Gonarthrosis, or knee arthrosis, is a serious degenerative-dystrophic pathology of the knee joint, leading to destruction of the cartilage tissue structure of the joint, which, in turn, causes deformation and loss of their function. Pathology often leads to human disability.
Defective knee gonarthrosis ranks first among all arthrosis, and if initially only a small portion of the joint is affected, then if there is no adequate treatment, as the disease progresses to a late stage of development, all are involved in pathological processes.
Often this disease occurs in people over 40 years of age, but in athletes it can occur even at a young age (after getting a serious joint injury).
Women are most likely to experience joint deformity, but it is more common in men as well as in small children. In order not to aggravate the condition, you should be able to recognize the first signs of the disease.
Variety
The classification of gonarthrosis depends on its etiology and localization. Each variety has its own developmental characteristics, which are always taken into account by the doctor while giving treatment. But based on the nature of the manifestations, they are almost the same.
Therefore, the type of acute arthrosis of the knee joint, depending on the etiology of the disease, is as follows:
- Gonarthrosis primer.The disease develops without preconditions. Risk groups include the elderly, women and obese patients. Primary type knee joint gonarthrosis can develop over many years without manifesting itself in any way. But the sooner it is found, the better the prognosis of its treatment.
- Secondary gonarthrosisKnee occurs due to trauma, but it can also be caused by a variety of infectious pathologies. If the damaged joint is healed in a timely manner, the patient has a chance to avoid the disease.
There are types of osteoarthritis with localization:
- Gonarthrosis of the right side, which develops in the articular tissue of the right knee. It often occurs in athletes, as well as in people whose work requires regular physical exercise.
- Left side gonarthrosisinvolves the left knee in a pathological process. Occurs in people who are professionally involved in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a damaging effect on the knee joint tissue of both feet. This type of disease is considered the most severe, both in terms of symptoms and in terms of 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 from the articular surface of the tibia and femur. In front of it, there is a patella, which, during movement, glides smoothly along the depression located between the condyles of the femoral joint.
The thighs and tibia together with the knees are covered with elastic clay cartilage, 5-6 mm thick. It helps reduce friction while doing physical activity by a person, and in the event of a fall, it performs a shock-absorbing function.
Pathological changes in joints: phase disorders
In the first stage of the development of knee joint gonarthrosis, the blood circulation is affected first. The small intraosseous blood vessels that supply blood to the hyalin joint are disrupted, causing its surface to dry out gradually. It becomes less elastic, and cracks begin to form on its surface.
As a result, instead of sliding smoothly, these cartilages come into contact with each other. Inflammation gradually begins to develop, and the diseased cartilage, shifting slightly, interfering with each other to perform its function fully. Due to the formation of large numbers of microcrats in the tissue areas that make up the cartilage, they gradually lose their protective properties.
In the second phase of the development of gonarthrosis, compensatory changes in the bone area begin to occur. Under the influence of increased load, the articular platform gradually begins to flatten, this leads to compaction of the subcondral zone (the area of bone located below the cartilage).
The articular surface along its edges begins to grow with a bony process, which looks like a sharp thorn on an x-ray.
As the lubricant 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 the radiograph, or becomes invisible at all.
If something like this is observed, this means that the disease is progressing smoothly (or fast - it all depends on the situation) flowing into the 3rd developmental phase.
In the third stage of gonarthrosis of the knee joint, there is significant bone deformation. They seem to be squeezed into each other, which causes a decrease in joint mobility. The cartilage tissue is almost completely dry.
Causes and factors of predisposition
The cause of arthrosis of the knee joint is not isolated - often the doctor determines several factors at once that cause the development of the disease.
The most common and common reasons are:
- previous joint injuries (moderate or high level);
- broken leg, especially if there is intra-articular damage;
- violation of the integrity of the meniscus structure;
- tears or complete ligament tears;
- excessive pressure on the knee joint.
Acute arthritis of the knee joint is directly related to a person's age. Thus, it is found that people over the age of 40 are most susceptible to it, because during this period the flexibility of cartilage begins to decrease, and the fluid of the lubricating joints gradually "dries up".
To delay this time, sports are recommended for patients, but physical activity should be moderate and not cause general discomfort.
Being overweight is also one of the factors that cause the development of gonarthrosis. The fact is that being overweight puts extra pressure on the bones and joints, which can not affect their health.
