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 people's disabilities.
Deforming gonarthrosis of the knee takes the 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 reaches a late stage of development, the entire joint is involved in the pathological process.
Most often, the disease develops in people older than 40 years, but in athletes it can also occur at a younger age (after serious joint injuries).
Women are most sensitive 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 know how 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 the doctor always takes into account when prescribing treatment.But in terms of the nature of their manifestation, they are almost identical.
So, 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 manifesting itself.But the sooner it is detected, the more favorable the prognosis for its treatment will be.
- Secondary gonarthrosisknee pain is caused by previous injuries, but it can also be the result 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 localization:
- Right-sided gonarthrosis, 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 activity.
- Gonarthrosis of the left sideinvolves the left knee in the pathological process.It occurs in people who are professionally involved in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritisit has a destructive effect on the joint tissues of the knees of both legs.This type of disease is considered the most severe, both in terms of symptoms and therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in people of an older age, that is, it is idiopathic in nature.
Anatomy and pathological changes
The knee joint is formed by the joint surfaces of the tibia and femur.In its front part, there is a patella, which during movement smoothly slides along the depression located between the condyles of the femoral joint.
The femur and tibia, together with the knee, are covered with elastic glial cartilage 5-6 mm thick.It helps to reduce friction when a person performs physical activity, and in case of falls, it has a cushioning function.
Pathological changes in the joints: gradual disorders
In the first stage of the development of gonarthrosis of the knee joint, blood circulation is primarily affected.Small intraosseous vessels that supply blood to the hyaline joint are disrupted, 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 gliding smoothly, these cartilages touch each other.The inflammation gradually begins to develop, and the diseased cartilages, moving slightly, prevent each other from fully performing their functions.Due to the creation of a large number of microcracks in the area of tissue that make up cartilage, they gradually lose their cushioning properties.
In the second stage of gonarthrosis progression, compensatory changes begin to appear in the bone area.Under the influence of increased loads, the joint platform begins to gradually flatten, which leads to the compaction of the subchondral zone (the area of the bone located under the cartilage).
The articular surfaces along the edges begin to heal into bony processes, which look like sharp spikes on an X-ray.
As the lubricating fluid in the joints becomes thicker, it loses much of its function.This leads to accelerated cartilage degeneration.For this reason, it looks like a thin thread on an X-ray or becomes completely invisible.
If this is observed, it means that the disease is progressing smoothly (or quickly - it all depends on the situation) in the 3rd stage of development.
In the third stage of gonarthrosis of the knee joint, a noticeable deformation of the bones occurs.They appear to be squeezed together, leading to reduced joint mobility.Cartilage tissue is almost completely depleted.
Causes and predisposing factors
The causes of arthrosis 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 severe);
- ankle fractures, especially if intra-articular damage has occurred;
- violation of the integrity of the meniscus structure;
- rupture or complete rupture of ligaments;
- excessively intense stress on the knee joints.
Acute arthrosis of the knee joint is directly related to a person's age.Thus, it was determined that people over 40 years of age are the most susceptible to it, because in that period the flexibility of the cartilage begins to decrease, and the lubricating joint fluid gradually "dries up".
In order to delay this moment, patients are recommended to play sports, but physical activity should be moderate and not cause general discomfort.
Excess weight is also one of the factors that predispose to the occurrence of gonarthrosis.The fact is that excess body weight creates additional stress for bones and joints, which cannot but affect their health.
In this case, the fact that the leg bears more load plays an important role.For example, if your "support" is your left leg, there is a high probability that you will develop left gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and bursting of small blood vessels.Rupture of the meniscus or ligament is also possible, which is considered a serious manifestation of joint injuries.
This disease is extremely difficult for patients with severe symptoms of varicose veins.In this case, the patient is advised to consult a phlebologist.
There is also a high risk of developing this pathology in people who:
- previously suffered from various types of arthritis;
- they have an unfavorable inheritance;
- you have problems with the ligament apparatus;
- suffer from metabolic disorders;
- suffered a traumatic brain injury;
- injured in a traffic accident;
- had spinal injuries.
Many of these factors are often closely related.Precise determination of the cause helps in making an accurate diagnosis and prescribes the correct and effective treatment for knee arthrosis to the patient.
Clinical manifestations
Symptoms of gonarthrosis do not manifest themselves immediately - they begin to appear gradually, depending on the stage of the disease.Therefore, the clinical picture must be considered in stages.
