The knee joint experiences regular stress. Running and jumping, walking and climbing stairs or just standing all affect the condition of the cartilage tissue in the knee. If the balance in the cartilage is disturbed, then 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 hyaline cartilage, as well as bones - the femur and tibia. Symptoms of the disease in the knee joint are pain that intensifies with movement. Due to the accumulation of fluid in it, movement is limited. Later, there is a limitation of knee movements due to a violation of the support in the leg. The diagnosis of pathology is based on the collection of anamnesis and complaints of the patient, the results of a visual examination and hardware examinations of the knee joint. Such age-related disorders of the musculoskeletal system appear in almost everyone in old age.
General information
Gonarthrosis (from the Latin articulatio genus - knee joint) is the most common arthrosis, which is a degenerative-dystrophic progressive lesion of the cartilage of the knee joint of a non-inflammatory nature. Women and elderly people 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. With gonarthrosis, salt deposits occur where the tendons are attached to the ligamentous apparatus, but they cannot be the cause of pain symptoms. First, cracks appear in the cartilage, which reduce 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 it disappears;
- changes in synovial fluid in composition and quantity;
- damage to the bones in the knee due to friction;
- the appearance of osteophytes;
- stiffness due to compaction of the joint capsule;
- muscle spasm.
As a result, the knee joint becomes deformed, its mobility is limited, as a result of which this can lead to disability and loss of ability to work.
Osteoarthritis of the knee joint can be unilateral and affect only one knee of the right or left leg; in the case of bilateral arthrosis, both knee joints are affected.
Symptoms of arthrosis of the knee joint
Symptoms of knee arthrosis can be very different:
- At first, slight discomfort appears when climbing up the stairs, then the pain syndrome increases and torments even at rest;
- stiffness occurs in the morning, at first it lasts a few minutes, then it can last up to half an hour;
- a sharp 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 as a result of the progression of the disease of the knee joint; in the later stages, the patient is forced to walk even with a walker.
The disease of arthrosis begins gradually. At the 1st stage of gonarthrosis, patients experience slight sensations of stiffness and pain that occur when going up or down the stairs. Possible tightening of the area under the knee. Characteristic are the starting pain sensations that arise from a sitting position during the beginning of the ascent. When the patient moves away, the pain decreases, but with exertion it reappears.
There are no external changes in the knee. Sometimes swelling and 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, intense pain occurs with prolonged exercise and intensifies when walking. Pain is usually localized along the anterior surface inside the joint. After rest, the pain disappears, but when moving it reappears.
As arthrosis progresses, the number of movements in the knee joint decreases; when you try to bend your 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 in them.
At stage 3, pain becomes constant and bothers you not only when walking, but also at rest. Painful sensations appear even at night; in order 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 cannot 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. As a result of leg deformation and limited movement, patients' gait becomes unstable and waddles. In severe cases of gonarthrosis, patients move with the support of crutches.
Causes of arthrosis of the knee joint
Most cases of arthrosis occur due to several reasons. These factors include:
- Injuries.25% of gonarthosis 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 to three months.
- Physical exercise.Often, gonarthrosis occurs after forty years of age 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 joints.
- Excess weight.Excess weight significantly increases the load on the knee joints, causing injury. Gonarthrosis is especially difficult if there are metabolic disorders and varicose veins.
- Sedentary lifestyle.
The process of development of gonarthrosis increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is genetic weakness in 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 patella. It slides when moving 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. When moving, cartilage reduces friction and acts as shock absorber.
There are 4 stages of arthrosis:
- 1st stage.There is a disturbance in blood circulation in the vessels that feed the hyaline cartilage. Its surface becomes dry and small cracks appear on it, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and, instead of soft sliding, clings, losing its shock-absorbing quality. There are no visual symptoms of arthrosis; the X-ray shows a slight deviation.
- 2nd stage.Changes occur in the structure of the bones, and the joint area is flattened to accommodate greater loads. The part of the bone that is located under 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 gap in the joint is also visible. The synovial capsule of the joint degenerates, becoming wrinkled. The fluid in the joint thickens, its viscosity increases, and its lubricating properties deteriorate. The process of degeneration in the cartilage accelerates, it becomes thinner, and in some places it disappears completely. After its disappearance, friction in the joint increases, and degeneration progresses sharply. Patients experience pain during exercise, when climbing stairs, when squatting, and when standing for a long time.
- 3rd stage.X-rays show a noticeable, sometimes asymmetrical narrowing of the joint space. Due to deformation of the meniscus, the bones become deformed and press against each other. Movement in the joint is limited due to the large number of large osteophytes. There is no cartilage tissue. Constant pain haunts the patient at rest; it is impossible to walk without support.