In this case, an important role is played by the fact that which leg has more load. For example, if your left leg is your "support", then you are more likely to have gonarthrosis of the left side.
In obesity, constant pressure on the joints causes microtrauma and rupture of small blood vessels. Rupture of the menisci or ligaments, which is considered a severe way to indicate joint injury, is also possible.
This disease is very difficult for patients with significant varicose vein symptoms. In this case, the patient is shown a consultation of a phlebologist.
High risk for developing this pathology is also present in people who:
- previously suffered from various types of arthritis;
- has bad offspring;
- having problems with ligament devices;
- suffers from metabolic disorders;
- has suffered a traumatic brain injury;
- injured in an accident;
- suffered a spinal cord injury.
Many of these factors are often closely related. Determining the exact cause can help determine an accurate diagnosis and prescribe proper and effective treatment for knee joint arthrosis.
Clinical manifestations
Symptoms of gonarthrosis 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 early stages of the development of the disease, patients complain of mild pain in the knee area, which is exacerbated by physical exercise. They become very strong as they go down and up the stairs.
In addition to pain, the patient feels a certain stiffness of movement, "narrowing" in the joint area. It feels in the popliteal area, and passes when the knee muscles are relaxed.
Another characteristic feature is the so-called "onset pain syndrome". It develops in the first step of the patient. When the knee becomes accustomed to the load, this anomaly disappears without a trace.
Second level
During this time, the symptoms of arthrosis of the knee joint become stronger and more pronounced. The pain is increasing, causing significant difficulty and discomfort while walking. The pain syndrome disappeared after a long rest, but with earnestness, it was felt again.
Inflammation of the joints causes swelling of the knee that can be seen even with the naked eye. There are strong and unpleasant cramps while walking. Movement becomes heavier and more constrained.
Stage Three
The pain becomes very severe and the patient cannot do it without pain medication. It is difficult for a person to bend the knee, he feels the stiffness of the joint movement. It becomes deformed and grows larger. In severe cases, the patient is unable to move without additional support.
All 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 cause 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 needed, you may need the help of a surgeon.
Diagnostic measures
To determine the cause of the disease, an integrated approach to patient examination is essential.
The diagnostic scheme consists of several stages:
- Orthopedic visual examination and taking anamnesis. The doctor determines if the patient has symptoms of acute knee joint arthrosis, grasping the affected foot area, measuring bones and performing angiometry - tests that can be used to assess joint movement at different angles.
- Clinical blood test for ESR assessment.
- Blood biochemistry.
- Studies on urine and blood for fibrinogen, urea and other substances.
- Radiography is one of the most common screening methods for arthrosis. However, in the early stages, photographs show no change - they can only be observed at a later stage of development. X-rays showed narrowing of the joint, sclerotic changes in the cartilage area, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, complete examination results can be achieved if ultrasound is performed in conjunction with radiography.
- MRI allows you to thoroughly examine all layers of articular tissue, cartilage and bone, and see the first dystrophic changes in the early stages of arthrosis. However, MRI has one major drawback - the procedure is quite expensive. But its high accuracy contributes to an accurate 99. 9% diagnosis.
Treatment
Treatment of acute knee arthrosis, as its diagnosis requires an integrated approach. But, first of all, it is necessary to use drug therapy, because sore joints can become inflamed at any time.
Medicine
How to treat knee joint gonarthrosis with pharmaceutical drugs, and which medication to choose? Only a traumatologist will say anything about it. Often, drugs from the following groups are included in the therapeutic regimen:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously damage the gastrointestinal tract, making them unusable for a long time. The same cannot be said of COX-2 drugs, which are milder. They are given intramuscularly or intravenously.
- Treatment of knee arthrosis also involves the use of hormone medications. They help relieve inflammation and swelling in the knees. Its use is recommended if there is synovitis (inflammation of the synovial membrane).
- Treatment with chondroprotectors.
- Apply ointments, gels, creams. They improve blood circulation, warm the body, relieve swelling and inflammation.
Method One
How to cure knee joint arthrosis using this technique? The main elements of the therapy scheme are:
- use of drugs (NSAIDs, chondroprotectors, pain relievers, ointments, creams, gels);
- light physiotherapy training;
- manual therapy;
- physiotherapy;
- warms up anti-inflammatory compresses with a drug solution.
