Gonarthrosis, or osteoarthritis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes destruction of the cartilage tissue structure of the joints, which in turn results in theirdeformation and loss of function. The pathology often leads to human disability.
Deforming knee osteoarthritis 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 stageadvanced development, all of this is involved in the pathological process.
Most often the disease develops in people over 40 years of age, but in athletes it can occur at a young age (after suffering severe joint injuries).
Women are the most susceptible to joint deformities, but they often occur in men and even in young children. In order not to make the situation worse, 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 characteristics of development, which are always taken into account by the doctor when prescribing treatment. But by the nature of the manifestation, they are virtually the same.
Thus, the types of acute osteoarthritis of the knee joint, depending on the etiology of the disease, are as follows:
- Primary osteoarthritis.This disease develops without any prerequisites. The risk group includes the elderly, women and obese patients. Primary knee osteoarthritis of the knee joint can develop over the years without showing up in any way. But the sooner it is discovered, the more favorable the prognosis for its treatment will be.
- secondary knee osteoarthritisof the knee is due to trauma, but it can also be the consequence of various infectious pathologies. If the damaged joints are healed in a timely manner, the patient has every chance to avoid this disease.
There are types of osteoarthritis by location:
- Gonarthrosis of the right side, which develops in the joint tissues of the right knee. It often occurs in athletes, as well as in people whose work requires frequent physical exertion.
- knee osteoarthritis of the left sideinvolves the left knee in the pathological process. Occurs in people professionally involved in sports, as well as in patients 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 severe, both in terms of symptoms and from the point of view of a therapeutic approach. In most cases, this type of gonarthrosis of the knee joint develops in older people, that is, it is idiopathic.
Anatomy and pathological changes
The knee joint is formed from the articular surfaces of the tibia and femur. In its front part there is a patella, which, during movement, gently slides along the depression between the condyles of the femoral joint.
The femur and tibia as well as the knee brace are covered with elastic clay cartilage 5 to 6 mm thick. It helps to reduce friction during a person's physical activity and in the event of a fall, it performs a shock absorbing function.
Pathological changes in the joints: staged disorders
In the first stage of development of knee osteoarthritis, first of all, the blood circulation suffers. The small intraosseous vessels that supply the hyaline joint are disrupted, leading to progressive drying of its surface. It becomes less elastic and cracks begin to form on its surface.
As a result, instead of sliding smoothly, these cartilages touch each other. Inflammation gradually begins to develop, and diseased cartilages, 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 damping properties.
In the second phase of knee osteoarthritis progression, compensatory changes in the bony region begin to occur. Under the influence of increased loads, the joint platform gradually begins to flatten, which leads to compaction of the subchondral area (the part of the bone located under the cartilage).
Joint surfaces along the edges begin to invade with bony processes, which look like sharp thorns on an x-ray.
As the lubricating fluid thickens in the joints, it loses most of its function. This leads to accelerated degeneration of the cartilage. Because of this, it looks like a fine thread on the x-ray, or it becomes completely invisible.
If anything like this has been noticed, it means that the disease is entering smoothly (or quickly - it all depends on the situation) entering the 3rd stage of development.
In the third stage of gonarthrosis of the knee joint, there is a noticeable deformation of the bones. They appear to be tightly packed together, resulting in decreased joint mobility. The cartilage tissue dries up 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 (moderate or high severity);
- fractures of the leg, especially if there were intra-articular lesions;
- 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. Thus, it has been found that people over 40 are the most sensitive to it, because during this period the flexibility of the cartilage begins to decrease and the lubricating joint fluid gradually "dries up".
To delay this moment, sport is recommended for patients, but physical activity should be moderate and not cause general discomfort.
Being overweight is also one of the predisposing factors for the development of knee osteoarthritis. The fact is that being overweight creates additional stress on the bones and joints, which can only affect their health.
In this case, an important role is played by which leg has the most loads. For example, if your "support" is the left leg, there is a high likelihood that you will develop knee OA on the left side.
In obesity, constant pressure on the joints leads to strain injuries and the rupture of small blood vessels. Ruptures of the menisci or ligaments, which are considered a serious way of manifesting joint damage, are also possible.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins. In this case, the patient receives a consultation with a phlebologist.
A high risk of developing this condition also exists in people who:
- have suffered from different types of arthritis before;
- have an unfavorable inheritance;
- have problems with the ligament system;
- suffer from metabolic disorders;
- have suffered a traumatic brain injury;
- were injured in an accident;
- had spinal injuries.
Many of these factors are often closely related. Accurate determination of the cause makes it possible to make an accurate diagnosis and prescribe the correct and effective treatment of osteoarthritis of the knee joint to the patient.
Clinical manifestations
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 should be considered in stages.
First step
At the initial stage of the development of the disease, patients complain of slight pain in the knee area, which increases with physical exertion. They become particularly intense when going down and up the stairs.
In addition to the pain, the patient feels a certain stiffness of movement, "constriction" in the joint area. It is felt in the popliteal area, and passes when the knee muscles are relaxed.
Another feature is the so-called "starting pain syndrome". It develops from the first steps of the patient. When the knees get used to the load, this anomaly goes away without leaving a trace.
Second step
At this time, the symptoms of osteoarthritis of the knee joint become more intense and noticeable. The pain intensifies, causing significant difficulty and discomfort when walking. The pain syndrome disappears after a long rest, but with intense effort it again makes itself felt.
Inflammation of the joint causes swelling of the knee that is visible even to the naked eye. There is a loud, unpleasant cracking sound while walking. The movements become heavier and more constrained.
Third step
The pain becomes very severe and the patient cannot do without pain relievers. 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.
All of these signs of osteoarthritis of the knee should not be ignored by the patient. The disease can put a person in a hospital bed for a long time and sometimes lead to disability.
