Gonarthrosis, or arthrosis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes the destruction of the cartilaginous tissue structure of the joints, which in turn leads to their deformation and loss of their functions. Pathology often leads to human disability.
Deforming gonarthrosis of the knee occupies a leading place among all arthrosis, and if initially only a small part of the joint is affected, then in the absence of adequate treatment, when the disease progresses to a late stage of development, all this will be involved in the pathological process.
The disease most often develops in people over the age of 40, but in athletes it can occur at a young age (after getting serious joint injuries).
Women are most susceptible to joint deformities, but they often occur in men and even in young children. In order not to make the situation worse, you must know how to recognize the first signs of this disease.
Sorte
The classification of gonarthrosis depends on its etiology and localization. Each of the varieties has its own developmental characteristics that the doctor always takes into account when prescribing treatment. But by the nature of the manifestation, they are practically the same.
Thus, the types of acute osteoarthritis of the knee joint, depending on the etiology of the disease, are as follows:
- Primary gonarthrosis. This disease develops without any preconditions. The risk group includes the elderly, women and obese patients. Primary type gonarthrosis of the knee joint can develop with age without manifesting in any way. But the sooner it is detected, the prognosis of its treatment will be more favorable.
- Secondary gonarthrosisof the knee occurs due to trauma, but can also be the result of various infectious pathologies. If the damaged joints heal in time, the patient has every chance to avoid this disease.
There are types of osteoarthritis according to localization:
- Gonarthrosis on the right side, which develops in the joint tissues of the right knee. It often occurs in athletes, as well as in people whose work requires frequent physical effort.
- Left gonarthrosisinvolves the left knee in the pathological process. It occurs in people who play sports professionally, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a destructive effect on the knee joint tissues of both legs. This type of disease is considered the most severe, both in terms of symptoms and from the point of view of the therapeutic approach. In most cases, this type of gonarthrosis of the knee joint develops in elderly people, ie it is idiopathic.
Anatomy and pathological changes
The knee joint is formed from the articular surfaces of the tibia and femur. In its front part, there is a patella that slides smoothly along the recess located between the condyles of the femoral joint during movement.
The femur and tibia, together with the knee pads, are covered with elastic clayey cartilage 5-6 mm thick. It helps reduce friction during a person's physical activity, and in the event of a fall, it performs the function of absorbing shock.
Pathological changes in the joints: phase disorders
In the first phase of the development of gonarthrosis of the knee joint, it primarily affects the blood circulation. Small intraosseous vessels that bring blood to the hyaline joint are obstructed, 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. Inflammation gradually begins to develop, and the diseased cartilage, moving slightly, interferes with each other to fully perform its functions. Due to the creation of a large number of microcracks in the area of tissues that form cartilage, they gradually lose their cushioning properties.
In the second stage of gonarthrosis progression, compensatory changes in the bone area begin to occur. Under the influence of increased loads, the articular platform gradually begins to flatten, which leads to the compaction of the subchondral zone (the area of bone below the cartilage).
The articular surfaces along the edges begin to overgrow with bony processes, which on the X-ray image look like sharp thorns.
As the lubricating fluid in the joints thickens, it loses most of its function. This leads to accelerated cartilage degeneration. For this reason on the radiograph it looks like a thin thread or becomes completely invisible.
If something like this is noticed, it means that the disease smoothly (or quickly - it all depends on the situation) passes into the 3rd phase of development.
In the third stage of gonarthrosis of the knee joint, bone deformation is noticeable. They seem to be squeezed into each other, which leads to a decrease in joint mobility. The cartilage tissue dries out almost completely.
Causes and predisposing factors
The causes of osteoarthritis of the knee joint are not isolated - often the doctor identifies several factors that led to the development of the disease.
The most common and common reasons are:
- previous joint injuries (moderate or severe);
- leg fractures, especially if intraarticular damage has occurred;
- violation of the integrity of the meniscus structure;
- tears or complete tears of ligaments;
- excessive stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to a person's age. Thus, it has been determined that people older than 40 are the most sensitive to it, because in that period, the flexibility of the cartilage begins to decline, and the lubricating joint fluid gradually "dries out".
To delay this moment, sports are recommended for patients, but physical activity should be moderate and should not lead to general discomfort.
