Gonarthrosis or osteoarthritis of the knee is a serious degenerative-dystrophic pathology of the knee joint, which leads to the destruction of the structure of the cartilage tissue of the joints, which leads to deformation and loss of function. Pathology often leads to human disability.
Knee deformity gonarthrosis is the leading cause of all osteoarthritis, and if only a small part of the joint is affected initially, in the absence of adequate treatment, all of them are involved in the pathological process when the disease progresses to the final stage of development.
Most often, the disease develops in people over the age of 40, but in athletes it can occur at a young age (after serious joint injuries).
Women are most susceptible to joint deformity, but it is more common in men and even young children. In order not to aggravate the situation, you must be able to recognize the first signs of this disease.
Varieties
The classification of gonarthrosis depends on the etiology and localization. Each of the varieties has its own developmental characteristics, which are always taken into account by the doctor when prescribing treatment. However, they are practically the same in nature.
Thus, depending on the etiology of the disease, the types of acute osteoarthritis of the knee joint are as follows:
- Primary Gonarthrosis.This disease develops unconditionally. The risk group includes the elderly, women and obese patients. Gonarthrosis of the primary type of knee joint can develop over the years without manifesting itself in any way. However, the sooner it is detected, the better the prognosis of treatment.
- Secondary gonarthrosis of the kneeoccurs due to trauma, but can also be the result of various infectious pathologies. If the damaged joints heal in time, the patient has every chance to avoid this disease.
There are types of osteoarthritis depending on the location:
- right-sided gonarthrosis developing in the articular tissues of the right knee. It often occurs in athletes, as well as in people whose work often requires physical strength.
- Left-sided gonarthrosisinvolves the left knee in a pathological process. It occurs in people who do professional sports, as well as in patients diagnosed with obesity.
- Binary osteoarthritishas a devastating effect on the joint tissues of the knees of both feet. 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 the elderly, ie is idiopathic.
Anatomy and pathological changes
The knee joint consists of the articular surfaces of the tibia and femur. In the anterior part, during movement, there is a patella that slides smoothly along the depression between the condyles of the femoral joint.
The femur and tibia, together with the knee pad, are covered with 5-6 mm thick elastic cartilage. Helps reduce friction during physical activity by a person and acts as a shock absorber in the event of a fall.
Pathological changes in the joints: gradual disorders
In the early stages of the development of gonarthrosis of the knee joint, blood circulation is primarily affected. The small intravascular vessels that supply blood to the hyaline joint are damaged, causing the surface to gradually dry out. It becomes less elastic and cracks begin to form on the surface.
As a result, these cartilages touch each other instead of sliding smoothly. Inflammation begins to develop gradually, and the diseased cartilage, slightly altered, interferes with each other to fully perform their functions. Due to the formation of a large number of micro-cracks in the area of cartilage-forming tissues, they gradually lose their cushioning properties.
In the second stage of gonarthrosis, compensatory changes begin to occur in the bone area. Under the influence of increasing loads, the joint platform gradually begins to straighten, which leads to compression of the subchondral zone (the area of bone under the cartilage).
Joint surfaces along the edges begin to grow with bony processes that resemble sharp pieces on X-ray.
As the lubricant thickens in the joints, it loses most of its function. This causes accelerated cartilage degeneration. Therefore, it looks like a thin thread on X-ray or becomes completely invisible.
If something like this is noticed, it means that the disease has progressed to the 3rd stage of development without any problems (or quickly - everything depends on the situation).
In the third stage of gonarthrosis of the knee joint, there is a significant deformation of the bones. They seem to be squeezed together, which leads to a decrease in joint mobility. Cartilage tissue dries almost completely.
Causes and predisposing factors
The causes of osteoarthritis of the knee joint are not isolated - often the doctor prescribes several factors at once that lead to the development of the disease.
The most common and common causes:
- previous joint injuries (moderate or severe);
- leg fractures, especially if there is intra-articular damage;
- violation of the integrity of the meniscus structure;
- tears of gardens or full tears;
- Excessive stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to a person's age. Thus, it was found that people over the age of 40 are more sensitive to this, because during this period, the elasticity of cartilage begins to decrease, and the lubricating joint fluid gradually "dries".
Exercise is recommended for patients to postpone this moment, but physical activity should be moderate and not cause general discomfort.
Being overweight is also a factor in the development of gonarthrosis. The fact is that excess weight puts extra stress on the bones and joints, which can not affect their health.
