The knee joint experiences regular stress. Running and jumping, walking, climbing stairs or simply standing are all factors that affect the state of the cartilage tissue in the knee. If the balance in the cartilage is disturbed, the development of arthrosis of the knee joint - gonarthrosis begins.
Gonarthrosis is arthrosis that deforms the knee joint, which is accompanied by chronic damage to the surfaces of the hyaline cartilage and bones: femur and tibia. Symptoms of the disease in the knee joint are pain that intensifies with movement. Due to the accumulation of fluids inside it, movement is limited. Subsequently, limitation of knee movements occurs due to a violation of leg support. The diagnosis of pathology is based on the collection of the patient's medical history and complaints, the results of visual examination and examinations of the hardware of the knee joint. Such age-related disorders of the musculoskeletal system appear in almost everyone at an older age.
general informations
Gonarthrosis (from the Latin articulatio genus - knee joint) is the most common arthrosis, that is, a progressive degenerative-dystrophic lesion of the cartilage of the knee joint of a non-inflammatory nature. Women and the elderly usually suffer from gonarthrosis. But after injuries during intense sports, gonarthrosis occurs even in young people.
The cause of arthrosis lies in a change in the structure of the cartilage inside the joint, and not in the deposition of salts there. In gonarthrosis, saline deposits occur at the point where the tendons insert into the ligament system, but they cannot cause painful symptoms. First, cracks appear in the cartilage, reducing the thickness in some areas. Gradually, the load is redistributed, the joint begins to come into contact with the bones, accelerating the painful process. As a result, the following changes occur in the knee joint:
- thinning of the knee cartilage until its disappearance;
- changes in synovial fluid in composition and quantity;
- damage to the knee bones due to friction;
- the appearance of osteophytes;
- stiffness due to compaction of the joint capsule;
- muscle spasm.
As a result, the knee joint is deformed, its mobility is limited, as a result of which this can lead to disability and loss of working capacity.
Osteoarthritis of the knee joint can be unilateral and affect only one knee of the right or left leg; in case of bilateral arthrosis, both knee joints are affected.
Symptoms of arthrosis of the knee joint
The symptoms of knee osteoarthritis can be very different:
- At first there is a slight discomfort when climbing stairs, then the pain syndrome increases and torments even at rest;
- the stiffness occurs in the morning, initially lasts a few minutes, then can last up to half an hour;
- a strong crunch occurs, which is already accompanied by pain in the second degree of damage;
- mobility is limited, it is difficult to bend and straighten the knee due to pain, bone friction and the growth of osteophytes; the joint may become blocked in the final stages (ankylosis);
- unstable gait due to muscle atrophy (reduction in muscle volume);
- deformation of the knee joint due to the growth of bones and changes in their shape, the occurrence of an inflammatory process in the muscles and ligaments increases swelling around the tissues of the joint;
- lameness due to progression of knee joint disease; in the later stages the patient is forced to walk even with a walker.
The disease of arthrosis begins gradually. In the 1st stage of gonarthrosis, patients experience mild sensations of stiffness and pain that occur when going up or down stairs. Possible stiffening of the area below the knee. Characteristic are the initial painful sensations that arise from the sitting position during the beginning of the ascent. When the patient moves away, the pain decreases, but with effort it reappears.
There are no external changes in the knee. Sometimes swelling and the development of synovitis are possible: accumulation of fluid with enlargement, swelling of the joint, while heaviness is felt and movement is limited.
At stage 2, severe pain occurs with prolonged exercise and intensifies when walking. The pain is usually localized along the anterior surface within the joint. After rest the pain disappears, but reappears when moving.
As osteoarthritis progresses, the number of movements of the knee joint decreases; when trying to bend the leg as much as possible, pain and a rough, sharp crunch appear. The configuration changes, the joint expands. Synovitis appears with an even greater accumulation of fluid inside them.
At stage 3, the pain becomes constant and bothers not only when walking, but also at rest. Painful sensations also appear at night; to fall asleep, patients take a long time to find a position for their leg. Flexion and extension of the joint are limited. Sometimes the patient is unable to straighten the leg completely. The joint is enlarged and deformed. Sometimes valgus deformity of the legs occurs in patients; they become X-shaped or O-shaped. Due to deformation of the leg and limitation of movement, patients' gait becomes unstable and sways. In severe cases of gonarthrosis, patients move with the support of crutches.
Causes of arthrosis of the knee joint
Most cases of osteoarthritis occur for several reasons. These factors include:
- Injuries.25% of gonartosis occurs due to injuries: meniscal damage, ligament ruptures. Gonarthrosis usually occurs three to five years after the injury, sometimes the disease can develop earlier, after two or three months.
