Gonarthrosis or osteoarthritis of the knee is a serious degenerative-dystrophic pathology of the knee joint, which leads to the destruction of the structure of the cartilage tissue of the joints, which in turn leads to their deformation and loss of functions. Pathology often leads to disabilities in humans.
The deforming gonarthrosis of the knee takes a leading place in all arthrosis. If initially only a small part of the joint is affected, then with inadequate treatment, when the disease reaches a late stage of development, everything is involved in the pathological process.
The disease is most common in people over 40 years of age, but in athletes it can occur at a young age (after severe joint injuries).
Women are most prone to joint deformities, but it is common in men and even in young children. In order not to worsen the situation, you need to be able to recognize the first signs of this disease.
varieties
The classification of osteoarthritis of the knee depends on its etiology and localization. Each of the varieties has its own developmental characteristics, which the doctor always takes into account when prescribing treatment. But by nature they are practically the same.
Thus, depending on the etiology of the disease, the types of acute osteoarthritis of the knee are as follows:
- Primary gonarthrosis.This disease develops without any prerequisites. The risk group includes the elderly, women and obese patients. Primary type gonarthrosis of the knee joint can develop over the years without manifesting itself in any way. But the earlier it is discovered, the more favorable the prognosis for its treatment will be.
- Secondary gonarthrosisof the knee occurs due to trauma, but it can also be the result of various infectious pathologies. If the damaged joints are healed in a timely manner, the patient has every chance to avoid this disease.
There are types of osteoarthritis by localization:
- Right-sided gonarthrosis, which develops in the joint tissue of the right knee. It often occurs in athletes, as well as people whose work requires frequent physical exertion.
- Left-sided gonarthrosisinvolves the left knee in the pathological process. Occurs in people who exercise for work, as well as in patients who have been diagnosed with obesity.
- Bilateral osteoarthritishas a destructive effect on the joint tissue of the knees in both legs. This type of disease is considered to be the most severe, both in terms of symptoms and from a therapeutic approach. In most cases, this type of osteoarthritis of the knee joint develops in people with age, that is, 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, during movement, gently slides along the recess between the condyles of the femoral joint.
The femur and tibia, together with the knee pad, are covered with elastic clay cartilage that is 5 to 6 mm thick. It helps reduce friction when a person is physically active and has a shock-absorbing function in the event of a fall.
Pathological changes in the joints: phase disorders
In the first stage of the development of osteoarthritis of the knee joint, the blood circulation suffers. Small intraosseous vessels that supply blood to the hyaline joint are disrupted, which leads to a gradual desiccation of its surface. It becomes less elastic and cracks form on its surface.
As a result, instead of sliding gently, these cartilages touch. Inflammation begins to develop gradually, and the diseased cartilage, which shifts easily, interferes with each other in order to fully perform its functions. Due to the formation of a large number of microcracks in the area of the tissues that make up cartilage, they gradually lose their cushioning properties.
In the second phase of the progression of osteoarthritis of the knee, compensatory changes occur in the bone area. Under the influence of increased loads, the articular platform gradually begins to flatten, which leads to compaction of the subchondral zone (the area of the bone that is located under the cartilage).
The articular surfaces along the edges begin to grow in bony processes that look like sharp thorns on an x-ray.
If the lubricating fluid thickens in the joints, it loses most of its function. This leads to accelerated cartilage degeneration. Because of this, it looks like a thin thread on the X-ray or it becomes completely invisible.
If something like this has been noticed, it means that the disease is moving smoothly (or quickly - it all depends on the situation) to the 3rd phase of development.
In the third stage of gonarthrosis of the knee joint, there is a noticeable deformation of the bones. They appear 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 - the doctor often determines several factors at the same time that led to the development of the disease.
The most common and most common reasons are:
- previous joint injuries (moderate or high severity);
- broken legs, especially with intra-articular damage;
- violation of the integrity of the meniscus structure;
- tears or complete tears in the ligaments;
- excessive stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to a person's age. It has been found that people over 40 are most susceptible to this, as it is during this time that the flexibility of the cartilage decreases and the lubricating joint fluid gradually "dries out".
