The knee joint undergoes regular stress. Running and jumping, walking and climbing stairs or simply standing affect the condition of the cartilage tissue of the knee. If the balance in the cartilage is disturbed, the development of osteoarthritis of the knee joint (gonarthrosis) begins.
Gonarthrosis is an arthrosis that deforms the knee joint and is accompanied by chronic damage to the surfaces of the hyaline cartilage, as well as the 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. Subsequently, a limitation of knee movements occurs due to a violation of support on the leg. Diagnosis of pathology is based on collecting the patient's anamnesis and complaints, the results of a visual examination and physical examinations of the knee joint. These age-related disorders of the musculoskeletal system appear in almost all people in old age.
General information
Gonarthrosis (from the Latin genus articulatio - knee joint) is the most common osteoarthritis, which is a progressive degenerative-dystrophic lesion of the cartilage of the knee joint of a non-inflammatory nature. Women and older people often suffer from gonarthrosis. But after injuries during intense sports, gonarthrosis occurs even in young people.
The cause of osteoarthritis lies in a change in the structure of the cartilage within the joint and not in the deposition of salts there. In gonarthrosis, salt deposits occur in the place where the tendons are attached to the ligamentous apparatus, but they cannot be the cause of the pain symptoms. First, cracks appear in the cartilage, which reduces 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 its disappearance;
- changes in synovial fluid in composition and quantity;
- damage to the bones of 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 and its mobility is limited, which 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 osteoarthritis, both knee joints are affected.
Symptoms of osteoarthritis of the knee joint.
The symptoms of knee osteoarthritis can be very different:
- At first, slight discomfort appears when climbing 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 osteophyte growth, the joint may lock in the final stages (ankylosis);
- unstable gait due to muscle atrophy (reduced muscle volume);
- deformation of the knee joint due to the growth of bones and changes in their shape, the appearance of an inflammatory process in the muscles and ligaments increases swelling around the tissues of the joint;
- limping 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 osteoarthritis begins gradually. In the first stage of gonarthrosis, patients experience slight sensations of stiffness and pain when going up or down stairs. Possible hardening of the area below the knee. Initial pain sensations that arise when sitting during the beginning of the ascent are characteristic. When the patient moves away, the pain decreases, but with effort it reappears.
There are no external changes to the knee. Sometimes swelling and the development of synovitis are possible - accumulation of fluid with enlargement, swelling of the joint, while heaviness is felt and movement is limited.
In stage 2, severe pain occurs with prolonged exercise and intensifies with walking. The pain is usually located along the anterior surface within the joint. After rest the pain disappears, but when moving it reappears.
As osteoarthritis progresses, the number of movements in the knee joint decreases; when trying to bend the leg as much as possible, pain and a harsh, sharp crunch appear. The configuration changes, the joint expands. Synovitis appears with an even greater accumulation of fluid in them.
In stage 3, the pain becomes constant and bothersome not only when walking, but also at rest. Painful sensations appear even at night; 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 patients develop a valgus deformity of the legs, which become X-shaped or O-shaped. As a result of the deformation of the legs and limited movement, patients' gait becomes unstable and waddles. In severe cases of gonarthrosis, patients move with the help of crutches.
Causes of osteoarthritis of the knee joint.
Most cases of osteoarthritis occur for several reasons. These factors include:
- Injuries.25% of gonartosis is caused by injuries: meniscus damage, ligament rupture. Gonarthrosis usually occurs three to five years after the injury; Sometimes the disease can develop earlier, after two or three months.
- Physical exercise.Often, gonarthrosis occurs after the age of forty 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 your joints.
- Overweight.Excess weight significantly increases the load on the knee joints and leads to injury. Gonarthrosis is especially difficult if there are metabolic disorders and varicose veins.
- Sedentary lifestyle.
The process of developing gonarthrosis increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is the genetic weakness of the ligaments and the alteration of 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 kneecap. It slides as it moves between the grooves of the femur. The articular surfaces of the tibia and femur are covered by very strong, smooth and elastic hyaline cartilage up to six mm thick. When moving, cartilage reduces friction and acts as a shock absorber.
There are 4 stages of osteoarthritis:
- 1st stage.There is a disturbance in blood circulation in the vessels that feed the hyaline cartilage. Its surface dries out and small cracks appear, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and, instead of sliding smoothly, sticks together, losing its shock-absorbing quality. There are no visual symptoms of osteoarthritis, the x-ray shows a slight deviation.
- 2nd stage.Changes occur in the structure of the bones and the joint area flattens to support greater loads. The part of the bone beneath 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; A narrowing of the gap in the joint is also visible. The synovial capsule of the joint degenerates and wrinkles. The joint fluid thickens, its viscosity increases, and its lubricating properties deteriorate. The process of cartilage degeneration accelerates, becomes thinner and in some places disappears completely. After its disappearance, friction in the joint increases and degeneration progresses sharply. Patients experience pain during exercise, climbing stairs, squatting, and prolonged standing.
- 3rd stage.X-rays show a noticeable, sometimes asymmetric, narrowing of the joint space. Due to the deformation of the meniscus, the bones are deformed and pressed against each other. Movement in the joint is limited due to the large number of large osteophytes. There is no cartilaginous tissue. Constant pain torments 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 bones can fuse with each other.