In this situation, which foot has the most load plays an important role. For example, if your "support" is the left foot, you are more likely to develop left-sided gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels. Rupture of the meniscus or ligaments, which is considered a severe manifestation of joint damage, is also possible.
This disease is very difficult for patients with obvious symptoms of varicose veins. In this case, the patient is advised to consult a phlebologist.
Those at high risk of developing this pathology:
- have previously suffered from various types of arthritis;
- has an unfavorable heredity;
- there are problems with the garden apparatus;
- suffers from metabolic diseases;
- suffered a traumatic brain injury;
- was injured in the accident;
- received spinal injuries.
Many of these factors are closely linked. Accurate identification of the cause helps to make an accurate diagnosis and determine the correct and effective treatment of osteoarthritis of the knee joint.
Clinical manifestations
Symptoms of gonarthrosis do not manifest immediately - they gradually appear, depending on the stage of the disease. For this reason, the clinical picture should be considered in stages.
First stage
In the early stages of the disease, patients complain of mild pain in the knee, which increases with physical force. They are especially crowded when going up and down stairs.
In addition to pain, the patient feels a certain stiffness of movement, "shrinkage" in the joint area. It is felt in the popliteal region and passes when the knee muscles relax.
Another characteristic feature is the so-called "onset pain syndrome". The patient develops in the first steps. When the knees become accustomed to the load, this anomaly disappears without a trace.
Second stage
In this case, the symptoms of osteoarthritis in the knee joint are more acute and noticeable. The pain intensifies, causing significant difficulty and discomfort while walking. The pain syndrome disappears after a long rest, but feels strong again.
Inflammation of the joint causes swelling of the knee, which can even be seen with the naked eye. There is a strong, unpleasant crisis while walking. Movements become heavier and more limited.
Third Stage
The pain is very severe and the patient cannot do without pain medication. It is difficult for a person to bend his knee, he feels the stiffness of joint movements. It deforms and increases in size. In severe cases, the patient can not move without additional support.
All these symptoms of osteoarthritis of the knee should not be ignored by the patient. The disease can place a person in a hospital bed for a long time and can sometimes lead to disability.
Which doctor treats knee gonarthrosis?
It is necessary to consult an orthopedic traumatologist for the diagnosis and treatment of knee gonarthrosis. If surgery is needed, you may need the help of a surgeon.
Diagnostic measures
An integrated approach to the examination of the patient is extremely important to determine the cause of the disease.
The diagnostic scheme consists of several stages:
- Visual examination and anamnesis of an orthopedist. The doctor determines if the patient has signs of acute osteoarthritis of the knee joint, palpates the affected part of the leg, measures the bone and performs angiometry - this can be used to assess the mobility of the joint at different angles.
- Clinical blood test for ESR assessment.
- Blood biochemistry.
- Examination of urine and blood for fibrinogen, urea and other substances.
- Radiography is one of the most common diagnostic methods for osteoarthritis. However, in the early stages, the snapshot does not show any change - it may differ only in the later stages of development. Radiography shows narrowing of the joint space, sclerotic changes in the cartilage area, bone tissue damage and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, if ultrasound is performed in conjunction with radiography, full-fledged examination results can be obtained.
- MRI allows you to thoroughly examine all layers of joint, cartilage and bone tissue and see the first dystrophic changes in the early stages of osteoarthritis. However, MRI has one major drawback - the procedure is quite expensive. However, the high accuracy of 99% helps to prepare an accurate diagnosis.
Treatment
Treatment and diagnosis of acute knee osteoarthritis requires a holistic approach. But first of all it is necessary to apply drug treatment, because the patient's joint can become inflamed at any time.
Medication
How to treat Gonarthrosis of the knee joint with pharmacy drugs and which drugs to choose? Only a traumatologist will tell you about it. Often the following groups of drugs are included in the therapy regimen:
- Non-steroidal anti-inflammatory drugs COX-1 or 2. The first group can cause serious damage to the gastrointestinal tract, so they can not be used for a long time. The same cannot be said of COX-2 drugs, which are milder. They are administered intramuscularly or intravenously.
- Treatment of osteoarthritis of the knee also includes the use of hormonal drugs. They help relieve inflammation and swelling in the knee. If you have synovitis (inflammation of the synovial membrane), their use is recommended.
- Treatment with chondroprotectors.
- Application of ointments, gels, creams. Improves blood circulation, warms, eliminates swelling and inflammation.
The first method
How to treat osteoarthritis of the knee using this technique? The main elements of the therapy scheme are:
- use of drugs (NSAIDs, chondroprotectors, painkillers, ointments, creams, gels);
- light physiotherapy exercises;
- manual treatment;
- physiotherapy;
- Heat anti-inflammatory compresses with medicinal solutions.
