Gonarthrosis, or osteoarthritis of the knee, is a serious degenerative-dystrophic disease of the knee joint, which causes the destruction of the structure of the cartilage tissues of the joints, which, in turn, leads to their deformation andto the loss of their functions. Pathology often leads to human disability.
Deforming knee osteoarthritis occupies a prominent place among all osteoarthritis, and if at first only a small part of the joint is affected, then in the absence of adequate treatment, when the disease progresses to an advanced stageof development, everything is involved in the pathological process.
Most often the disease develops in people over the age of 40, but in athletes it can occur even at a young age (after receiving severe injuries to the joints).
Women are more susceptible to joint deformation, but it often occurs in men and even young children. In order not to aggravate the situation, you need to be able to recognize the first signs of this disease.
Variety
The classification of gonarthrosis depends on its etiology and localization. Each of the varieties has its own developmental features, which are always taken into account by the doctor when prescribing treatment. But by the nature of the manifestation, they are pretty much the same.
Therefore, 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 prerequisites. The risk group includes the elderly, women and obese patients. Primary knee joint gonarthrosis can develop over years without manifesting itself in any way. But the sooner it is discovered, the more favorable the prognosis of its treatment will be.
- Secondary gonarthrosisof the knee occurs due to trauma, but can also be a consequence of various infectious diseases. If the damaged joints are treated in a timely manner, the patient has every chance to avoid this disease.
There are types of osteoarthritis by localization:
- Gonarthrosis of 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 exertion.
- Gonarthrosis of the left sideinvolves the left knee in the disease process. It occurs in people who are professionally involved in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a destructive effect on the joint tissues of the knees of both legs. This type of disease is considered the most serious, 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 people of old age, that is, it is idiopathic.
Anatomy and pathological changes
The knee joint is formed by the articular surfaces of the tibia and femur. In its front part there is a patella which, during the movements, smoothly slides along the depression located between the condyles of the femoral joint.
The femur and tibia together with the knee brace are covered with elastic clay cartilage, which is 5-6 mm thick. It helps to reduce friction during a person's physical activity and, in the event of falls, it performs a cushioning function.
Pathological changes in the joints: phased disorders
In the first stage of the development of gonarthrosis of the knee joint, blood circulation is affected first of all. The small intraosseous vessels that supply blood to the hyaline joint are disrupted, which leads to a gradual drying of its surface. It becomes less elastic and cracks begin to form on its surface.
Consequently, instead of sliding smoothly, these cartilages touch. Inflammation gradually begins to develop, and diseased cartilages, moving slightly, interfere with each other to fully perform 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 cushioning properties.
In the second stage of the progression of gonarthrosis, compensatory changes in the bone area begin to occur. Under the influence of increased loads, the joint platform gradually begins to flatten, this leads to compaction of the subchondral zone (the area of the bone that is under the cartilage).
The joint surfaces along the edges begin to overgrow with the bony processes, which look like sharp spines on an x-ray.
As the lubricating fluid thickens in the joints, it loses most of its function. This leads to accelerated degeneration of the cartilage. Because of this, it looks like a thin thread on the x-ray, or it becomes completely invisible.
If something like this was noticed, it means that the disease flows smoothly (or quickly - it all depends on the situation) in the third stage of development.
At the third stage of gonarthrosis of the knee joint, there is a noticeable deformation of the bones. They seem to be squeezed into each other, which leads to a decrease in joint mobility. Cartilage tissue almost completely dries up.
Causes and predisposing factors
The causes of osteoarthritis of the knee joint are not isolated - often the doctor determines several factors at once that led to the development of the disease.
The most common and common reasons are:
- previous joint injuries (moderate or high severity);
- leg fractures, especially if there was intra-articular damage;
- violation of the integrity of the structure of the meniscus;
- tears or complete tears of the ligaments;
- excessive stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to a person's age. Thus, it was found that people over 40 are more sensitive to it, since during this time the flexibility of the cartilage begins to decrease and the lubricating joint fluid gradually "dries up".
To delay this moment, sports are recommended for patients, but physical activity should be moderate and not lead to general discomfort.
Excess weight is also one of the factors that predispose to the development of gonarthrosis. The fact is that being overweight creates additional stress on bones and joints, which can only affect their health.