The first stage
In the initial stage of the disease, patients complain of mild pain in the knee area, which is aggravated by physical activity.They are especially intense when going down and climbing stairs.
In addition to pain, the patient feels a certain stiffness of movement, "tightness" in the joint area.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 during the patient's first steps.When the knees get used to the load, this anomaly disappears without a trace.
The second stage
At this moment, the symptoms of arthrosis of the knee joint become more intense and noticeable.The pain intensifies, causing significant difficulty and discomfort when walking.The pain syndrome disappears after a long rest, but it is felt again with intense exercise.
Inflammation of the joint causes swelling of the knee, which is visible to the naked eye.A loud, unpleasant creaking sound occurs when walking.Movements become increasingly difficult and restricted.
The third phase
The pain becomes very strong, 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 becomes deformed and increases in size.In severe cases, the patient cannot move without additional support.
The patient must not ignore all these signs of arthrosis of the knee joint.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?
In order to diagnose and treat knee gonarthrosis, you must consult an orthopedic traumatologist.If surgery is necessary, a surgeon may be needed.
Diagnostic measures
A comprehensive approach to the examination of the patient is extremely important for determining the cause of the disease.
The diagnostic scheme consists of several stages:
- Orthopedic visual examination 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.
- A 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 arthrosis.However, in the initial stages, the picture does not show any changes - they can be noticed only in the later stages of development.An X-ray reveals narrowing of the joint space, sclerotic changes in the area of cartilage, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure.However, complete examination results can be obtained if ultrasound is done together with radiography.
- MRI allows you to thoroughly study all layers of joint, cartilage and bone tissue and notice the first dystrophic changes in the early stages of the development of arthrosis.However, magnetic resonance imaging has one major drawback - the procedure is quite expensive.But its high accuracy contributes to 99.9% accurate diagnosis.
Treatment
Treatment of acute knee arthrosis, as well as its diagnosis, requires an integrated approach.But, first of all, it is necessary to apply drug therapy, because the affected 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 that.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, so they cannot be used for a long time.This cannot be said for COX-2 drugs, which are gentler.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 eliminate knee swelling.Their use is recommended if synovitis occurs (inflammatory process in the area of the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams.They improve blood circulation, warm, relieve swelling and inflammation.
The first method
How to cure arthrosis of the knee joint with this method?The main elements of the treatment regimen are:
- use of drugs (NSAIDs, chondroprotectors, painkillers, 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.With a properly designed diet and the use of all the above methods, you can achieve amazing results of therapy in the shortest possible time.
Method two
This method is often used to treat arthrosis of the knee joint, as well as other joint pathologies.
The development of the famous doctor is based on the use of:
- medicines;
- surgical intervention;
- adherence to a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends more swimming in the pool, visiting the sauna and going for a massage.This will help improve the patient's health, especially if the disease has been ignored and untreated for a long time.
Treatment by the third method
Treatment of gonarthrosis of the knee joint with this method completely eliminates dynamic loads, because they can significantly accelerate the deformation process.Physical exercises should be slow, of low amplitude.
Example: sit on a chair "riding", i.e. facing your 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 accesses 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 performed for osteoarthritis of the knee joints:
- Removal of deformed cartilage 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 longer than 3 years.
- Sawing and fixing the diseased joint at a different 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 resorted to rarely, and only in the absence of a method that treats 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 treating gonarthrosis.This is the type of surgery that allows you to fully preserve 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 implanted with an artificial joint, which can last for 20 years.Although, of course, everything 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 exercise
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease.However, the principles of performing 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 painful joint.
Exercises that are allowed:
- slight shaking of legs while kneeling on a blanket spread on the floor;
- careful movements on the 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 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 medical solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave processing;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
In order to prevent the recurrence of the disease, physiotherapy courses must 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 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 gradual stretching of the painful 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, not even the most experienced traumatologist, can give an unequivocal answer to this question.It all depends on the severity of the disease.If you engage in therapy in the first 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 recur.
Prevention
To prevent gonarthrosis, you need:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, raising and lowering the legs);
- enrich the diet with food containing many vitamins;
- limit the consumption of salt, hot spices, fried, smoked, sweets;
- maintaining a normal physical shape;
- consult a doctor immediately if you suffer even the slightest knee injury;
- preventive use of chondroprotectors after the age of 35;
- drink the daily norm of water (2 l).
By following these simple recommendations, you will reliably protect yourself from arthrosis of the knee joint, as well as from other diseases that can reduce your quality of life for a long time.