In addition, according to well-known rheumatologists, diet plays an important role in arthrosis. Due to proper diet and the use of all the above techniques, you can get amazing results from therapy in the shortest possible time.
Method two
Often the treatment of arthrosis of the knee joint, like other articular pathologies, is done using this method.
The development of well-known physicians based on applications:
- medicine
- ;
- surgical intervention;
- adheres to a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
Also, doctors recommend swimming more in the pool, going to the sauna and doing a massage. This will help improve the patient's health, especially if the disease has long been neglected and untreated.
Treatment according to the third method
Treatment of knee joint gonarthrosis using this technique completely eliminates dynamic loads, as they can significantly accelerate the deformation process. Exercise must be slow, low amplitude.
Example: sitting on a chair "above", that is, facing backwards. Spread your legs wide, but do not let them touch the floor. Slowly move each leg alternately. Exercise until you feel a little tired. The number of approaches depends on the well-being of the patient.
Surgery
How to treat advanced knee joint arthrosis? In this case, there is only one way out - operation. There are several types of surgery for osteoarthritis of the knee joint:
- Removal of deformed cartilage tissue and diseased joints (arthrodesis). It is very rare.
- Removal of damaged cartilage tissue without removing the joint. This intervention is called arthroscopic debridement. It is performed using a special tool - arthroscope. The procedure is simple, but the effect is not more than 3 years.
- Seeing and tying a sore joint at different angles. This is called periarticular osteotomy. The technique is a bit complicated, but it is possible to forget the pathology for 3-5 years.
Surgical intervention is rare, and only if there is no method that can cure the disease, for at least 1-2 years. In the early stages of the disease, surgery is almost never performed.
Endoprosthetics
Endoprosthetics are considered the most common treatment for gonarthrosis. This is the type of surgery that allows you to maintain the mobility of the affected knee. But, despite its effectiveness, this technique requires long-term recovery. In addition, it can lead to quite serious consequences.
The "real" patient's place is implanted with artificial joints, which can function for 20 years. Although, of course, it all depends on the material from which it is made. The procedure is not cheap, but quite effective, which is why it is gaining some popularity.
Physiotherapy training
The course of exercise therapy is prescribed by a doctor depending on the stage of the disease. However, the principle of doing exercises is the same for all cases:
- avoids strong pressure on the knee joint;
- sudden and forced movement is prohibited;
- do not do exercises that require a full load on a sore joint.
Exercises Allowed:
- light tremors on the feet while kneeling on a blanket spread on the floor;
- neat kneeling movements in the same position;
- in the same position, alternately straighten the foot, trying not to tear the heel off the floor, and then bend it again, avoiding sudden movements.
This exercise, combined with medication and physical therapy, gives excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission. Among the most effective techniques, it should be noted:
- electrophoresis with drug solution;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- bath with radon or hydrogen sulfide;
- mud treatment.
To prevent recurrence of the disease, a course of physiotherapy should be taken at least 2 times a year. This will help prolong the forgiveness phase.
Sort
Knee massage is done to improve blood circulation. It is performed along the lymph flow in the direction from the periphery to the central zone. Fossa popliteal is not involved in this process.
Often, along with massage, manual therapy sessions are performed, aimed at slowly stretching the diseased joint. Such a procedure stabilizes 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? Probably no one, not even the most experienced traumatologist, can give a clear answer to this question. It all depends on the severity of the disease. If you undergo therapy in the early stages of its development, you can stop joint deformity further.
However, if the pathology is found in the last stage, surgical intervention does not even guarantee the disappearance of unpleasant symptoms. The operation can only be cured for a few years, after which the disease can remind itself.
Prevention
To prevent gonarthrosis, it is necessary to:
- avoid knee injuries;
- exercise regularly (squat, run, raise and lower legs);
- enrich your diet with foods high in vitamins;
- limit the use of salt, hot spices, fried, smoked, sweet;
- maintain normal physical shape;
- seek medical attention immediately if you have a slight knee injury;
- use of prophylactic chondroprotectors after reaching the age of 35;
- daily water intake (2 liters).
By following these simple suggestions, you will protect yourself from arthrosis of the knee joint, as well as from other diseases that can reduce your quality of life in the long run.