Gonarthrosis, or osteoarthritis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes the destruction of the structure of the cartilaginous tissue of the joints, which leads to their deformation and loss of functions.Pathology often leads to human disability.
Deforming 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 an advanced 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 occur at a young age (after serious joint injuries).
Women are most susceptible to the process of joint deformation, but it often occurs in men and even in young children.In order not to aggravate the situation, you must be able to recognize the first signs of this disease.
Varieties
The classification of knee osteoarthritis depends on its etiology and location.Each of the varieties has its own developmental characteristics, which are always taken into account by the doctor when prescribing treatment.But by the nature of their manifestation, they are almost identical.
So, 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 elderly people, women and patients suffering from obesity.Gonarthrosis of the knee joint of the primary type can develop for years without manifesting itself.But the earlier it is detected, the more favorable the prognosis for its treatment will be.
- Secondary gonarthrosisKnee pain is due to previous injuries, but it can also be the consequence of various infectious pathologies.If damaged joints are treated promptly, the patient has every chance of avoiding this disease.
There are types of osteoarthritis depending on the location:
- Right-sided knee osteoarthritis, which develops in the joint tissues of the right knee.This often occurs in athletes, as well as people whose work requires frequent physical activity.
- Gonarthrosis on the left sideinvolves the left knee in the pathological process.This occurs in people 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 in terms of therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in older people, that is, it is idiopathic in nature.
Anatomy and pathological changes
The knee joint is formed from the articular surfaces of the tibia and femur.In its anterior part is the patella which, during movements, slides gently along the depression located between the condyles of the femoral joint.
The femur and tibia, as well as the patella, are covered with elastic glial cartilage 5 to 6 mm thick.It helps reduce friction when a person performs physical activity and, in the event of a fall, it performs a shock absorption function.
Pathological changes in the joints: progressive disorders
At the first stage of development of gonarthrosis of the knee joint, blood circulation is mainly affected.The small intraosseous vessels which irrigate the hyaline joint are disrupted, which leads to progressive drying of its surface.It becomes less elastic and cracks begin to form on its surface.
As a result, instead of sliding gently, these cartilages touch each other.Inflammation gradually begins to develop and diseased cartilages, slightly displaced, prevent themselves from fully performing their functions.Due to the formation of a large number of microcracks in the tissues that make up the cartilage, they gradually lose their shock absorption properties.
In the second phase of progression of gonarthrosis, compensatory changes in the bone area begin to occur.Under the influence of increased loads, the joint platform begins to gradually flatten, which leads to compaction of the subchondral zone (the area of the bone located under the cartilage).
The articular surfaces along the edges begin to be overgrown with bony processes, which on an x-ray look like sharp points.
As the lubricating fluid in the joints becomes thicker, it loses much of its function.This leads to accelerated degeneration of cartilage.For this reason, it looks like a thin thread on an x-ray or becomes completely invisible.
If this was noticed, it means that the disease smoothly (or quickly - it all depends on the situation) enters the 3rd phase of development.
At the third stage of gonarthrosis of the knee joint, a noticeable deformation of the bones occurs.They appear to be pressed against each other, leading to decreased joint mobility.Cartilage tissue is almost completely depleted.
Causes and predisposing factors
The causes of osteoarthritis of the knee joint are not isolated - the doctor often 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 severe);
- ankle fractures, especially in cases of intra-articular injuries;
- violation of the integrity of the meniscal structure;
- tears or complete ruptures of ligaments;
- excessively intense stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to a person's age.Thus, it has been established that people over 40 years old are the most susceptible to it, because during this period the flexibility of the cartilage begins to decrease and the lubricating joint fluid gradually “drys up”.
To delay this moment, patients are advised to play sports, but physical activity should be moderate and not cause general discomfort.
Excess weight is also one of the predisposing factors for the development of knee osteoarthritis.The fact is that excess 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 that the leg bears the most load.For example, if your “support” is your left leg, there is a high probability that you will develop left-sided knee osteoarthritis.
