Gonarthrosis or arthrosis of the knee is a serious degenerative-dystrophic pathology of the knee joint, which causes the destruction of the structure of the cartilage tissue of the joints, which in turn causes their deformation and loss of functions.Pathology often causes human disability.
Deforming gonarthrosis of the knee takes the leading place among all arthrosis, and if a small part of the joint is affected at first, if there is no adequate treatment, when the disease reaches a late stage of development, the entire joint is involved in the pathological process.
Most often, the disease develops in people over 40 years old, but it can also occur in athletes at a young age (after receiving serious joint injuries).
Women are most susceptible to the process of joint deformation, but it often occurs in men and even small children.In order not to worsen the situation, it is necessary to recognize the first signs of this disease.
Varieties
The classification of gonarthrosis depends on its etiology and location.Each of the varieties has its own development characteristics, which are always taken into account by the doctor when prescribing treatment.But in terms of the nature of their manifestations, they are almost the same.
Thus, depending on the etiology of the disease, the types of acute arthrosis of the knee joint are as follows:
- Primary gonarthrosis.This disease develops without any conditions.The risk group includes the elderly, women and obese patients.Primary type gonarthrosis of the knee joint can develop without showing itself for years.But the sooner it is detected, the more favorable the prognosis for its treatment will be.
- Secondary gonarthrosisknee pain occurs due to previous injuries, but it can also be the result of various infectious pathologies.If the damaged joints are treated in time, the patient has every chance to avoid this disease.
According to localization, there are types of osteoarthritis:
- Right-sided gonarthrosis, develops in the articular tissues of the right knee.It often occurs in athletes, as well as in people whose work requires frequent physical activity.
- Left-sided gonarthrosisthe pathological process involves the left knee.It occurs in people professionally engaged in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritisit has a destructive effect on the joint tissues of the knees of both legs.This type of disease is considered the most severe both in terms of symptoms and treatment approach.In most cases, this type of gonarthrosis of knee joints develops in elderly people, that is, it is idiopathic in nature.
Anatomical and pathological changes
The knee joint is formed by the articular surfaces of the tibia and femur.In its front part, there is a patella, which smoothly slides along the depression located between the condyles of the femoral joint during movements.
The femur and tibia, together with the knee cap, are covered with elastic glial cartilage, 5-6 mm thick.It helps reduce friction when a person engages in physical activity, and acts as a shock absorber in the event of a fall.
Pathological changes in the joints: gradual disorders
At the first stage of the development of gonarthrosis of the knee joint, blood circulation is primarily affected.The small intraosseous vessels that supply the hyaline joint with blood are disrupted, which causes its surface to gradually dry out.It becomes less flexible and cracks begin to form on its surface.
As a result, these cartilages touch each other instead of sliding smoothly.Inflammation begins to develop gradually, and the diseased cartilages are slightly displaced, preventing each other from fully performing their functions.Due to the formation of a large number of microcracks in the area of the tissues that make up the cartilages, they gradually lose their shock-absorbing properties.
In the second stage of the progression of gonarthrosis, compensatory changes begin to occur in the bone area.Under the influence of increased loads, the articular platform gradually begins to flatten, which causes compression of the subchondral zone (bone area located under the cartilage).
Along the edges, the joint surfaces begin to grow with bone processes, which look like sharp spikes on X-ray.
As the lubricant in the joints thickens, it loses its function significantly.This causes cartilage degeneration to accelerate.For this reason, it appears as a thin thread on X-ray or is completely invisible.
If this is noticed, it means that the disease is moving smoothly (or quickly - it all depends on the situation) to the 3rd stage of development.
In the third stage of gonarthrosis of the knee joint, significant deformation of the bones occurs.They seem to be pressed together, which leads to reduced joint mobility.Cartilage tissue is almost completely depleted.
Causes and predisposing factors
The causes of arthrosis of the knee joint are not isolated - often the doctor identifies several factors that lead to the development of the disease at once.
The most common and common reasons are:
- previous joint injuries (moderate or severe);
- ankle fractures, especially if there is intra-articular damage;
- violation of the integrity of the meniscus structure;
- rupture or complete rupture of ligaments;
- excessive stress on the knee joints.
Acute arthrosis of the knee joint directly depends on the age of the person.Thus, it has been determined that people over 40 years of age are most susceptible to it, because during this period the elasticity of the cartilage begins to decrease and the lubricating joint fluid gradually "dries up".
