Gonarthrosis, or knee arthrosis, is a severe degenerative-dystrophic pathology of the knee joint, which causes destruction of the structure of the cartilaginous tissues of the joints, which, in turn, leads to deformation and losstheir functions. Pathology often leads to human disability.
Deforming knee gonarthrosis occupies a prominent 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 progresses to a late stage of development, everything is involved in the pathological process.
Most of the time, the disease develops in people over 40, but in athletes it can occur at a young age (after receiving severe joint injuries).
Women are more susceptible to joint deformation, but it usually occurs in men and even small children. In order not to make the situation worse, you need to be able to recognize the first signs of the disease.
Varieties
The classification of gonarthrosis 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 the treatment. But, by the nature of the demonstration, they are practically the same.
Thus, 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 obese patients. Primary type gonarthrosis of the knee joint can develop over the years without manifesting itself in any way. But the sooner it is discovered, the more favorable the prognosis of your treatment will be.
- Secondary gonarthrosisof the knee occurs due to trauma, but it can also be the result of various infectious pathologies. If damaged joints are treated in a timely manner, the patient has every chance of avoiding this disease.
There are types of osteoarthritis by location:
- Gonarthrosis of the right side, which develops in the articular tissues of the right knee. It usually occurs in athletes, as well as in people whose work requires frequent physical effort.
- Gonarthrosis on the left sideinvolves the left knee in the pathological process. It occurs in people who practice sports professionally, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a destructive effect on the tissues of the knee joints of both legs. This type of disease is considered to be the most serious, both in terms of symptoms and in terms of a therapeutic approach. In most cases, this type of gonarthrosis of the knee joint develops in people in 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 frontal part there is a patella that, during the movement, slides smoothly along the depression located between the condyles of the femoral joint.
The femur and tibia, together with the knee pad, are covered by elastic clay cartilage, 5 to 6 mm thick. It helps to reduce friction during a person's physical activity and, in the event of a fall, performs a shock-absorbing function.
Pathological changes in the joints: staged disorders
In the first stage of development of gonarthrosis of the knee joint, blood circulation is affected first. The small intraosseous vessels that supply blood to the hyaline joint are ruptured, which leads to a gradual dryness 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. The inflammation gradually begins to develop and the sick cartilages, changing 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 phase 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 compression of the subchondral zone (the area of bone that is located under the cartilage).
The joint surfaces along the edges begin to grow too large with bone 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 cartilage degeneration. So it looks like a fine wire on the X-ray, or becomes completely invisible.
If something like this is noticed, it means that the disease smoothly (or quickly - everything depends on the situation) flows into the 3rd stage of development.
In the third stage of gonarthrosis of the knee joint, there is a noticeable deformation of the bones. They appear to be compressed together, which leads to decreased joint mobility. The cartilage tissue dries up almost completely.
Causes and predisposing factors
The causes of knee arthrosis are not isolated - often the doctor determines several factors at the same time that led to the development of the disease.
The most common and common reasons are:
- anterior joint injuries (moderate or high severity);
- leg fractures, especially if there is intra-articular damage;
- violation of the integrity of the meniscus structure;
- ruptures or complete ruptures of the ligaments;
- excessive stress on the knee joints.
Acute arthrosis of the knee joint is directly related to the person's age. Thus, it was found that people over 40 are the most susceptible to it, because in this period the flexibility of the cartilage begins to decrease, and the joint lubricating fluid gradually "dries up".
To delay this moment, sports are recommended for patients, but physical activity should be moderate and not cause 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 the bones and joints, which cannot fail to affect your health.
In this case, an important role is played by the fact that the leg has more loads. For example, if your "support" is your left leg, there is a high likelihood that you will develop gonarthrosis on the left side.
In obesity, constant pressure on the joints leads to microtrauma and the rupture of small blood vessels. Ruptures of the menisci or ligaments, 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 is referred to a phlebologist consultation.
A high risk of developing this pathology also exists in people who:
- has previously suffered from different types of arthritis;
- has unfavorable heredity;
- 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. Accurate determination of the cause helps to establish an accurate diagnosis and prescribe the correct and effective treatment for osteoarthritis of the knee joint to the patient.
Clinical manifestations
The symptoms of gonarthrosis do not manifest immediately - they start to appear gradually, depending on the stage of the disease. For this reason, the clinical picture must be considered in stages.
First stage
In the early stage of disease development, patients complain of mild pain in the knee area, which increases with physical exertion. They become especially intense when descending and climbing stairs.
In addition to pain, the patient feels a certain stiffness in his movements, "constriction" in the joint region. It is felt in the popliteal part and passes when the knee muscles are relaxed.
Another characteristic is the so-called "initial 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 that time, the symptoms of osteoarthritis of the knee joint become more intense and noticeable. The pain intensifies, causing great 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 and unpleasant crack when walking. The movements become heavier and more restricted.
Stage three
The pain becomes very severe and the patient cannot be without painkillers. It is difficult for a person to bend the knee, he feels the rigidity of joint movements. It deforms and increases in size. In severe cases, the patient cannot move without additional support.
All of these signs of knee arthrosis 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 gonarthrosis?
For the diagnosis and treatment of knee gonarthrosis, it is necessary to consult an orthopedic traumatologist. If surgery is necessary, you may need the help of a surgeon.