Which doctor treats gonarthrosis of the knee?
For the diagnosis and treatment of knee osteoarthritis, it is necessary to consult an orthopedic traumatologist. If surgery is needed, you may need the help of a surgeon.
Diagnostic measures
In order to establish the cause of the disease, an integrated approach to the examination of the patient is extremely important.
The diagnostic scheme consists of several steps:
- Visual examination of the orthopedist and taking an 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 takes an angle measurement - a test that can be used to assess mobilityof the joint from different angles.
- Clinical blood test for ESR evaluation.
- Biochemistry of blood.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- An x-ray is one of the most common examinations for osteoarthritis. However, at the initial stage, the snapshot shows no changes - they can only be noticed at later stages of development. The x-ray shows a narrowing of the cleft 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 obtained if an ultrasound is performed along with an x-ray.
- MRI allows you to deeply examine all layers of joint, cartilage and bone tissue, and notice the first dystrophic changes in the early stages of osteoarthritis. However, MRI has one big drawback - the procedure is quite expensive. But its high precision contributes to the formulation of 99. 9% of an accurate diagnosis.
Processing
The treatment of acute osteoarthritis of the knee, as well as its diagnosis, requires an integrated approach. But, first of all, it is necessary to apply drug therapy, since the diseased joint can become inflamed at any time.
Drugs
How to treat gonarthrosis of the knee joint with pharmacy drugs and which drugs to choose? Only a traumatologist will say about this. Often, drugs from the following groups are included in the treatment regimen:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can severely damage the gastrointestinal tract, so they cannot be used for a long time. The same cannot be said of drugs in the COX-2 group, which are milder. They are administered intramuscularly or intravenously.
- Treatment for osteoarthritis of the knee also involves the use of hormonal drugs. They help relieve inflammation and swelling in the knee. Their use is recommended in cases of 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 treat osteoarthritis of the knee joint with this technique? The main elements of the treatment regimen are:
- use of drugs (NSAIDs, chondroprotectors, analgesics, ointments, creams, gels);
- light physiotherapy exercises;
- manual therapy; physiotherapy
- ;
- anti-inflammatory warming compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in osteoarthritis. With a well-developed diet and the use of all of the above techniques, you can achieve amazing results with therapy in the shortest possible time.
Method two
Often, treatment of osteoarthritis of the knee joint, like other joint pathologies, is carried out using this method.
The development of a famous doctor is based on the application:
- drugs
- ;
- surgical intervention;
- adherence to a diet that removes excess fluid from the body;
- physiotherapy; 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.
Processing according to the third method
Treatment of gonarthrosis of the knee joint with this technique completely eliminates dynamic loads, as they can significantly accelerate the process of deformation. Exercise should be slow and low in amplitude.
Example: Sit in a chair "on top", ie facing your back. Spread your legs apart, but don't let them touch the ground. Gently wiggle 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 performed using a special device - an arthroscope. The procedure is simple, but its effect lasts no more than 3 years.
- Saw and secure the diseased joint at a different angle. This is called a periarticular osteotomy. The technique is quite complicated, but it allows you to forget about the pathology for 3 to 5 years.
Surgical intervention is rarely used, and only in the absence of a method that will cure the disease, at least for 1 to 2 years. In the early stages of the disease, the operation is almost never performed.
Endoprostheses
Stent grafts are considered the most common treatment for knee osteoarthritis. It 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. Moreover, it can have quite serious consequences.
The place of the “real” patient is implanted with an artificial joint, which can serve for 20 years. Although, of course, it all depends on the material from which it was made. The procedure is not cheap, but quite effective, which is why it has gained special popularity.
Physiotherapy exercises
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease. However, the principles of performing the exercises are the same in all cases:
- avoid severe stress on the knee joint;
- sudden and forced movements are prohibited;
- do not perform exercises that require a full load on the painful joint.
Authorized exercises:
- slight trembling of the legs while kneeling on a blanket lying on the floor;
- sharp knees 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 medication and physical therapy, give excellent results.
Physiotherapy
All physiotherapy procedures are prescribed for knee osteoarthritis in remission. Among the most effective techniques, it should be noted:
- electrophoresis
- with medicinal solutions; magnetotherapy
- ; ultrasound therapy
- ; microwave treatment
- ; paraffin therapy
- ;
- baths with radon or hydrogen sulphide;
- mud treatment.
To avoid a recurrent outbreak of the disease, physiotherapy courses should be taken at least 2 times a year. This will help prolong the remission phase.
Massage
Knee massage is performed to improve blood circulation. It is carried out along the lymphatic flow in the direction of the peripheral zone towards the central zone. The popliteal fossa is not involved in this process.
Often with massage, manual therapy sessions are conducted, aimed at gradually stretching the diseased joint. Such procedures stabilize the patient's condition, but can only be performed by a specialist.
Is knee osteoarthritis completely cured?
Is it possible to completely cure osteoarthritis of the knee joint? Perhaps no one, even the most experienced traumatologist, will be able to unambiguously answer 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 joint deformity.
However, if a pathology is found in the later stages, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms. The operation cures only for a few years, after which the disease can again be remembered.
Prevention
To prevent knee osteoarthritis, you should:
- avoid knee injuries;
- constant exercise (squatting, running, raising and lowering your legs);
- enrich the diet with foods containing many vitamins;
- limit the use of salt, hot spices, fried, smoked, sweet;
- maintaining normal physical form;
- immediate medical attention if you sustain any injury to your knee;
- prophylactic use of chondroprotectors after reaching 35 years of age;
- daily water consumption (2 liters).
By following these simple recommendations, you will reliably protect yourself against osteoarthritis of the knee joint, as well as other diseases that can reduce your quality of life for a long time.