To delay this moment, exercise is recommended for patients, but physical activity should be moderate and not cause general discomfort.
Obesity is also one of the factors that predispose to the development of osteoarthritis of the knee. The fact is that excessive body weight puts additional stress on bones and joints, which can only affect their health.
In this case, the fact that the leg has more weight plays an important role. For example, if your "support" is your left leg, there is a high chance that you will develop left-sided gonarthrosis.
In the case of obesity, constant pressure on the joints leads to microtrauma and the rupture of small blood vessels. Torn menisci or ligaments, which are considered a serious form of manifestation of joint injuries, are also possible.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins. In this case, the patient will be shown a phlebologist consultation.
People who:
are also at high risk of developing this pathology- have previously suffered from various types of arthritis;
- have an unfavorable inheritance;
- have problems with the tape apparatus;
- suffer from metabolic disorders;
- have suffered a traumatic brain injury;
- were injured in an accident;
- had spinal injuries.
Many of these factors are often closely related. Accurate determination of the cause will help make an accurate diagnosis and prescribe the correct and effective treatment for osteoarthritis of the knee joint to the patient.
Clinical manifestations
Symptoms of osteoarthritis of the knee do not manifest themselves immediately - they appear gradually depending on the stage of the disease. For this reason, the clinical picture must be viewed gradually.
First stage
In the early stages of the development of the disease, patients complain of slight pain in the knee area, which increases with physical exertion. They become particularly intense when descending and ascending the stairs.
In addition to the pain, the patient feels a certain stiffness of the movements, a "narrowing" in the joint area. It can be felt in the back of the knee and goes away when the muscles of the knee are relaxed.
Another characteristic feature is the so-called "starting pain syndrome". It develops in the patient's first steps. When the knees get used to the load, this anomaly disappears without a trace.
Second stage
At this point, the symptoms of osteoarthritis of the knee joint become more intense and noticeable. The pain increases and causes considerable difficulty and discomfort when walking. The pain syndrome disappears after a long break, but becomes noticeable again with intense exertion.
The inflammation of the joint leads to swelling of the knee, which is also visible to the naked eye. There is a strong, uncomfortable crunch when walking. The movements become heavier and more restricted.
Level 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 the movements of the joints. It deforms and increases in size. In severe cases, the patient cannot move without additional support.
All of 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 become disabled.
Which doctor treats knee osteoarthritis of the knee?
An orthopedic traumatologist must be consulted for the diagnosis and treatment of knee osteoarthritis of the knee. If surgery is required, you may need the help of a surgeon.
Diagnostic measures
To determine the cause of the disease, an integrated approach to patient examination is extremely important.
The diagnostic scheme consists of several phases:
- Visual examination of the orthopedic surgeon and anamnesis. The doctor determines if 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 assess the mobility of the joint at different angles.
- Clinical blood test for ESR assessment.
- blood biochemistry.
- Examination 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 initial stages, the snapshot shows no changes - they can only be noticed in the later stages of development. The x-ray shows a narrowing of the joint space, sclerotic changes in the cartilage area, damage to the bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic method. However, full-fledged examination results can be achieved if ultrasound is carried out together with radiography. With the
- MRI, you can thoroughly examine all layers of joint, cartilage and bone tissue and determine the first dystrophic changes in the early stages of osteoarthritis. However, MRI has one major drawback: the procedure is quite expensive. However, the high accuracy contributes to a diagnosis that is 99. 9% accurate.
Treatment
The treatment of acute osteoarthritis of the knee, like the diagnosis, requires an integrated approach. First of all, however, drug therapy is necessary, as the diseased joint can become inflamed at any time.
Medicines
How is gonarthrosis of the knee joint treated with pharmacy drugs and which drugs should be chosen? Only a traumatologist will say about this. Often drugs from the following groups are included in the therapy plan:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously damage the gastrointestinal tract, so it cannot be used for a long time. The same does not apply to the drugs in the COX-2 group, which are gentler. They are given intramuscularly or intravenously.
- Hormonal drugs are also used to treat knee osteoarthritis. They help with inflammation and swelling in the knee. Their use is advisable in case of synovitis (inflammation of the synovial membrane).
