes of arthrosis of the knee joint are not isolated - often the doctor immediately determines several factors that led to the development of the disease.
The most common and common reasons are:
- previous joint injuries (of moderate or severe severity);
- ankle fractures, especially if there was intra-articular damage;
- violation of the integrity of the meniscus structure;
- ruptures or complete ruptures of ligaments;
- too intense stress on the knee joints.
Acute arthrosis of the knee joint is directly related to a person's age.Thus, it has been proven that people over 40 are more susceptible to it, since during this period the flexibility of the cartilage begins to decrease, and the lubricating fluid of the joint gradually "dry up".
To delay this moment, patients are recommended to play sports, but physical activity should be moderate and not lead to general discomfort.
Excess weight is also one of the predisposing factors for the development of gonarthrosis.The fact is that excess body weight creates additional stress on bones and joints, which cannot but affect their health.
In this case, an important role is played by the fact which leg carries more loads.For example, if your "support" is your left leg, then there is a high probability that you will develop left-sided gonarthrosis.
In obesity, constant pressure on the joint leads to microtrauma and rupture of small blood vessels.Ruptures of the meniscus or ligaments are also possible, which are considered a serious way of manifesting joint injuries.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins.In this case, the patient is advised to consult a phlebologist.
A high risk of developing this pathology also exists in people who:
- previously suffered from various types of arthritis;
- have unfavorable heredity;
- have problems with the ligamentous apparatus;
- suffer from metabolic disorders;
- suffered traumatic brain injuries;
- injured in a traffic accident;
- had spinal injuries.
Many of these factors are often closely related.Determining the exact cause helps to establish an accurate diagnosis and prescribe the patient the appropriate and effective treatment for knee arthrosis.
Clinical manifestations
Symptoms of gonarthrosis do not appear immediately - they begin to appear gradually, depending on the stage of the disease.For this reason, the clinical picture should be considered in stages.
The first stage
In the initial stage of the disease, patients complain of mild pain in the knee area, which intensifies with physical activity.They become especially intense when going down and up stairs.
In addition to pain, the patient feels a certain stiffness of movement, "tightness" in the joint area.It is felt in the popliteal region and goes away when the knee muscles relax.
Another characteristic symptom is the so-called "initial pain syndrome".It develops in the first steps of the patient.When the knees get used to the load, this abnormality disappears without a trace.
The second stage
At this time, the symptoms of arthrosis of the knee joint become more intense and visible.The pain intensifies, causing significant difficulty and discomfort while walking.The pain syndrome disappears after a long rest, but with intense exercise it is felt again.
Inflammation of the joint causes swelling of the knee, which can also be seen with the naked eye.When you walk, a loud and unpleasant crunching noise appears.Movements become more difficult and limited.
The third stage
The pain becomes very strong, and the patient cannot do without painkillers.It is difficult for a person to bend his knee, he feels stiffness in the movements of the joint.It deforms and increases in size.In severe cases, the patient cannot move without additional support.
All these signs of arthrosis of the knee joint should not be ignored by the patient.The disease can put a person in a hospital bed for a long time and sometimes lead to disability.
Which doctor treats gonarthrosis of the knee joint?
To diagnose and treat knee gonarthrosis, you should consult an orthopedic traumatologist.If surgery is necessary, the help of a surgeon may be needed.
Diagnostic measures
To determine the cause of the disease, a comprehensive approach to examining the patient is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination by an orthopedist and medical history.The doctor determines whether the patient has symptoms of acute arthrosis of the knee joint, palpates the affected area of the leg, measures the bone and performs angiometry - a test that can be used to assess the mobility of the joint from different angles.
- Clinical blood test to evaluate ESR.
- Blood biochemistry.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common methods of examining arthrosis.However, in the initial stages, the image does not show any changes - they can be observed only in the later stages of development.An x-ray reveals a narrowing of the joint space, sclerotic changes in the cartilage area, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure.However, the results of the complete examination can be achieved if ultrasound is performed together with radiography.
- MRI allows you to fully study all layers of articular, cartilage and bone tissues and notice the first dystrophic changes in the early stages of the development of arthrosis.However, MRI has a major disadvantage - the procedure is quite expensive.But its high accuracy contributes to establishing a 99.9% correct diagnosis.
Treatment
Treatment of acute knee arthrosis, as well as its diagnosis, requires an integrated approach.But, first of all, it is necessary to use drug therapy, because the diseased joint can become inflamed at any time.
Drug treatment
How to treat gonarthrosis of the knee joint with the help of pharmaceutical drugs and which drugs to choose?Only a traumatologist will tell you about this.Often, the treatment regimen includes drugs from the following groups:
- Non-steroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously damage the gastrointestinal tract, so they cannot be used for a long time.This cannot be said about COX-2 group drugs, which are milder.They are administered intramuscularly or intravenously.