Overweight is also one of the factors that predispose to the development of gonarthrosis. The fact is that being overweight creates additional stress on the bones and joints, which cannot but affect their health.
In this case, the fact that the foot has more load plays an important role. For example, if your “support” is your left foot, there is a good chance that you may develop left gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels. Ruptures of the meniscus or ligaments are also possible, which are considered a difficult way to express joint injuries.
This disease is extremely severe for patients with severe symptoms of varicose veins. In this case, the patient is shown a consultation with a phlebologist.
There is a high risk of developing this pathology in people who:
- have previously suffered from various types of arthritis;
- have unfavorable heredity;
- have problems with the ligament apparatus;
- suffer from metabolic disorders;
- suffered a traumatic brain injury;
- were injured in the accident;
- had spinal injuries.
Many of these factors are often closely related. Precise determination of the cause helps to establish an accurate diagnosis and prescribes the patient an accurate and effective treatment of osteoarthritis of the knee joint.
Clinical manifestations
The symptoms of gonarthrosis do not manifest immediately - they begin to appear gradually, depending on the stage of the disease. Therefore, the clinical picture must be considered in stages.
Phase One
In the initial stage of disease development, patients complain of mild pain in the knee area, which increases with physical exertion. They become especially intense during the descent and ascent of stairs.
In addition to the pain, the patient also feels a certain stiffness of movement, "squeezing" in the area of the joint. It is felt in the popliteal part and passes when the knee muscles relax.
Another characteristic feature is the so-called "initial pain syndrome". It develops in the first steps of the patient. Once the knees get used to the load, this anomaly disappears without a trace.
Second phase
At this point, the symptoms of osteoarthritis of the knee joint become more intense and noticeable. The pain intensifies, causing significant difficulty and discomfort in walking. The pain syndrome disappears after a long rest, but with intense effort it is felt again.
Inflammation of the joint causes swelling of the knee, which is visible to the naked eye. There is a strong, uncomfortable contraction when walking. The movements become heavier and more limited.
Third phase
The pain becomes very strong and the patient cannot do without painkillers. The man finds it difficult to bend the knee, he feels the stiffness of the joint movements. It deforms and increases in size. In severe cases, the patient cannot move without additional support.
The patient should not ignore all these signs of osteoarthritis of the knee. The disease can put a person in a hospital bed for a long time and sometimes lead to disability.
Which doctor treats knee gonarthrosis?
For the diagnosis and treatment of knee gonarthrosis it is necessary to visit an orthopedic traumatologist. If surgery is needed, you may need the help of a surgeon.
Diagnostic measures
To determine the cause of the problem, an integrated approach to examining the patient is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination by an orthopedist and taking a medical history. The doctor determines if the patient has symptoms of acute osteoarthritis of the knee, palpates the affected area of the leg, measures the bone and performs angiometry - a test that can be used to assess joint mobility at different angles.
- Clinical blood test to assess ESR.
- Blood biochemistry.
- Examination of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common methods of examining osteoarthritis. However, in the initial stages of the image does not show any changes - they can be noticed only in the later stages of development. Radiography shows narrowing of the joint gap, sclerotic changes in the area of cartilage, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, full-fledged examination results can be achieved if ultrasound is performed together with radiography.
- MRI allows you to thoroughly examine all layers of joint, cartilage and bone tissue and detect the first dystrophic changes in the early stages of osteoarthritis. However, MRI has one major drawback - the procedure is quite expensive. But its high accuracy contributes to 99. 9% accurate diagnosis.
Treatment
Treatment of acute knee osteoarthritis, as well as diagnosis, requires an integrated approach. But, above all, it is necessary to apply drug therapy, because the diseased joint can be inflamed at any time.
Medications
How to treat gonarthrosis of the knee joint with pharmaceutical drugs and which drugs to choose? Only a traumatologist will tell about this. Drugs from the following groups are often included in the treatment regimen:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously damage the gastrointestinal tract, so they can not be used for a long time. The same cannot be said for COX-2 drugs, which are gentler. They are administered intramuscularly or intravenously.
- Treatment of knee osteoarthritis also involves the use of hormonal medications. They help relieve inflammation and swelling in the knee. Their use is desirable if there is synovitis (inflammation of the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams. They improve blood circulation, warm up, relieve swelling and inflammation.
