Osteoarthritis (gonarthrosis) is a pathological change in the knee joint that is chronic and can progress over time. The disease affects all components of the knee joint: cartilage, subchondral bones, menisci, synovial membranes, ligaments, capsules and periarticular muscles.
The knee joint, which connects the femur and tibia, is subjected to heavy stress throughout life and is regularly injured. Sometimes minor damage goes unnoticed at first, but only becomes noticeable in the second half of life. Joint damage is often found in older people. But young people also suffer from knee joint diseases that can be attributed to sports or an active lifestyle.
In order to maintain maximum mobility and a high standard of living, you should consult a doctor as soon as you experience any problems with your knee joint. Experienced orthopedic traumatologists will diagnose your condition and prescribe the necessary treatment.
Types of arthrosis of the knee joint
Inside the joint, the bones are covered with cartilage tissue, which provides shock absorption and smooth gliding and also prevents the bones from rubbing against each other. The cartilage tissue is supplied with nutrients by the synovial fluid in the joint and the blood flowing through the vessels.
Cartilage has a sponge-like structure so that it absorbs fluid when at rest and displaces it when stressed. At the same time, the cartilage constantly suffers microtrauma during movements and is restored at rest.
If the consequences of a mechanical injury exceed the joint's ability to recover, the cartilage is not adequately supplied with nutrients and regeneration does not take place. Damage accumulates and changes the structure of the cartilage tissue. This is how osteoarthritis of the knee joint begins.
Depending on the causes that caused it, arthrosis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
Degenerative changes in the joint are associated with age. The causes include the following:
- natural degeneration or deterioration due to a slowdown in metabolic processes in the body;
- obesity;
- sedentary lifestyle;
- malnutrition;
- genetic predisposition.
Primary gonarthrosis usually affects both knees at the same time and is referred to as bilateral.
Secondary gonarthrosis
Secondary osteoarthritis of the knee joint can occur at any age as it can be caused by:
- various injuries – bruises, fractures, dislocations, fractures and sprains of ligaments or menisci;
- Joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, gonitis, etc. ;
- regional vascular diseases;
- Overload on the knee joints during sports or due to the specifics of work;
- endocrine diseases;
- O-shaped and X-shaped curvature of the legs.
Secondary osteoarthritis of the knee joint usually only occurs in one leg and is referred to as unilateral.
In rare cases, idiopathic gonarthrosis is detected - a disease that occurs for no apparent reason.
Stages and symptoms of osteoarthritis of the knee joint
Regardless of how arthrosis of the knee joint occurred, experts distinguish three stages of its development, which are determined during an X-ray examination. Each stage is accompanied by characteristic symptoms:
Stage 1– mild pain that occurs after prolonged exercise, when climbing stairs, after heavy physical activity and disappears after rest. There are no restrictions on movement, although there may sometimes be slight swelling of the joint. If nothing is done, this condition can last for years - at which point the cartilage is just beginning to lose its smoothness due to compromised blood supply. The x-ray shows a slight narrowing of the joint space and hardening of the bones.
- Level 2– The pain becomes severe and lasts for quite a long time even with slight exertion. A crunching sound can be heard when the joint is flexed and extended. Due to the severe pain, it is impossible to fully bend the leg. There is slight deformation, muscle loss and restricted movement. Pain can be relieved with painkillers or can go away on its own after rest.
At this stage, the cartilage layer has already become significantly thinner and has even disappeared completely in some places. The synovial fluid becomes thicker and more viscous, compromising its nutritional and lubricating properties. Osteophytes appear - bone growths.
- level 3– The pain increases and worries constantly, even at night. The deformation of the joint becomes noticeable, the gait changes and the lower part of the limb becomes bent. The range of motion in the knee joint is limited - the leg cannot be fully bent or extended. When walking, support in the form of a cane or crutch is required. Painkillers no longer help.
The cartilage is almost completely destroyed, the bones are compacted, and the joint space is severely narrowed or missing. The presence of many osteophytes is noted.
A common symptom of arthrosis of the knee joint is pain of varying intensity localized along the anterior inner surface of the joint.
diagnosis
If you observe symptoms similar to gonarthrosis, you should consult a doctor. At the initial appointment, the doctor takes a medical history, checks the biomechanical capabilities of the joint and prescribes the necessary examinations. Be sure to inform him about injuries and illnesses sustained, lifestyle, diet, medications taken and work characteristics.
The most informative and simple way to confirm or refute a diagnosis is an X-ray of the knee joint - this allows you to carry out a differential diagnosis, determine the degree of development of arthrosis and monitor the course of treatment.
However, radiological signs appear much later than morphological changes. Therefore, gonarthrosis in the early stages is difficult to detect, even on x-rays. In such situations, the doctor may prescribe arthroscopy - a highly accurate method of diagnosing joint changes using special endoscopic equipment.
Other examination methods include ultrasound and MRI - they are prescribed if the X-ray is not informative enough.