To delay this moment, patients are advised to do sports, but physical activity should be moderate and should not cause general discomfort.
Excess weight is one of the factors predisposing to the development of gonarthrosis.The fact is that excess body weight creates additional stress on bones and joints, which cannot but affect their health.
In this case, which leg carries more load plays an important role.For example, if your "support" is your left leg, then you are more likely to develop left-sided gonarthrosis.
In obesity, constant pressure on the joints causes microtrauma and rupture of small vessels.Tearing of the meniscus or ligaments is also possible, which is considered a serious way of manifesting joint injuries.
This disease is quite difficult for patients with obvious signs of varicose veins.In this case, the patient is recommended to consult a phlebologist.
It is also present in people with a high risk of developing this pathology:
- previously suffered from various types of arthritis;
- there is an unfavorable heredity;
- there are problems with the garden apparatus;
- suffers from metabolic disorders;
- suffered traumatic brain injuries;
- injured during a road accident;
- had spinal injuries.
Many of these factors are often closely related.Accurate determination of the cause helps to make an accurate diagnosis and prescribe the correct and effective treatment for arthrosis of the knee joint to the patient.
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 should be reviewed in stages.
The first stage
At the initial stage of the disease, patients complain of mild pain in the knee area, which is intensified by physical activity.They are especially intense when going up and down stairs.
In addition to pain, the patient feels a certain stiffness of movement, "tightening" in the joint area.It is felt in the popliteal region and disappears when the knee muscles relax.
Another characteristic symptom is the so-called "initial pain syndrome".It develops during the patient's first steps.When the knees get used to the load, this anomaly disappears without a trace.
The second stage
At this time, the symptoms of arthrosis of the knee joint become more intense and noticeable.The pain intensifies, causing significant difficulty and discomfort during walking.The pain syndrome disappears after a long rest, but is felt again with intensive training.
Inflammation of the joint causes swelling in the knee, which is noticeable even with the naked eye.A strong, unpleasant creaking sound occurs during walking.Movements become more difficult and limited.
The third stage
The pain is very severe and the patient cannot do without painkillers.It is difficult for a person to bend the knee, he feels stiffness in the movements of the joint.It deforms and increases in size.In severe cases, the patient cannot move without additional support.
All these symptoms of arthrosis of the knee joint should not be ignored by the patient.The disease keeps a person in a hospital bed for a long time, and sometimes it can lead to disability.
Which doctor treats gonarthrosis of the knee joint?
You should consult an orthopedic traumatologist for the diagnosis and treatment of knee gonarthrosis.If surgery is needed, a surgeon may be needed.
Diagnostic measures
To determine the cause of the disease, a comprehensive approach to the examination of the patient is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination by an orthopedist and medical history.The doctor determines whether the patient has signs of acute arthrosis of the knee joint, palpates the affected area of the leg, measures the bone and performs angiometry - a test that can be used to evaluate the mobility of the joint from different angles.
- Clinical blood test to evaluate ESR.
- Biochemistry of blood.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common examination methods for arthrosis.However, in the initial stages, the image does not show any changes - they can be observed only in the later stages of development.X-ray reveals 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 together with radiography, complete examination results can be obtained.
- MRI makes it possible to thoroughly study all layers of articular, cartilage and bone tissues and to mark the first dystrophic changes in the early stages of the development of arthrosis.However, MRI has one major drawback - the procedure is quite expensive.However, its high accuracy helps to make a 99.9% accurate diagnosis.
Treatment
Treatment of acute arthrosis of the knee, as well as its diagnosis, requires an integrated approach.But, first of all, it is necessary to use drug therapy, because the diseased joint can become inflamed at any time.
Drug treatment
How to treat gonarthrosis of the knee joint with the help of pharmaceutical drugs and which drugs should be chosen?Only a traumatologist will tell you about this.Often, the treatment regimen includes drugs from the following groups:
- Non-steroidal 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.This cannot be said about the drugs of the COX-2 group, which are milder.They are given intramuscularly or intravenously.
- Treatment of arthrosis of the knee joint also involves the use of hormonal drugs.They help to eliminate inflammation and get rid of knee swelling.Their use is appropriate if synovitis (an inflammatory process in the region of the synovial membrane) occurs.
- Treatment with chondroprotectors.