- Treatment with chondroprotectors.
- Use of ointments, gels, creams. They improve blood circulation, warm up, relieve swelling and inflammation.
Method one
How can you cure osteoarthritis of the knee joint with this technique? The main elements of the therapy scheme are:
- Use of drugs (NSAIDs, chondroprotectors, pain relievers, ointments, creams, gels);
- light physical therapy exercises;
- manual therapy;
- physiotherapy;
- Warming anti-inflammatory compresses with medicinal solutions.
According to the famous rheumatologist, diet also plays an important role in osteoarthritis. Thanks to a properly developed diet and the use of all of the above techniques, you can achieve amazing results with therapy in no time.
Method two
Often the treatment of osteoarthritis of the knee joint is carried out with this method, as is the case with other joint pathologies.
The development of a famous doctor is based on the application:
- drugs;
- surgical intervention;
- adherence to a diet that removes excess fluid 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 and untreated for a long time.
Treatment according to the third method
The treatment of gonarthrosis of the knee joint with this technique completely excludes dynamic loads, as they can significantly accelerate the deformation process. The exercise should be slow and with a low amplitude.
Example: Sit on a chair "above", ie to the back. Spread your feet wide apart, but don't let them touch the ground. Gently move 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 do you treat advanced osteoarthritis of the knee joints? In this case there is only one way out - operation. There are different types of operations 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 procedure is known as arthroscopic debridement. It is carried out 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 a different angle. This is called a periarticular osteotomy. The technique is quite complicated, but it makes it possible to forget about the pathology for 3-5 years.
Surgical intervention is rarely resorted to, and only when there is no method that will cure the disease for at least 1-2 years. In the initial stages of the disease, the operation is almost never performed.
Endoprosthetics
Endoprosthetics are considered the most common treatment for osteoarthritis of the knee. This is a type of surgery that allows you to fully maintain the range of motion of the affected knee. Despite its effectiveness, this technique requires long-term rehabilitation. In addition, it can lead to serious consequences.
The location of the "real" patient is implanted with an artificial joint that can serve for 20 years. Although, of course, it all depends on the material from which it was made. It's not cheap, but it's very effective, which is why it has become particularly popular.
Physiotherapy exercises
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease. However, the principles for the exercises are the same in all cases:
- Avoiding excessive stress on the knee joint;
- abrupt and forced movements are prohibited;
- Do not perform any exercises that require the painful joint to be fully loaded.
Permitted exercises:
- slight shaking of the legs when kneeling on a blanket spread out on the floor;
- proper 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 to avoid sudden movements.
These exercises, in combination with medication and physiotherapy, give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission. The most effective techniques include:
- electrophoresis with medical solutions;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent the disease from breaking out again, physiotherapy courses should be completed at least twice a year. This will help extend the remission phase.
Massage
A knee massage is performed to improve blood circulation. It is performed along the lymph flow in the direction from the peripheral area to the central zone. The back of the knee is not involved in this process.
Often, together with a massage, manual therapy sessions are carried out, aimed at gradually stretching the diseased joint. Such procedures stabilize the patient's condition, but they can only be carried out by a specialist.
Is the osteoarthritis of the knee completely healed?
Is it possible to completely cure osteoarthritis of the knee joint? Perhaps no one, even the most experienced traumatologist, can give an unequivocal answer to this question. It all depends on the severity of the disease. Undergoing therapy at an early stage of development can stop further joint deformation.
However, if a pathology is found in the latter stages, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms. The operation only helps to heal for a few years, after which the disease can remember itself again.
Prevention
To prevent osteoarthritis of the knee, the following is required:
- Avoid knee injuries;
- constantly exercising (squatting, running, raising and lowering legs);
- enrich the diet with foods that contain many vitamins;
- limit the use of salt, hot spices, fried, smoked, sweet;
- Maintaining normal physical form;
- Immediate medical attention if you receive the slightest knee injury;
- prophylactic use of chondroprotectors after reaching the age of 35;
- Consumption of daily water intake (2 liters).
If you follow these simple recommendations, you will reliably protect yourself against osteoarthritis of the knee joint as well as against other diseases that can affect your quality of life for a long time.