In cases of obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels.Ruptures of the meniscus or ligaments are also possible, 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 head injuries;
- injured in a road accident;
- had spinal injuries.
Many of these factors are often closely related.Accurate determination of the cause makes it possible to establish an accurate diagnosis and prescribe the patient the correct and effective treatment of osteoarthritis of the knee joint.
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 must be considered in stages.
First step
At the initial stage of development of the disease, patients complain of slight pain in the knee area, which intensifies with physical activity.They become particularly intense when going down and up stairs.
In addition to pain, the patient feels a certain stiffness in movements, a “tightness” in the joint.It is felt in the popliteal area and disappears when the knee muscles relax.
Another characteristic symptom is the so-called “initial pain syndrome”.It develops from the patient's first steps.When the knees get used to the load, this anomaly disappears without a trace.
Second step
At this stage, the symptoms of osteoarthritis of the knee joint become more intense and more visible.The pain intensifies, causing significant difficulty and discomfort when walking.The pain syndrome disappears after a long rest, but with intense exercise it makes itself felt again.
Inflammation of the joint causes swelling of the knee, visible even to the naked eye.When walking, a loud and unpleasant crunching noise occurs.Movements become more difficult and constrained.
Third step
The pain becomes very intense and the patient cannot do without painkillers.It is difficult for a person to bend the knee, he feels stiffness in the movements of the joint.It deforms and grows.In severe cases, the patient cannot move without additional support.
All these signs of osteoarthritis of the knee joint should not be ignored by the patient.The disease can leave a person confined to a hospital bed for a long time and sometimes lead to disability.
Which doctor treats gonarthrosis of the knee joint?
To diagnose and treat gonarthrosis of the knee, you need to consult an orthopedic traumatologist.If surgery is necessary, help from a surgeon may be needed.
Diagnostic measures
To establish the cause of the disease, a comprehensive approach to the patient's examination is extremely important.
The diagnostic scheme includes several stages:
- Visual examination by an orthopedist and 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 performs angiometry - a test that can be used to assess the mobility of the joint from different angles.
- Clinical blood test to assess ESR.
- Biochemistry of blood.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- X-ray is one of the most common methods of examining osteoarthritis.However, in the early stages, the picture does not show any changes - they can only be noticed in later stages of development.An x-ray reveals narrowing of the joint space, sclerotic changes in the cartilaginous area, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure.However, complete examination results can be obtained if the ultrasound is performed at the same time as the x-ray.
- MRI allows you to study in depth all layers of joint, cartilaginous and bone tissues and notice the first dystrophic changes in the early stages of development of osteoarthritis.However, MRI has a big drawback: the procedure is quite expensive.But its high precision contributes to establishing a 99.9% accurate diagnosis.
Treatment
The treatment of acute osteoarthritis of the knee, as well as its diagnosis, requires an integrated approach.But first of all, it is necessary to resort to drug treatment, because the diseased joint can become inflamed at any time.
Drug treatment
How to treat gonarthrosis of the knee joint using pharmaceutical drugs and which drugs to choose?Only a traumatologist will tell you about it.Often, the treatment regimen includes drugs from the following groups:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously harm the gastrointestinal tract and therefore cannot be used for a long time.The same cannot be said about drugs from the COX-2 group, which are milder.They are administered intramuscularly or intravenously.
- Treatment of knee osteoarthritis also involves the use of hormonal drugs.They help relieve inflammation and eliminate swelling in the knee.Their use is recommended in cases of synovitis (inflammatory process in the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams.They improve blood circulation, warm, relieve swelling and inflammation.
First method
How to treat knee osteoarthritis with this method?The main elements of the treatment regimen are:
- use of medications (NSAIDs, chondroprotectors, analgesics, ointments, creams, gels);
- light physiotherapy;
- manual therapy;
- physiotherapy;
- hot anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in osteoarthritis.Thanks to a well-designed diet and the use of all of the above methods, you can achieve amazing therapeutic results in the shortest possible time.
Second method
Often, the treatment of osteoarthritis of the knee joint, as well as other joint pathologies, is carried out using this method.