- Application of ointments, gels, creams.They improve blood circulation, heat, remove swelling and inflammation.
The first method
How to treat arthrosis of the knee joint with this method?The main elements of the treatment regimen are:
- use of drugs (NSAIDs, chondroprotectors, painkillers, ointments, creams, gels);
- light physical therapy;
- manual therapy;
- physiotherapy;
- warm anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in arthrosis.By using a properly designed diet and all the above methods, you can get amazing results from therapy in the shortest possible time.
The second method
Often, the treatment of arthrosis of the knee joint, as well as other articular pathologies, is carried out using this method.
The development of the famous doctor is based on the use of:
- medicines;
- surgical intervention;
- follow a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, visiting the sauna and going for a massage.This will help to improve the patient's health, especially if the disease is ignored and untreated for a long time.
Treatment by the third method
Treatment of gonarthrosis of the knee joint using this method completely eliminates dynamic loads, as they can significantly accelerate the deformation process.Physical exercises should be slow, low amplitude.
Example: sit on the chair, that is, turn back.Spread your feet wide apart, but do not let them touch the floor.Lightly swing each leg alternately.Exercise until you feel a little tired.The number of approaches depends on the patient's well-being.
Surgical intervention
How to treat advanced arthrosis of knee joints?In this case, there is only one way out - surgery.Several types of surgery are performed for osteoarthritis of the knee joints:
- Removal of deformed cartilage tissue and diseased joint (arthrodesis).This is done very rarely.
- Removal of damaged cartilage tissue without removing the joint.This intervention is called arthroscopic debridement.It is performed using a special device - an arthroscope.The procedure is simple, but its effect does not last more than 3 years.
- Cutting and fixing the diseased joint at a different angle.This method is called periarticular osteotomy.The technique is quite complicated, but it allows you to forget the pathology for 3-5 years.
Surgical intervention is rarely used and only when there is no method that cures the disease for at least 1-2 years.In the early stages of the disease, surgery is almost never performed.
Endoprostheses
Endoprosthesis replacement is considered the most common method of gonarthrosis treatment.This is a type of operation that allows you to fully preserve the mobility of the diseased knee.However, despite its effectiveness, this technique requires long-term rehabilitation.In addition, it can cause quite serious consequences.
Instead of the "real" one, the patient is implanted with an artificial joint that can last 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.
Therapeutic exercise
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease.However, the principles of conducting exercises are the same in all cases:
- avoid strong stress on the knee joint;
- sudden and forced actions are prohibited;
- Do not perform exercises that require full load on the painful joint.
Allowed exercises:
- slight trembling of the legs when kneeling on a blanket spread on the floor;
- careful movements on your knees in the same position;
- in the same position, straighten your legs one by one, try not to lift your heels off the floor, and then bend again, avoiding sudden movements.
Such exercises in combination with drug treatment and physiotherapy give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission.Among the most effective methods should be noted:
- electrophoresis with drug solutions;
- magnetic therapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
Physiotherapy courses should be taken at least 2 times a year to prevent relapse of the disease.This will help prolong the remission phase.
Massage
Knee massage is done to improve blood circulation.Lymph is carried along the flow from the peripheral region to the central zone.The popliteal fossa is not involved in this process.
Often, along with massage, manual therapy sessions aimed at gradually stretching the painful joint are performed.Such procedures stabilize the patient's condition, but can only be performed by a specialist.
Is gonarthrosis completely cured?
Is it possible to treat arthrosis of the knee joint completely?Perhaps no one, not even the most experienced traumatologist, can give an unambiguous answer to this question.It all depends on the severity of the disease.If you engage in therapy in the early stages of its development, you can stop further deformation of the joint.
However, if pathology is detected at the last stage, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms.The operation provides treatment for only a few years, after which the disease can re-introduce itself.
Prevention
To prevent gonarthrosis, the following is necessary:
- avoid knee injuries;
- constantly do physical exercises (squats, running, raising and lowering legs);
- enrich the diet with foods containing many vitamins;
- limit the consumption of salt, hot spices, fried, smoked, sweets;
- maintain normal physical shape;
- if you get the slightest knee injury, see a doctor immediately;
- Prophylactic use of chondroprotectors after the age of 35;
- drink a daily norm of water (2 l).
By following these simple recommendations, you will reliably protect yourself from arthrosis of the knee joint, as well as other diseases that can reduce your quality of life for a long time.