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 tissues of the joints, which, in turn, leads to its deformation and loss of its functions. Pathology often leads to human disability.
Deforming gonarthrosis of the knee occupies a prominent place among all osteoarthritis, 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 stagedevelopment, everything is involved in the pathological process.
The disease most often develops in people over the age of 40, but in athletes it can occur at a young age (after severe joint injuries).
Women are more susceptible to joint deformation, but it often occurs in men and even young children. In order not to aggravate the situation, you need to 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 the doctor always takes into account when prescribing treatment. But by the nature of the demonstration, they are practically the same.
Therefore, the types of acute osteoarthritis of the knee joint, according to the etiology of the disease, are the following:
- Primary osteoarthritis.This disease develops without any prerequisites. The risk group includes the elderly, women and obese patients. Gonarthrosis of the knee joint of the primary type can develop over the years without manifesting itself in any way. But the sooner it is discovered, the more favorable the prognosis for your treatment.
- Secondary knee osteoarthritisoccurs due to trauma, but can also be the result of various infectious pathologies. If the damaged joints heal in a timely manner, the patient has every chance to avoid this disease.
There are types of osteoarthritis by location:
- Gonarthrosis on the right side, which develops in the articular tissues of the right knee. It often occurs in athletes, as well as in people whose work requires frequent physical exertion.
- Left knee osteoarthritisinvolves the left knee in the pathological process. It occurs in people who are professionally engaged 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 from the point of view of the symptoms and from the therapeutic point of view. In most cases, this type of gonarthrosis of the knee joint develops in elderly people, that is, it is idiopathic.
Anatomy and pathological changes
The knee joint is formed from the articulating surfaces of the tibia and femur. In its anterior part there is a patella that, during movement, glides smoothly through the depression located between the condyles of the femoral joint.
The femur and tibia together with the knee pad are covered with elastic clay cartilage, which is 5-6mm thick. It helps to reduce friction during a person's physical activity and, in case of falls, performs a cushioning function.
Pathological changes in the joints: disorders by phases
In the early stage of development of knee joint osteoarthritis, the blood circulation is affected first. The small intraosseous vessels supplying blood to the hyaline joint are disturbed, leading 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. Inflammation begins to develop gradually, and diseased cartilage, moving 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 begin to occur in the bone area. Under the influence of increased loads, the articular platform gradually begins to flatten, this leads to a compaction of the subchondral zone (the part of the bone that is under the cartilage).
The articular surfaces along the edges begin to overgrow with bony processes, which look like sharp spines on an X-ray.
As lubricating fluid thickens in the joints, it loses most of its function. This leads to accelerated cartilage degeneration. For this reason, it looks like a thin thread on x-ray or becomes completely invisible.
If something like this was noticed, it means that the disease is flowing smoothly (or rapidly, it all depends on the situation) towards the third stage of development.
In the third stage of knee joint osteoarthritis, a marked deformation of the bones occurs. They appear to compress together, leading to decreased joint mobility. The cartilage tissue dries out almost completely.
Causes and predisposing factors
The causes of osteoarthritis 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 (of moderate or high severity);
- leg fractures, especially if there was intra-articular damage;
- violation of the integrity of the meniscus structure;
- tears or complete tears of the ligaments;
- excessive stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to a person's age. So, it was found that people over 40 are the most susceptible, since during this period the flexibility of the cartilage begins to decrease and the lubricating fluid in the joints gradually "dries up".
To delay this time, 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, being overweight creates additional stress on your bones and joints, which cannot help but affect your health.
In this case, the fact which leg has the most loads plays an important role. For example, if your "support" is your left leg, then there is a high probability that you will develop left-sided osteoarthritis.
In obesity, constant pressure on the joints causes microtrauma and small blood vessels ruptured. Tears of the menisci or ligaments, which are considered a serious form of joint injury, are also possible.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins. In this case, the patient is shown the consultation of a phlebologist.
There is also a high risk of developing this pathology in people who:
- have previously suffered from different types of arthritis;
- has unfavorable inheritance;
- has problems with the ligamentous apparatus;
- suffers from metabolic disorders;
- has suffered a traumatic brain injury;
- were injured in an accident;
- had spinal injuries.
Many of these factors are often closely related to each other. An accurate determination of the cause helps to establish an accurate diagnosis and prescribe the patient the correct and effective treatment for osteoarthritis of the knee joint.
Clinical manifestations
The symptoms of knee osteoarthritis 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 stage
In the initial stage of the development of the disease, patients complain of mild pain in the knee area, which increases with physical exertion. They become especially intense during the descent and ascent of the stairs.
In addition to pain, the patient feels a certain stiffness of movements, "constriction" in the joint area. It is felt in the popliteal part and passes when the knee muscles are relaxed.
Another characteristic feature is the so-called "initial pain syndrome". It develops in the first steps of the patient. When the knees get used to the load, this anomaly disappears without a trace.
Second stage
At this 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 crunch when walking. The movements become heavier and more restricted.
Stage Three
The pain becomes very intense and the patient cannot do without painkillers. It is difficult for a person to bend the knee, he feels the stiffness of the joint movements. It deforms and increases in size. In severe cases, the patient cannot move without additional support.
The patient should not ignore all these signs of knee osteoarthritis. The disease can put a person in a hospital bed for a long time and can sometimes lead to disability.
What doctor treats knee osteoarthritis?