Diagnostic measures
To establish the cause of the disease, a comprehensive approach to examining the patient is extremely important.
The diagnostic scheme consists of several steps:
- Visual examination of the orthopedist and anamnesis. The doctor determines whether the patient has symptoms of acute knee joint arthrosis, palpates the affected region of the leg, measures the bone and performs angiometry - an exam that can be used to assess joint mobility at different angles.
- Clinical blood test for ESR assessment.
- Blood biochemistry.
- 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 shows no changes - they can be seen only in the later stages of development. Radiography 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, complete test results can be obtained if the ultrasound is performed together with the radiography.
- Magnetic resonance imaging allows you to carefully examine all layers of articular, cartilaginous and bone tissues and observe the first dystrophic changes in the early stages of arthrosis. However, MRI has a major drawback - the procedure is quite expensive. But its high accuracy contributes to an accurate diagnosis of 99. 9%.
Treatment
The 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, as the diseased joint can ignite at any time.
Medication
How to treat knee joint gonarthrosis with pharmacy medications and which medications to choose? Only a traumatologist will tell you about it. Often, medications from the following groups are included in the therapy regimen:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can cause serious damage to the gastrointestinal tract, so they cannot be used for a long time. The same cannot be said about COX-2 drugs, which are milder. They are administered intramuscularly or intravenously.
- Treatment of knee arthrosis also involves the use of hormonal medications. They help to relieve inflammation and swelling in the knee. Its 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 arthrosis of the knee joint using this technique? The main elements of the therapy scheme are:
- use of medicines (NSAIDs, chondroprotectors, pain relievers, ointments, creams, gels);
- light physical therapy exercises;
- manual therapy;
- physiotherapy;
- anti-inflammatory heating pads with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in osteoarthritis. Due to a well-developed diet and the use of all of the above techniques, you can get amazing results with therapy in the shortest possible time.
Method two
Often, the treatment of osteoarthritis of the knee joint, like other joint pathologies, is performed using this method.
The development of a famous doctor is based on the application:
- medications;
- surgical intervention;
- follow 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 having a massage. This will help to 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
The treatment of gonarthrosis of the knee joint with this technique completely excludes dynamic loads, since they can significantly accelerate the deformation process. Exercise should be slow and of low amplitude.
Example: sit on a chair "on top", that is, facing the back. Spread your legs wide apart, but don't let them touch the floor. Gently shake each leg at a time. 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 knee joint arthrosis? In this case, there is only one exit - operation. There are several types of surgery for osteoarthritis of the knee joints:
- Removal of deformed cartilage and diseased joint (arthrodesis). It is extremely rare.
- Removal of damaged cartilage tissue without removing the joint. This intervention is called arthroscopic debridement. It is performed with a special device - an arthroscope. The procedure is simple, but its effect does not last more than 3 years.
- Saw and hold the diseased joint at a different angle. This is called periarticular osteotomy. The technique is quite complicated, but it allows to forget the pathology for 3-5 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, the operation is almost never performed.
Endoprosthesis
The endoprosthesis is considered the most common treatment for gonarthrosis. This is a type of surgery that allows the mobility of the affected knee to be fully maintained. But, despite its effectiveness, this technique requires long-term rehabilitation. In addition, it can lead to quite serious consequences.
The "real" patient site is implanted with an artificial joint, which can serve for 20 years. Although, of course, everything depends on the material from which it was made. 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 the doctor, depending on the stage of the disease. However, the principles for doing the exercises are the same for all cases:
- avoiding intense stress in the knee joint;
- abrupt and forced movements are prohibited;
- do not perform exercises that require full load on the aching joint.
Exercises allowed:
- slight trembling of the legs while kneeling on a blanket lying on the floor;
- simple movements of kneeling in the same position;
- in the same position, stretch your legs alternately, trying not to pull 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 physiotherapeutic procedures are prescribed for gonarthrosis in remission. Among the most effective techniques, the following should be highlighted:
- electrophoresis with medicinal solutions; magnetotherapy;
- ultrasound therapy;
- microwave treatment; paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent a recurrent outbreak of the disease, physiotherapy courses should be taken at least twice a year. This will help to prolong the remission phase.
Massage
The knee massage is performed to improve blood circulation. It is carried out along the lymphatic flow from the peripheral area to the central zone. The popliteal fossa is not involved in this process.
Often, together with a massage, manual therapy sessions are conducted with the aim of gradually stretching the diseased joint. These 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 joint? Perhaps no one, even the most experienced traumatologist, can give an unambiguous answer to that question. It all depends on the severity of the disease. If you start therapy in the early stages of its development, it may stop deforming the joint.
However, if a pathology is found in the later 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 remember itself again.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- constant exercises (squatting, running, raising and lowering the legs);
- enrich the diet with foods that contain many vitamins;
- limit the use of salt, hot, fried, smoked, sweet spices;
- maintaining normal physical shape;
- immediate medical attention if you receive the slightest knee injury;
- prophylactic use of chondroprotectors from the age of 35;
- Daily water consumption (2 liters).
By following these simple recommendations, you will safely protect yourself from knee joint arthrosis, as well as other diseases that can reduce your quality of life for a long time.