- 4th stage.Movements in the knee joint are impossible; x-rays show complete deformation of the cartilage and destruction of the articular bones, many osteophytes, and the bones can fuse with each other.
Classification
Considering the pathogenesis of the disease, two types are distinguished: primary – idiopathic and secondary gonarthrosis. Primary occurs without injury, usually in elderly patients and is bilateral. Secondary develops as a result of diseases and developmental disorders or against the background of injuries in the knee joint. It can occur at any age and is usually unilateral.
Diagnostics
Diagnosis of joint arthrosis is carried out by an orthopedist or traumatologist in a medical clinic.
- The appointment begins with collecting anamnesis - the main complaints and symptoms that worry the patient. The doctor finds out complaints, the presence of chronic diseases, past injuries, fractures and injuries, and asks additional questions.
- Upon 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 coarsening of the joint contours, limitation of movements and curvature of the legs are detected. When the patella moves, a sharp crunching 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, fluctuation is felt.
- The patient is referred for laboratory tests. When taking a general blood test, inflammation is detected, while a biochemical test reveals possible causes of problems.
- Next, instrumental diagnostics of the patient is required. X-rays are used for this. X-ray is a diagnostic method that allows you to detect signs of knee arthrosis: narrowing of the joint gap, osteophytes and bone deformities. X-ray of the joint is a technique that clarifies the diagnosis of pathological changes and dynamics of arthrosis. At the onset of gonarthrosis, changes are not visible on x-rays. Subsequently, a narrowing of the joint space and compaction of the subchondral zone are determined. Gonarthrosis can be diagnosed only with x-rays and clinical tests.
- Nowadays, in addition to radiography, to diagnose arthrosis, computed tomography (CT) is used, which makes it possible to study bone changes in detail, as well as magnetic resonance imaging (MRI), which makes it possible to visually assess the condition 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 assessed.
- 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 additional consultations with more specialized specialists.
Treatment of arthrosis of the knee joint
Treatments for arthrosis can be divided into three groups:
- medicinal;
- physiotherapy;
- surgical.
Arthrosis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins at an early stage. When arthrosis worsens, doctors recommend maximum rest for the joint. Patients are prescribed the necessary procedures: exercise 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, then surgery and surgical intervention are used.
Drug treatment
Proper administration of medications 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 medications, chosen independently and without consulting a doctor, can only aggravate the situation and lead to serious complications.
Drug therapy for arthrosis includes taking the following medications:
- anti-inflammatory:relieve inflammation and relieve pain in the joint;
- 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 each specific situation, tablets, intra-articular injections of steroid hormones and local forms of drugs are used. The selection of medications is carried out by the attending physician. Sometimes a patient with arthrosis is sent for treatment to a sanatorium and is recommended 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 for treating arthrosis are used:
- 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 resource of the whole organism, since the pathological process occurring locally in the joint area is the result of many processes occurring in the body as a whole. During the osteopathic session, work is carried out 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 nerves and blood vessels throughout the body!
Physiotherapy
Physiotherapeutic methods are used to improve blood circulation in the joint, increase its mobility, and enhance the medicinal effect of drugs. The doctor may prescribe the following procedures:
- shock wave therapy:ultrasound eliminates osteophytes;
- magnetotherapy:the magnetic field affects metabolic processes and stimulates regeneration;
- laser therapy:laser heating of deep tissues;
- electrotherapy (myostimulation):electric shock to 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. Then the patient with severe pain syndrome is prescribed surgical treatment and operations for knee arthrosis:
- endoprosthetics:replacement of the entire joint with a prosthesis;
- arthrodesis:fastening between bones for their immobility, to reduce pain and give a person the opportunity to lean on the leg;
- osteotomy:cutting one bone to place it at an angle in the joint to reduce stress.
If endoprosthesis replacement is not possible, then arthrodesis and osteotomy are used.
Prevention
Prevention measures and compliance with doctor’s recommendations play an important role in the occurrence of gonarthrosis. To slow down the processes of joint degeneration, it is important to follow the rules:
- engage in special physical activity: physical therapy and gymnastics without unnecessary joint loads;
- avoid strenuous 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 depends largely on nutrition. In case of arthrosis, it is necessary to exclude:
- carbonated drinks;
- alcoholic drinks;
- fatty and overly spicy foods;
- canned food and semi-finished products;
- products with dyes, preservatives, artificial flavors.
The diet should contain: protein, 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 arise:
- joint deformation and change in the overall configuration of the knee due to muscle restructuring and curvature of the bone frame;
- shortening of the lower limbs;
- ankylosis – complete immobilization of the joint in the knee;
- damage to the musculoskeletal system.