In addition, according to a well-known rheumatologist, diet plays an important role in osteoarthritis. With a well-developed diet and all of the above methods, you can get incredible results from therapy as soon as possible.
The second method
This method is often used to treat osteoarthritis of the knee joint, as well as other joint pathologies.
The development of a famous doctor is based on application:
- medicines;
- surgical intervention;
- follow a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
In addition, the doctor recommends more swimming in the pool, going to the sauna and massage. This will help to improve the patient's health, especially if the disease is ignored and left untreated for a long time.
Treatment according to the third method
Treatment of gonarthrosis of the knee joint using this method completely eliminates the dynamic loads, as they can significantly accelerate the process of deformation. Training should be slow, low amplitude.
Example: Sit in an "upstairs" chair, ie look at the back. Spread your legs wide, but do not allow them to touch the ground. Gently shake each leg in turn. Practice until you feel a little tired. The number of approaches depends on the patient's well-being.
Surgery
How to treat advanced osteoarthritis of the knee joints? There is only one way out of this situation - surgery. There are several types of surgery for osteoarthritis of the knee joints:
- Removal of deformed cartilage and a diseased joint (arthrodesis). It is very rare.
- Removal of damaged cartilage tissue without removing the joint. This intervention is called arthroscopic debridment. It is performed using a special device - an arthroscope. The procedure is simple, but the effect does not last more than 3 years.
- Saw and reinforce the patient's joint at a different angle. This is called a periarticular osteotomy. The technique is quite complicated, but allows you to forget the pathology for 3-5 years.
Surgery is rarely used and only in the absence of a method that treats the disease for at least 1-2 years. In the early stages of the disease, surgery is almost never performed.
Endoprosthetic
Endoprosthetic is the most common treatment for gonarthrosis. This is a type of operation that allows you to fully maintain the mobility of the affected knee. However, despite its effectiveness, this technique requires long-term rehabilitation. In addition, it can lead to quite serious consequences.
The location of a "real" patient is implanted with an artificial joint that can serve for 20 years. Of course, everything depends on the material from which it is made. The procedure is not cheap, but quite effective, so it has gained special popularity.
Physiotherapy exercises
The course of sports therapy is prescribed by a doctor depending on the stage of the disease. However, the principles of training are the same for all cases:
- avoid strong stress on the knee joint;
- Abrupt and forced actions are prohibited;
- Do not perform exercises that require full load on the painful joint.
Allowed exercises:
- slight shaking of the legs while kneeling on a blanket spread on the floor;
- neat kneeling exercises in the same position;
- In the same position, take turns straightening the legs, try not to tear the heels off the ground, and then bend again, avoiding sudden movements.
These exercises give excellent results in combination with medication and physical therapy.
Physiotherapy
All physiotherapy procedures are prescribed for gonarthrosis in remission. Among the most effective techniques should be noted:
- electrophoresis with drug solution;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- radon or hydrogen sulfide baths;
- mud treatment.
To prevent a recurrence of the disease, physiotherapy courses should be taken at least twice a year. This will help prolong the remission phase.
Massage
Knee massage is done to improve blood circulation. It is carried along the lymph flow from the peripheral area to the central zone. The popliteal fossa is not involved in this process.
Often, in addition to massage, manual therapy sessions are performed to gradually lengthen the patient's joint. Such procedures stabilize the patient's condition, but can be performed only by a specialist.
Is Gonarthrosis Completely Cured?
Is it possible to completely cure osteoarthritis of the knee joint? Perhaps no one, not even the most experienced traumatologist, will be able to give an unequivocal answer to this question. It all depends on the severity of the disease. If you engage in therapy in the early stages of development, you can stop more joint deformities.
However, even if surgery is found in the late stages, surgery does not guarantee the complete disappearance of unpleasant symptoms. The operation only helps to improve for a few years, after which the disease may recur.
Prevention
Needed to prevent gonarthrosis:
- Avoid knee injuries;
- exercise regularly (squat, run, lift and lower legs);
- enrich the diet with foods rich in vitamins;
- Limit the use of salt, hot spices, fried, smoked, sweet;
- maintain normal physical shape;
- immediate medical attention if you have the slightest knee injury;
- Prophylactic use of chondroprotectors after the age of 35;
- daily water consumption (2 liters).
By following these simple tips, you will reliably protect yourself from osteoarthritis of the knee joint and other diseases that can reduce your quality of life for a long time.