In this case, an important role is played by the fact that the leg has more loads. For example, if your left leg is your "support", then there is a high probability that you can develop left-sided gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels. Ruptures of the menisci or ligaments are also possible, which are considered a serious way of manifesting joint injury.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins. In this case, the patient is shown the advice of a phlebologist.
A high risk of developing this condition also exists in people who:
- has previously suffered from several types of arthritis;
- have an unfavorable inheritance;
- has problems with the ligament apparatus;
- suffers from metabolic disorders;
- suffered traumatic brain injury;
- were injured in an accident;
- had spinal injuries.
Many of these factors are often closely related. An accurate determination of the cause helps establish an accurate diagnosis and prescribes the correct and effective treatment for the patient for osteoarthritis of the knee joint.
Clinical manifestations
Symptoms of gonarthrosis do not manifest themselves immediately: they begin to appear gradually, depending on the stage of the disease. For this reason, the clinical picture must be considered in stages.
First stage
At the initial stage of the development of the disease, patients complain of mild pain in the knee area, which increases with physical exertion. They become particularly intense during the descent and ascent of stairs.
In addition to pain, the patient feels a certain stiffness of movements, "constriction" in the joint area. It is felt in the popliteal part and passes when the knee muscles are relaxed.
Another characteristic feature 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 anomaly disappears without a trace.
Second stage
At this time, the symptoms of osteoarthritis of the knee joint become more intense and noticeable. The pain intensifies, causing considerable difficulty and discomfort when walking. The pain syndrome disappears after a long rest, but with intense effort it makes itself felt again.
Inflammation of the joint causes swelling of the knee that is visible even to the naked eye. There is a loud, unpleasant crunch when walking. The movements become more difficult and more limited.
Phase three
The pain becomes very severe and the patient cannot do without pain medication. It is difficult for a person to bend the knee, he feels the stiffness of joint movements. It deforms and increases in size. In severe cases, the patient cannot move without additional support.
All these signs of knee osteoarthritis 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 knee osteoarthritis?
For the diagnosis and treatment of knee gonarthrosis, it is necessary to consult an orthopedic traumatologist. If surgery is needed, help from a surgeon may be needed.
Diagnostic measures
To establish the cause of the disorder, an integrated approach to examining the patient is extremely important.
The diagnostic scheme consists of several phases:
- Visual inspection of the orthopedist and taking the medical history. The doctor determines whether the patient has symptoms of acute osteoarthritis of the knee joint, palpates the affected area of the leg, measures the bone, and takes an angle measurement - a test that can be used to assess the mobility of the jointat different angles.
- Clinical blood test for the evaluation of ESR.
- Biochemistry of blood.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common examination methods for osteoarthritis. However, in the early stages, the snapshot does not show any changes - they can only be noticed in the later stages of development. The x-ray shows a narrowing of the joint gap, sclerotic changes in the cartilage area, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, full-fledged examination results can be obtained if ultrasound is performed together with radiography.
- Magnetic resonance imaging allows you to thoroughly examine all layers of joint, cartilage and bone tissues and to notice 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 its diagnosis, requires an integrated approach. But, first of all, it is necessary to apply drug therapy, because the diseased joint can become inflamed at any time.
Medication
How to treat gonarthrosis of the knee joint with pharmacy drugs and which drugs to choose? Only a traumatologist will tell. Often, drugs from the following groups are included in the therapeutic regimen:
- Non-steroidal anti-inflammatory drugs COX-1 or 2. The first group can severely damage the gastrointestinal tract, so they cannot be used for a long time. The same cannot be said of drugs from the COX-2 group, which are gentler. They are administered intramuscularly or intravenously.
- Treatment of knee osteoarthritis also involves the use of hormonal drugs. They help relieve inflammation and swelling in the knee. Their use is advisable in case of synovitis (inflammation of the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams. They improve blood circulation, warm up, relieve swelling and inflammation.
Method one
How to cure osteoarthritis of the knee joint using this technique? The main elements of the therapeutic scheme are:
- use of drugs (NSAIDs, chondroprotectors, analgesics, ointments, creams, gels);
- light physiotherapy exercises;
- manual therapy;
- physiotherapy;
- anti-inflammatory warming compresses with medicinal solutions.