- Treatment of arthrosis of the knee joint also includes the use of hormonal drugs.They help relieve inflammation and remove swelling of the knee.Their use is advised if synovitis occurs (an inflammatory process in the area of the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams.They improve blood circulation, warm up, relieve swelling and inflammation.
The first method
How to cure arthrosis of the knee joint using this method?The main elements of the treatment regimen are:
- use of drugs (NSAIDs, chondroprotectors, pain relievers, ointments, creams, gels);
- light physical therapy;
- manual therapy;
- physiotherapy;
- warm anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in arthrosis.Through a properly designed diet and the use of all the above methods, you can achieve amazing results from therapy in the shortest possible time.
Method two
Often, the treatment of arthrosis of the knee joint, as well as other articular pathologies, is carried out using this method.
The development of the famous doctor is based on the use of:
- medications;
- surgical intervention;
- following a diet that removes excess fluids from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, visiting the sauna and getting a massage.This will help improve the patient's health, especially if the disease has been ignored and untreated for a long time.
Treatment using the third method
Treatment of gonarthrosis of the knee joints using this method completely eliminates dynamic loads, as they can significantly accelerate the deformation process.Physical exercises should be slow, with low amplitude.
Example: sit in a chair "more upright", that is, facing the back.Spread your legs wide, but do not let them touch the floor.Gently swing each leg in turn.Do the exercise until you feel a little tired.The number of approaches depends on the patient's well-being.
Surgical intervention
How to treat advanced arthrosis of the knee joints?In this case, there is only one way out - surgery.There are several types of surgery that are performed for osteoarthritis of the knee joints:
- Removal of deformed cartilaginous tissue and diseased joint (arthrodesis).This is done extremely rarely.
- Removal of damaged cartilage tissue without removing the joint.This intervention is called arthroscopic debridement.It is performed using a special device - an arthroscope.The procedure is simple, but its effect does not last more than 3 years.
- Sawing and securing the diseased joint at another angle.This method is called periarticular osteotomy.The technique is quite complex, but it makes it possible to forget the pathology for 3-5 years.
Surgical intervention is used rarely and only in the absence of a method that cures the disease, at least for 1-2 years.In the initial stages of the disease, surgery is almost never performed.
Endoprosthetics
Endoprosthesis replacement is considered the most common method of gonarthrosis treatment.This is a type of surgery that allows you to fully maintain the mobility of the diseased knee.But, despite its effectiveness, this technique requires long-term rehabilitation.In addition, it can lead to quite serious consequences.
Instead of the "real" one, the patient is given an artificial joint, which can last for 20 years.Although, of course, it all depends on the material from which it is made.The procedure is not cheap, but quite effective, which is why it has gained special popularity.
Therapeutic exercises
A course of exercise therapy is prescribed by a doctor depending on the stage of the disease.However, the principles of performing the exercises are the same for all cases:
- avoiding intense stress on the knee joint;
- Sudden and forced movements are prohibited;
- do not perform exercises that require full load on the injured joint.
Allowed exercises:
- slight trembling of the legs while kneeling on a blanket spread on the floor;
- careful movement of the knees in the same position;
- in the same position, straighten your legs one by one, trying not to lift the heels off the floor, and then bend them again, avoiding sudden movements.
Such exercises in combination with drug treatment and physiotherapy give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis that is in remission.Among the most effective methods should be noted:
- electrophoresis with medicinal solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulphide;
- mud treatment.
To prevent the recurrence of the disease, physiotherapy courses should be carried out at least 2 times a year.This will help prolong the remission phase.
Massage
Knee massage is performed to improve blood circulation.It is carried out along the lymphatic flow in the direction from the peripheral zone to the central zone.The popliteal fossa is not involved in this process.
Often, along with the massage, manual therapy sessions are performed, aimed at gradually stretching the injured joint.Such procedures stabilize the patient's condition, but can only be performed by a specialist.
Is gonarthrosis completely curable?
Is it possible to completely cure osteoarthritis of the knee joint?Perhaps no one, even the most experienced traumatologist, can give a clear answer to this question.It all depends on the severity of the disease.If you engage in therapy in the early stages of its development, you can stop further deformation of the joint.
However, if the pathology is detected in the final stages, then even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms.The operation provides a cure only for a few years, after which the disease may become known again.
Preventing
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, lifting and lowering legs);
- enrich the diet with foods containing many vitamins;
- limit the consumption of salt, hot spices, fried, smoked, sweets;
- maintaining normal physical shape;
- consult a doctor immediately if you get the slightest knee injury;
- preventive use of chondroprotectors after reaching the age of 35;
- drinking the daily rate of water (2 l).
By following these simple recommendations, you will surely be protected from arthrosis of the knee joint, as well as from other diseases that can reduce the quality of your life for a long time.