Classification
Taking into account the pathogenesis of the disease, two types are distinguished: primary gonarthrosis – idiopathic and secondary. The primary occurs without lesion, generally in elderly patients and is bilateral. Secondary develops as a result of diseases and developmental disorders or against the background of injuries to the knee joint. It can occur at any age and is usually unilateral.
Diagnosis
The diagnosis of joint osteoarthritis is made by an orthopedist or traumatologist in a medical clinic.
- The appointment begins with collecting a history, the main complaints and symptoms that concern the patient. The doctor discovers complaints, the presence of chronic diseases, past injuries, fractures and injuries and asks additional questions.
- Upon examination, features of mobility, deformation and pain of the joints are revealed. In stage 1 of gonarthrosis, the patient does not have external changes. In the second and third stages, deformation and hardening of the contours of the joints, limitation of movement and curvature of the legs are detected. When the kneecap moves, a sharp crack is heard. On palpation, the doctor detects pain in the inner part of the joint space. The joint may increase in size. Swelling of the joint is detected. When palpating the joint, a fluctuation is felt.
- The patient is referred for laboratory tests. A general blood test detects inflammation, while a biochemical test reveals possible causes of problems.
- Next, an instrumental diagnosis of the patient is required. X-rays are used for this. X-ray is a diagnostic method that allows us to detect signs of knee osteoarthritis: 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 the dynamics of osteoarthritis. At the beginning of gonarthrosis, the changes are not visible on x-rays. Subsequently, a narrowing of the joint space and a compaction of the subchondral area are determined. Gonarthrosis can only be diagnosed with x-rays and clinical tests.
- Nowadays, in addition to radiography, computed tomography (CT) is used to diagnose osteoarthritis, which allows bone changes to be studied in detail, as well as magnetic resonance imaging (MRI), which makes it possible to visually evaluate the state 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 additional studies and consultations with more specialized specialists.
Treatment of osteoarthritis of the knee joint.
Treatments for osteoarthritis can be divided into three groups:
- medicinal;
- physiotherapy;
- surgical.
Osteoarthritis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins at an early stage. When osteoarthritis worsens, doctors recommend maximum rest for the joint. Patients are prescribed the necessary procedures: physiotherapy, massage, mud therapy.
When a patient is diagnosed with stage 1 and 2 disease, medications and physical therapy are used; if the injury is extensive, surgery and surgical intervention are used.
Pharmacotherapy
Proper administration of medications can stop pain and inflammation, as well as slow down the process of cartilage tissue destruction. Therefore, it is important to consult a doctor as soon as possible.
Important: do not self-medicate. Incorrect medications, chosen independently and without consulting a doctor, can only aggravate the situation and lead to serious complications.
Drug therapy for osteoarthritis includes taking the following medications:
- anti-inflammatory:relieve inflammation and relieve pain in the joint;
- hormonal:prescribed when anti-inflammatory medications are ineffective;
- antispasmodics:help eliminate 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;
- medications to improve microcirculation: improve nutrition and oxygen supply.
Depending on each specific situation, tablets, intra-articular injections of steroid hormones and local forms of medications are used. The selection of medications is carried out by the treating physician. Sometimes a patient with osteoarthritis is sent to a sanatorium for treatment 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.
Additionally, complex non-drug methods are used to treat osteoarthritis:
- physiotherapy (physiotherapy)which is carried out under the supervision of a specialist;
- massage coursesin the absence of an inflammatory process;
- osteopathic effectin the treatment of osteoarthritis, which is aimed not only at the affected area, but also at restoring the resources of the entire 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, we work with the musculoskeletal system as a whole 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 improve the medicinal effect of drugs. The doctor may prescribe the following procedures:
- Shock wave therapy:ultrasound removes osteophytes;
- magnetotherapy:the magnetic field affects metabolic processes and stimulates regeneration;
- laser therapy:deep tissue laser heating;
- electrotherapy (myostimulation):electric shock to the muscles;
- Electrophoresis or phonophoresis:administration of chondroprotectors and analgesics using ultrasound and electric current;
- ozone therapy:gas injection 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 osteoarthritis:
- endoprosthesis:replacement of the entire joint with a prosthesis;
- arthrodesis:fastening between the bones for immobility, to reduce pain and give the person the opportunity to lean on the leg;
- osteotomy:Cut a bone to angle it into the joint to reduce stress.
If replacement of the endoprosthesis is not possible, arthrodesis and osteotomy are used.
Prevention
Prevention measures and compliance with the 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:
- perform special physical activity: physiotherapy and gymnastics without unnecessary joint loads;
- avoid strenuous physical activity;
- choose comfortable orthopedic shoes;
- Monitor your weight and your daily routine: alternate special exercises and time to rest.
Diet
The state of the affected cartilage depends largely on nutrition. In case of osteoarthritis, it is necessary to exclude:
- carbonated drinks;
- alcoholic beverages;
- fatty and too spicy foods;
- preserved and semi-finished products;
- products with artificial colors, preservatives, flavorings.
The diet should contain: proteins, fatty acids, for example, omega-3, collagen, which is found in gelatin. It is necessary to eat without increasing body weight.
Consequences and complications.
Osteoarthritis of the knee joints develops slowly, but if left untreated, serious complications arise:
- joint deformation and change in the general configuration of the knee due to muscle restructuring and curvature of the bone structure;
- shortening of the lower extremities;
- ankylosis – complete immobilization of the knee joint;
- damage to the musculoskeletal system.