Treatment of arthrosis of the knee joint
After the diagnosis, the doctor selects the optimal treatment depending on the stage of the disease and individual characteristics. This solves three problems:
- pain relief;
- stopping the progression of pathology;
- Restoration of joint functionality.
The specialist chooses a comprehensive solution that can be adjusted throughout the treatment process.
In modern medicine there are many ways to treat joint diseases. All of them can be divided into three types: conservative, minimally invasive, surgical.
Conservative method of treating gonarthrosis
Usually used in stages 1-2 of arthrosis of the knee joint. Treatment begins with reducing the load on the joint - the patient should avoid excessive vertical loads on the joint: jumping, running, etc. If necessary, it is recommended to lose excess weight. The doctor will recommend a diet and select a set of gentle exercises that reduce axial shocks and improve the nutrition of cartilage tissue.
To improve blood circulation in the joint area, increase the range of motion, and also enhance the effect of medications, physiotherapy is prescribed:
- Shock wave therapy – short-term exposure to bones and connective tissue with acoustic pulses of large amplitude and low frequency;
- Electrotherapy – exposure to electric current, magnetic or electromagnetic fields to the affected area;
- Laser therapy – exposure to optical radiation produced by a laser;
- Phonophoresis – exposure of the affected area to ultrasound and medications applied to the skin;
- Electrophoresis – exposing the affected area to electricity.
Massage, compresses, wearing an orthosis and kinesiotaping have also proven effective in the treatment of osteoarthritis.
In addition, well-chosen drug therapy helps to relieve pain, stop inflammation and slow down the process of cartilage tissue destruction. For this purpose, anti-inflammatory, hormonal drugs, antispasmodics and chondroprotectors are prescribed. They can be in tablet, injection or topical form depending on the situation.
Minimally invasive method for the treatment of gonarthrosis
If the above procedures do not have any effect, the doctor may prescribe intra-articular injections:
- Hyaluronic acid – as a replacement for synovial fluid to improve friction, relieve pain and improve knee joint function. The average duration of action of the drug is 3-6 months;
- autologous plasma enriched with platelets – to nourish and restore cartilage tissue;
- Corticosteroids – to reduce inflammation.
Surgical method for the treatment of gonarthrosis
If conservative treatment turned out to be ineffective or you initially turned to a specialist in the third stage of knee arthrosis, the doctor may resort to surgical intervention:
- Arthrodesis – artificial immobilization of the affected joint in a physiological position to relieve pain;
- arthroscopic debridement – joint reconstruction with an arthroscope;
- Corrective osteotomy – elimination of bone deformities through artificial fracture;
- Endoprosthetics – replacement of a worn-out joint with an artificially created implant made of biocompatible materials.
The type of operation is selected by the doctor based on the peculiarities of arthrosis of the knee joint. But arthroplasty is considered the gold standard because it allows a complete return to your normal lifestyle. At the same time, a good implant does not need to be replaced for 15 to 30 years. To fully recover after surgery, a rehabilitation course is required, which lasts 3-4 months.
Complications
Gonarthrosis develops quite slowly, but can be recognized in good time and the necessary treatment started. Ignoring the disease and its symptoms can have serious consequences:
- constant pain that is not relieved by medication;
- complete immobility of the diseased joint;
- inability to lean on the injured limb;
- severe joint deformity and curvature of the legs;
- Damage to other parts of the musculoskeletal system;
- Shortening of the leg.
In particularly difficult situations and without timely treatment, osteoarthritis can lead to disability and a deterioration in motor activity, including immobility.
It is important to remember that it is impossible to completely cure arthrosis. However, it is entirely possible to stop the progression of the disease and improve quality of life.
prevention
There is no preventive treatment for gonarthrosis. However, people at risk are recommended to follow certain rules:
- Make sure that your weight does not exceed the age norm.
- Do not do any sports that put a lot of strain on the knee joint.
- if possible, completely cure infectious diseases without causing complications;
- Don't allow yourself to become hypothermic or overtired;
- Avoid injuries and overloading of the joint;
- avoid stressful situations;
- don't forget rest;
- engage in exercise therapy;
- wear orthopedic shoes.
The risk groups include older people, athletes and dancers. You can also add here those who lead a sedentary lifestyle, stand a lot at work or lift weights and are overweight.
Any change in the axis of the lower extremity or the normal biomechanics of the joint, dysplasia, a decrease in the volume and strength of the leg muscles, or trauma can also lead to osteoarthritis.
Get checked regularly and take preventive measures.
question answer
- What is the difference between knee arthritis and knee osteoarthritis?
Arthritis is the collective name for joint inflammation; osteoarthritis is a degenerative-dystrophic process.
- Which doctor treats osteoarthritis?
Traumatologist-orthopedist or rheumatologist.
- Is it possible to play sports with arthrosis of the knee joint?
Prolonged and heavy loading of the joint as well as axial impacts should be avoided. But you shouldn't completely eliminate sport from your life - when you move, your joints are better "nourished" and regenerated. It is important to comply with the measure and adhere to the recommendations of the doctor who determines the method of exerciseselects.