- Physical exercise.Often gonarthrosis occurs after the age of forty due to professional sports and excessive physical stress on the knee joint, which leads to the development of degenerative-dystrophic changes. Fast running and intense squats are especially dangerous for the joints.
- Excess weight.Excess weight significantly increases the load on the knee joints, causing injury. Gonarthrosis is particularly difficult if metabolic disorders and varicose veins are present.
- Sedentary lifestyle.
The process of development of gonarthrosis increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is the genetic weakness of the ligaments and impaired innervation in neurological diseases.
Pathogenesis
The knee joint is formed by the surfaces of the femur and tibia. In front of the surface of the knee joint is the kneecap. It slips when it moves between the grooves of the femur. The articular surfaces of the tibia and femur are covered with very strong, smooth and elastic hyaline cartilage up to six mm thick. During movement, cartilage reduces friction and acts as a shock absorber.
There are 4 stages of osteoarthritis:
- 1st phase.There is a disturbance in blood circulation in the vessels supplying the hyaline cartilage. Its surface becomes dry and small cracks appear, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and, instead of sliding smoothly, it clings, losing its shock-absorbing quality. There are no visual symptoms of osteoarthritis; the x-ray shows a slight deviation.
- 2nd phase.Changes occur in the structure of the bones and the joint area is flattened to accommodate greater loads. The part of the bone that lies beneath the cartilage becomes denser. Along the edges of the joint, manifestations of initial calcification of the ligaments appear: osteophytes that resemble spikes on an x-ray; narrowing of the space in the joint is also visible. The synovial capsule of the joint degenerates, becoming shriveled. The fluid in the joint thickens, its viscosity increases, and its lubricating properties deteriorate. The process of cartilage degeneration accelerates, becomes thinner and in some places disappears completely. After its disappearance, friction in the joint increases and degeneration progresses sharply. Patients experience pain during physical activity, when climbing stairs, when squatting, and when standing for long periods of time.
- 3rd phase.Radiographs show clear, sometimes asymmetric, narrowing of the joint space. Due to the deformation of the meniscus, the bones deform and press against each other. Movement in the joint is limited due to the large number of large osteophytes. There is no cartilaginous tissue. Constant pain torments the patient at rest; it is impossible to walk without support.
- 4th phase.Movements of the knee joint are impossible, x-rays show complete deformation of the cartilage and destruction of the articular bones, many osteophytes and bones can fuse with each other.
Classification
Considering the pathogenesis of the disease, two types are distinguished: primary gonarthrosis - idiopathic and secondary. The primary form occurs without lesions, usually in elderly patients and is bilateral. The secondary develops due to diseases and developmental disorders or against the background of injuries to the knee joint. It can occur at any age and is usually unilateral.
Diagnostics
The diagnosis of joint arthrosis is made by an orthopedist or traumatologist in a medical clinic.
- The appointment begins with taking the medical history: the main complaints and symptoms that worry the patient. The doctor finds out the complaints, the presence of chronic diseases, past injuries, fractures and injuries and asks additional questions.
- On examination, joint mobility, deformation and pain characteristics are revealed. At stage 1 of gonarthrosis, the patient has no external changes. At the 2nd and 3rd stages, deformation and thickening of the joint contours, limitation of movements and curvature of the legs are detected. When the kneecap moves, a loud cracking sound is heard. Upon palpation, the doctor detects pain in the internal part of the joint space. The joint may increase in size. Swelling of the joint is detected. When palpating the joint, a fluctuation is felt.
- The patient is sent for laboratory tests. When performing a general blood test, inflammation is detected, while a biochemical test reveals possible causes of problems.
- Subsequently, instrumental diagnostics of the patient is necessary. For this purpose, X-rays are used. X-ray is a diagnostic method that allows you to detect signs of knee osteoarthritis: narrowing of the joint gap, osteophytes and bone deformities. Joint radiography is a technique that clarifies the diagnosis of pathological changes and the dynamics of arthrosis. At the onset of gonarthrosis, changes are not visible on x-rays. Subsequently, there is a narrowing of the joint space and a compaction of the subchondral area. Gonarthrosis can only be diagnosed with x-rays and clinical examinations.
- Nowadays, in addition to x-ray, computed tomography (CT) is used to diagnose arthrosis, which allows you to study bone changes in detail, as well as magnetic resonance imaging (MRI), which allows you to visually assess the conditions of arthrosis. of the joint and is used to identify changes in muscle tissue and ligaments.
- When performing an ultrasound examination (ultrasound), the condition of the tendons, muscles and joint capsule is evaluated.