For the diagnosis and treatment of knee osteoarthritis, 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 ailment, an integrated approach to examining the patient is extremely important.
The diagnostic scheme consists of several stages:
- Orthopedist's visual examination 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 performs an angle measurement, a test that can be used to assess the mobility of the joint indifferent angles
- Clinical blood test for ESR evaluation.
- Blood biochemistry.
- Study of urine and blood to determine the content of fibrinogen, urea and other substances.
- Radiography is one of the most common screening methods for osteoarthritis. However, in the initial stages, the snapshot shows no change; They can only be noticed in later stages of development. The x-ray shows a narrowing of the joint space, sclerotic changes in the cartilage area, damage to bone tissue, and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, comprehensive examination results can be achieved if an ultrasound is performed in conjunction with an x-ray.
- MRI allows you to thoroughly examine all layers of articular, cartilaginous and bone tissues, and notice the first dystrophic changes in the early stages of osteoarthritis. However, MRI has one major drawback: the procedure is quite expensive. But its high precision contributes to a diagnosis of 99. 9% accuracy.
Treatment
The treatment of acute knee osteoarthritis, as well as its diagnosis, requires an integrated approach. But, first of all, it is necessary to apply drug therapy, because the diseased joint can become inflamed at any time.
Medications
How to treat gonarthrosis of the knee joint with pharmacy drugs and what drugs to choose? Only a traumatologist will tell about this. Often drugs from the following groups are included in the therapy regimen:
- COX-1 or 2 non-steroidal anti-inflammatory drugs. The first group can seriously damage the gastrointestinal tract, so they cannot be used for a long time. The same cannot be said for COX-2 group drugs, which are milder. They are administered intramuscularly or intravenously.
- Treatment of knee osteoarthritis also involves the use of hormonal medications. They help relieve inflammation and swelling in the knee. Its use is advisable if there is 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 osteoarthritis of the knee joint with this technique? The main elements of the therapy scheme are:
- drug use (NSAIDs, chondroprotectors, analgesics, ointments, creams, gels);
- light physical therapy exercises;
- manual therapy;
- physiotherapy;
- warming anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in osteoarthritis. Thanks to a properly developed diet and the use of all the above techniques, you can achieve amazing results from therapy in the shortest time possible.
Method Two
Often, the treatment of osteoarthritis of the knee joint, like other joint pathologies, is carried out by this method.
The development of a famous doctor is based on the application:
- medications;
- 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 health of the patient, especially if the disease has been ignored for a long time and has not been treated.
Treatment by the third method
Treatment of knee joint osteoarthritis with this technique completely excludes dynamic loads, as they can significantly accelerate the deformation process. Exercise should be slow and low in amplitude.
Example: sitting in a chair "on top", that is, looking back. Spread your legs wide, but don't let them touch the ground. Gently shake each leg in turn. Do the exercise until you feel a little 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 way out: the 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 procedure is called 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.
- Cut and secure the diseased joint at a different angle. This is called a periarticular osteotomy. The technique is quite complicated, but it allows to forget about the pathology for 3-5 years.
Surgical intervention is rarely used, and only in the absence of a method that cures the disease, at least for 1-2 years. In the initial stages of the disease, the operation is almost never performed.
Endoprosthesis
Stenting is considered the most common treatment for knee osteoarthritis. This is a type of surgery that allows you to fully maintain the mobility of the affected knee. But, despite its effectiveness, this technique requires long-term rehabilitation. In addition, it can have quite serious consequences.
The "real" patient site is implanted with an artificial joint, which can serve for 20 years. Although, of course, it all depends on the material from which it is made. The procedure is not cheap, but it is quite effective, which is why it has gained special popularity.
Physiotherapy exercises
The doctor prescribes the course of exercise therapy depending on the stage of the disease. However, the principles for performing the 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 a full load on the sore joint.
Allowed exercises:
- slight trembling of the legs when kneeling on a blanket spread on the floor;
- neat kneeling movements in the same position;
- in the same position, alternately straighten the legs, trying not to tear the heels off the floor, and then bend them again, avoiding sudden movements.
These exercises, combined with medications and physical therapy, give excellent results.
Physiotherapy
All physiotherapy procedures are prescribed for gonarthrosis in remission. Among the most effective techniques, it is worth highlighting:
- electrophoresis with medicinal solutions;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- radon or hydrogen sulfide baths;
- sludge treatment.
To prevent a recurrence of the disease, physiotherapy courses should be taken at least 2 times a year. This will help prolong the remission phase.
Massage
The knee massage is done to improve blood circulation. It is performed along the lymphatic flow in the direction of the peripheral area to the central area. The popliteal fossa is not involved in this process.
Often, together with 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 performed by a specialist.
Is gonarthrosis completely healed?
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 participate in therapy in the early stages of its development, you can stop further deformation of 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 remind itself of itself again.
Prevention
To prevent knee osteoarthritis it is necessary:
- avoid knee injuries;
- constantly exercising (squatting, running, lifting and lowering the legs);
- enrich the diet with foods that contain many vitamins;
- limit the use of salt, hot spices, fried, smoked, sweet;
- maintain a normal physical form;
- immediate medical attention if you receive the slightest knee injury;
- prophylactic use of chondroprotectors after 35 years of age;
- consumption of daily water intake (2 liters).
By following these simple tips, you will reliably protect yourself from osteoarthritis of the knee joint, as well as other diseases that can reduce your quality of life for a long time.