Furthermore, according to the famous rheumatologist, diet plays an important role in osteoarthritis. Thanks to a properly developed diet and the use of all the above techniques, you can achieve amazing results from therapy in the shortest possible time.
Method two
Often the treatment of osteoarthritis of the knee joint, like other joint pathologies, is carried out using this method.
The development of a famous doctor is based on the application:
- drugs;
- surgery;
- adherence to a diet that removes excess fluids from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, going to the sauna and getting 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 cured.
Treatment according to the third method
Treatment of gonarthrosis of the knee joint using this technique completely excludes dynamic loads, since they can significantly accelerate the deformation process. Exercise should be slow, of low amplitude.
Example: sitting on a chair "on top", ie facing the backrest. Spread your legs, but don't let them touch the floor. Gently shake each leg in turn. Do the exercise until you feel a little tired. The number of approaches depends on the patient's well-being.
Surgery
How to treat advanced osteoarthritis of the knee joints? In this case, there is only one way out - operation. There are several types of surgery for osteoarthritis of the knee joints:
- Removal of deformed cartilage tissue and a diseased joint (arthrodesis). It is extremely rare.
- Removal of damaged cartilage tissue without removing the joint. This surgery is called arthroscopic debridement. It is performed using a special device - an arthroscope. The procedure is simple, but its effect lasts no more than 3 years.
- Saw and fix the affected joint at a different angle. This is called a periarticular osteotomy. The technique is quite complicated, but it allows you to forget about the pathology for 3-5 years.
Surgery is rarely used and only in the absence of a method that cures the disease, at least for 1-2 years. In the early stages of the disease, the operation is almost never performed.
Endoprosthesis
Endoprosthesis is considered 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 rather serious consequences.
An artificial joint is implanted in place of the "real" patient, which can last 20 years. Although, of course, it all depends on the material with which it was made. The procedure is not cheap, but effective enough, which is why it has gained particular popularity.
Physiotherapy exercises
The course of physical therapy is prescribed by the doctor depending on the stage of the disease. However, the principles for performing the exercises are the same for all cases:
- avoid intense stress on the knee joint;
- sudden and forced movements are prohibited;
- does not perform exercises that require full load on the aching joint.
Exercises allowed:
- slight trembling of the legs while kneeling on a blanket spread on the floor;
- accurate kneeling movements in the same position;
- in the same position, alternately straighten your legs, trying not to tear your heels off the floor, then bend them again, avoiding sudden movements.
These exercises, combined with drugs and physical therapy, give excellent results.
Physiotherapy
All physiotherapy procedures are prescribed for gonarthrosis in remission. Among the most effective techniques, it should be noted:
- electrophoresis with medicinal solutions;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulphide;
- mud treatment.
To prevent a recurrent outbreak of the disease, physiotherapy courses should be taken at least 2 times a year. This will help prolong the remission phase.
Massage
The knee massage is performed to improve blood circulation. It is performed along the lymphatic flow in the direction from the peripheral area to the central zone. The popliteal fossa is not involved in this process.
Often, along with massage, manual therapy sessions are performed, aimed at gradually stretching the diseased joint. Such procedures stabilize the patient's condition, but they can only be performed by a specialist.
Is the gonarthrosis completely cured?
Is it possible to completely cure osteoarthritis of the knee joint? Perhaps no one, not even the most experienced traumatologist, will be able to give a single answer to this question. It all depends on the severity of the disease. If you engage in therapy early in its development, you can stop further deformation of the joint.
However, if a pathology is found in the late stages, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms. The operation helps to heal only for a few years, after which the disease can again remember itself.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- constant exercise (squatting, running, raising and lowering the legs);
- enrich the diet with foods containing many vitamins;
- limit the use of salt, hot spices, fried, smoked, sweets;
- to maintain normal physical shape;
- immediate medical assistance if you suffer the slightest knee injury;
- prophylactic use of chondroprotectors after reaching 35 years of age;
- consumption of daily water intake (2 liters).
By following these simple tips, you will reliably protect yourself from osteoarthritis of the knee joint and other diseases that can reduce your quality of life for a long time.