- Fluid is drained from the affected joint to allow a camera to be inserted to view the inside of the joint (arthroscopy).
If necessary, the doctor prescribes studies and further consultations with more specialized specialists.
Treatment of arthrosis of the knee joint
Treatments for osteoarthritis can be divided into three groups:
- medicinal;
- Physiotherapy;
- surgical.
Osteoarthritis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins at an early stage. When osteoarthritis worsens, doctors recommend maximum rest of the joint. Patients are prescribed the necessary procedures: physical therapy, massage, mud therapy.
When a patient is diagnosed with stage 1 and 2 disease, medications and physical therapy are used; if the lesion is extensive, surgical intervention and surgery are used.
Pharmacological treatment
Correct administration of drugs can stop pain and inflammation, as well as slow down the process of destruction of cartilage tissue. Therefore, it is important to consult a doctor promptly.
Important: do not self-medicate. The wrong drugs, chosen independently and without consulting the doctor, can only aggravate the situation and lead to serious complications.
Drug therapy for arthrosis involves taking the following drugs:
- anti-inflammatory:relieve inflammation and relieve joint pain;
- hormonal:prescribed when anti-inflammatory drugs are ineffective;
- antispasmodics:help get rid of muscle spasms and alleviate the patient's condition;
- chondroprotectors:improve metabolic processes in the joint and help restore joint function, as well as drugs that replace synovial fluid;
- drugs to improve microcirculation: improve nutrition and oxygen supply.
Depending on the specific situation, tablets, intra-articular injections of steroid hormones and local forms of drugs are used. The selection of drugs is carried out by the attending physician. Sometimes a patient with arthrosis is sent for treatment to a sanatorium and is advised to walk with crutches or a cane. To relieve the load on the knee joint, individual orthoses or special insoles are used.
In addition, complex non-drug methods are used for the treatment of arthrosis:
- physical therapy (physical therapy)which is carried out under the supervision of a specialist;
- massage coursesin the absence of an inflammatory process;
- osteopathic effectin the treatment of arthrosis, which is aimed not only at the affected area, but also at restoring the resources of the entire organism, since the pathological process occurring locally in the joint area is the result of many processes occurring in the body as a whole Together . During the osteopathic session, we work with the musculoskeletal system as a whole in order to achieve maximum restoration of innervation and mobility in the spine, pelvic bones, sacrum and eliminate compression of the nerves and vessels blood all over the body!
Physiotherapy
Physiotherapeutic methods are used to improve blood circulation in the joint, increase its mobility and enhance the medicinal effect of drugs. Your doctor may prescribe the following procedures:
- shock wave therapy:ultrasound eliminates osteophytes;
- magnetotherapy:the magnetic field influences metabolic processes and stimulates regeneration;
- laser therapy:laser heating of deep tissues;
- electrotherapy (myostimulation):electric shock to the muscles;
- electrophoresis or phonophoresis:administration of chondroprotectors and analgesics using ultrasound and electric current;
- ozone therapy:injection of gas into the joint cavity.
Surgery
Even with properly selected treatment, in some cases treatment methods are ineffective. So the patient with severe pain syndrome is prescribed surgical treatment and operations for knee arthrosis:
- endoprosthesis:replacement of the entire joint with a prosthesis;
- arthrodesis:fixation between the bones for their immobility, to reduce pain and give a person the opportunity to lean on the leg;
- osteotomy:cut a bone to place it at an angle in the joint to reduce stress.
If replacement of the endoprosthesis is not possible, arthrodesis and osteotomy are used.
Prevention
Preventive measures and compliance with the doctor's recommendations play an important role in the onset of gonarthrosis. To slow down the processes of joint degeneration it is important to follow the rules:
- engage in special physical activities: physiotherapy and gymnastics without unnecessary joint loads;
- avoid intense physical activity;
- choose comfortable orthopedic shoes;
- Monitor your weight and daily routine - alternate special exercises and time for rest.
Diet
The condition of the affected cartilage largely depends on nutrition. In case of arthrosis it is necessary to exclude:
- carbonated drinks;
- alcoholic beverages;
- fatty and excessively spicy foods;
- canned and semi-finished food products;
- products with colourants, preservatives, artificial flavours.
The diet should contain: proteins, fatty acids, for example omega-3, collagen, which is contained in gelatin. It is necessary to eat without increasing body weight.
Consequences and complications
Osteoarthritis of the knee joints develops slowly, but if it is not treated, serious complications occur:
- joint deformation and change in the overall configuration of the knee due to muscle restructuring and curvature of the bone structure;
- shortening of the lower limbs;
- ankylosis – complete immobilization of the knee joint;
- damage to the musculoskeletal system.