The development of the famous doctor is based on the use of:
- drugs;
- surgery;
- follow a diet that removes excess fluid from the body;
- physiotherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, visiting the sauna and getting massages.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 joint using this method completely eliminates dynamic loads, as they can significantly accelerate the deformation process.Physical exercises should be slow and of low amplitude.
Example: sit on a chair “straddling”, that is to say facing the back.Spread your legs wide, but don't let them touch the floor.Lightly swing each leg in turn.Perform the exercise until you feel slightly tired.The number of approaches depends on the well-being of the patient.
Surgery
How to treat advanced osteoarthritis of the knee joints?In this case, there is only one solution: surgery.There are several types of surgery performed for osteoarthritis of the knee joints:
- Removal of deformed cartilage tissue and the diseased joint (arthrodesis).This is done extremely rarely.
- Removal of damaged cartilage tissue without removing the joint.This procedure is called arthroscopic debridement.It is carried out using a special device - an arthroscope.The procedure is simple, but its effect lasts no more than 3 years.
- Saw and secure the diseased joint from a different angle.This method is called periarticular osteotomy.The technique is quite complex, but it allows you to forget about the pathology for 3 to 5 years.
Surgical intervention is rarely used and only in the absence of a method to cure the disease, at least for 1-2 years.In the early stages of the disease, surgery is almost never performed.
Endoprostheses
Endoprosthesis replacement is considered the most common method of treating knee osteoarthritis.This is a type of surgery that allows full mobility of the diseased knee to be preserved.But despite its effectiveness, this technique requires long-term rehabilitation.Moreover, this can lead to quite serious consequences.
Instead of the “real” one, the patient is implanted with an artificial joint, which can last 20 years.Of course, it all depends on the material from which it was made.The procedure is not cheap, but quite effective, which is why it has gained popularity.
Therapeutic exercise
A course of exercise therapy is prescribed by a doctor depending on the stage of the disease.However, the principles for carrying out the exercises are the same in all cases:
- avoid intense stress on the knee joint;
- sudden and forced movements are prohibited;
- do not perform exercises that require full load on the painful joint.
Authorized exercises:
- slight tremor of legs when kneeling on a blanket spread on the floor;
- careful movements on your knees in the same position;
- in the same position, straighten your legs one by one, trying not to lift your heels off the floor, then bend them again, avoiding sudden movements.
Such exercises, combined with drug treatment and physiotherapy, give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission.Among the most effective methods, it is worth noting:
- electrophoresis with medicinal solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- radon or hydrogen sulfide baths;
- mud treatment.
To prevent a recurrence of the disease, physiotherapy courses should be attended at least 2 times a year.This will help prolong the remission phase.
Massage
A knee massage is performed to improve blood circulation.It is carried out along the lymphatic flow in the direction going from the peripheral zone to the central zone.The popliteal fossa is not involved in this process.
Often, in addition to massage, manual therapy sessions are carried out, aimed at gradually stretching the painful joint.Such procedures stabilize the patient's condition, but can only be carried out by a specialist.
Is knee osteoarthritis completely curable?
Is it possible to completely cure osteoarthritis of the knee?Perhaps no one, even the most experienced traumatologist, can give an unambiguous answer to this question.It all depends on the severity of the disease.If you undergo therapy from the early stages of its development, you can stop further deformation of the joint.
However, if pathology is detected in the final stages, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms.The operation cures only for a few years, after which the disease can manifest itself again.
Prevention
To prevent knee osteoarthritis you must:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, raising and lowering your legs);
- enrich the diet with foods containing many vitamins;
- limit the consumption of salt, hot spices, fried, smoked, sweets;
- maintain normal physical fitness;
- seek immediate medical attention if you suffer any knee injury;
- preventive use of chondroprotectors after 35 years;
- drink the daily norm of water (2 l).
By following these simple recommendations, you will reliably protect yourself from osteoarthritis of the knee joint, as well as other diseases that can reduce your long-term quality of life.