First method
How to cure osteoarthritis of the knee joint with this technique? The main elements of the therapeutic scheme are:
- use of drugs (NSAIDs, chondroprotectors, painkillers, ointments, creams, gels);
- light physiotherapy exercises;
- manual therapy;
- physiotherapy;
- warming anti-inflammatory compresses with medicinal solutions.
In addition, according to a well-known rheumatologist, diet plays an important role in osteoarthritis. Thanks to a properly developed diet and the use of all the above techniques, the therapy can achieve amazing results in the shortest possible time.
Method two
Often the treatment of osteoarthritis of the knee joint, as well as other joint pathologies, is carried out by this method.
The development of the famous doctor is based on the application:
- medicines;
- surgical intervention;
- after a child who removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends more swimming in the pool, going to the sauna and going for a massage. This will help improve the patient’s health, especially if the disease has been ignored for a long time and has not been treated.
Treatment according to the third method
Treatment of gonarthrosis of the knee joint with this technique completely eliminates dynamic loads, because they can significantly accelerate the deformation process. The exercise should be slow, small amplitude.
Example: sit on a chair "on top", or turn towards your back. Spread your legs wide, but do not allow them to touch the floor. Gently wave each leg in a row. Exercise until you feel a little tired. The number of approaches depends on the well-being of the patient.
Surgery
How to treat advanced osteoarthritis of the knee? In this case, there is only one way out - surgery. There are several types of knee osteoarthritis surgery:
- Removal of deformed cartilage and diseased joint (arthrodesis). It is extremely rare.
- Removal of damaged cartilage tissue without removal of the joint. This intervention is called arthroscopic debridement. It is performed using a special device - an arthroscope. The procedure is simple, but its effect lasts no longer than 3 years.
- Sawing and securing the diseased joint at different angles. This is called a periarticular osteotomy. The technique is quite complex, but it allows forgetting the pathology for 3-5 years.
Endoprosthetics
Endoprosthetics are considered to be the most common treatment for gonarthrosis. This is a type of surgery that allows you to fully maintain the mobility of the affected knee. But, despite its effectiveness, this technique requires long-term rehabilitation. In addition, it can lead to quite serious consequences.
An artificial joint that can serve for 20 years is installed in place of the "real" patient. Although, of course, it all depends on the material it is made of. The procedure is not cheap, but quite effective, which is why it has gained special popularity.
Physiotherapy exercises
The 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 forbidden;
- does not perform exercises that require a full load of a sore joint.
Allowed exercises:
- slight trembling of the legs while kneeling on a blanket spread on the floor;
- regular knee movements in the same position;
- in the same position, alternately straighten your legs, trying not to tear your heels off the floor, and then bend them again, avoiding sudden movements.
These exercises, combined with medication and physical therapy, give excellent results.
Physiotherapy
All physiotherapy procedures are prescribed for gonarthrosis in remission. Among the most effective techniques should be noted:
- electrophoresis with drug solutions;
- magnetotherapy;
- ultrasound therapy;
- microwave processing;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent recurrence of the disease, a course of physiotherapy 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 performed along the flow of lymph in the direction from the peripheral area to the central zone. The popliteal fossa is not involved in this process.
In addition to massage, manual therapy sessions are often performed, the goal of which is to gradually stretch the diseased joint. Such procedures stabilize the patient's condition, but can only be performed by a specialist.
Is gonarthrosis completely cured?
Is it possible to completely cure osteoarthritis of the knee? Perhaps no one, not even the most experienced traumatologist, will be able to give an unambiguous answer to this question. It all depends on the severity of the disease. If you join the therapy in the early stages of its development, you can stop further deformation of the joint.
However, if the pathology is found in the last stages, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms. Surgery helps to heal for only a few years, after which the disease can remind itself again.
Prevention
To prevent gonarthrosis, you need:
- avoid knee injuries;
- exercise constantly (squatting, running, raising and lowering legs);
- enrich your diet with foods high in vitamins;
- limit the use of salt, hot spices, fried, smoked, sweet;
- maintaining normal physical shape;
- emergency medical care if you receive even the slightest knee injury;
- prophylactic use of chondroprotectors after the age of 35;
- consumption of daily water intake (2 liters).
By following these simple recommendations, you will reliably protect yourself from osteoarthritis of the knee joint, as well as from other diseases that can reduce your quality of life for a long time.