Gonarthrosis, or osteoarthritis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes destruction of the cartilaginous tissue structure of the joint, which, in turn, leads to their deformation andloss of their functions. Pathology often leads to human disability.
Deforming gonarthrosis of the knee occupies a major 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 passes into a late stage of development, all thisinvolved in the pathological process.Most often the disease develops in people over 40 years, but in athletes it can occur at a young age (after you have received serious joint damage).
Women are more susceptible to joint deformity, but it often occurs in men and even young children. In order not to aggravate the situation, you should be able to recognize the first signs of this disease.
Varieties
The classification of gonarthrosis depends on its etiology and localization. Each of the varieties has its own developmental characteristics, which are always taken into account by the doctor when prescribing treatment. But by the nature of manifestation, they are practically the same.
Thus, the types of acute knee osteoarthritis, depending on the etiology of the disease, are as follows:
- Primary gonarthrosis. This disease develops without any preconditions. The risk group includes the elderly, women and obese patients. Primary-type knee gonarthrosis can develop over the years without manifesting itself in any way. But the sooner it is discovered, the more favorable the prognosis of its treatment will be.
- Secondary gonarthrosisof the knee occurs due to trauma, but can also be the result of various infectious pathologies. If the damaged joints are treated in a timely manner, the patient has every chance of avoiding this disease.
There are types of osteoarthritis by localization:
- Right gonarthrosis, which develops in the articular tissues of the right knee. It often occurs in athletes, as well as in people whose work requires frequent physical exertion.
- Left gonarthrosisinvolves the left knee in the pathological process. Occurs in people who are professionally involved in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a devastating effect on the joint tissues of the knees of both feet. This type of disease is considered the most serious, 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 joints develops in elderly people, that is, it is idiopathic.
Anatomy and pathological changes
The knee joint is formed by the articular surfaces of the tibia and femur. In front of it, there is a patella, which, during movements, slides smoothly along the depression placed between the condyles of the femoral joints.
The femur and tibia together with the knee pad are covered with elastic clay cartilage, which is 5-6 mm thick. Helps to reduce friction during physical activity by a person, and in case of fall, it performs a shock-absorbing function.
Pathological changes in the joints: stage disorders
In the first stage of development of gonarthrosis of the knee joints, first of all it affects the blood circulation. The small intraosseous vessels that supply blood to the hyaline node break down, leading to a gradual 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 the 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 stage of gonarthrosis progression, compensatory changes begin to occur in the bone area. Under the influence of increased loads, the articular platform gradually begins to flatten, this leads to a compression of the subchondral area (the part of the bone located below the cartilage).
Articular surfaces along the edges begin to grow with bony processes, which in an X-ray image look like sharp ridges.
As the lubricating fluid thickens in the joints, it loses most of its function. This leads to accelerated cartilage degeneration. For this reason, it looks like a thin thread on X-rays, or becomes completely invisible.
If something like this is noticed, it means that the disease smoothly (or quickly - it all depends on the situation) flows into the third stage of development.
In the third stage of gonarthrosis at the knee joint, there is a noticeable deformation of the bone. They seem to be squeezed into each other, which leads to reduced joint mobility. Cartilage tissue dries almost completely.
Causes and predisposing factors
The causes of osteoarthritis of the knee joints 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);
- foot fractures, especially if there have been injuries within the article;
- violation of the integrity of the meniscus structure;
- tears or full tears of ligaments;
- Excessive stress on the knee joints.
Acute knee osteoarthritis is directly related to a person's age. So it was found that people over 40 years old are more sensitive to it, as during this period the flexibility of the cartilage begins to decrease, and the fluid of the lubricating joints gradually "dries".
To delay this moment, sports are recommended for patients, but physical activity should be moderate and not lead to general discomfort.
Excess weight is also one of the factors that predispose to the development of gonarthrosis. The fact is that being overweight creates extra stress on the bones and joints, which can not but affect their health.
In this case, an important role is played by which foot has the most loads. For example, if your "support" is the left foot, then there is a high probability that you may develop gonarthrosis on the left.
In overweight, constant joint pressure leads to microtrauma and rupture of small blood vessels. Meniscus or ligament damage, which is considered a serious way of occurring joint injuries, is also possible.
This disease is extremely difficult for patients with severe symptoms of varicose veins. In this case, the patient is told to consult a phlebologist.
A high risk of developing this pathology also exists in people who:
- have previously suffered from various types of arthritis;
- have unfavorable inheritance;
- have problems with the ligament apparatus;
- suffer from metabolic disorders;
- have suffered traumatic brain injury;
- were injured in an accident;
- had spinal cord injuries.
Many of these factors are often closely related. An accurate determination of the cause helps in establishing an accurate diagnosis and description of the patient for correct and effective treatment for osteoarthritis of the knee joints.
Clinical manifestations
Symptoms of gonarthrosis do not manifest immediately - they begin to appear gradually, depending on the stage of the disease. Therefore, the clinical picture should be considered in stages.
The first phase
In the initial stage of disease development, patients complain of mild pain in the knee area, which increases with physical exertion. They become particularly intense during the descent and ascent of stairs.
In addition to pain, the patient feels a certain stiffness of movements, "tightening" in the joint area. It is felt in the popliteal region, and passes when the knee muscles are relaxed.
Another characteristic feature is the so-called "initial pain syndrome". It develops in the first steps of the patient. When the knees become accustomed to the load, this anomaly disappears without a trace.
The second phase
At this time, the symptoms of osteoarthritis of the knee joints become more intense and noticeable. The pain intensifies, causing considerable difficulty and discomfort when walking. The pain syndrome disappears after a long rest, but with an intense exertion it again makes itself felt.
Inflammation of the wrist causes swelling of the knee that is visible even to the naked eye. There is a strong, uncomfortable crisis when you walk. Movements become heavier and more restricted.
Third Phase
The pain becomes very severe and the patient can not do without pain medication. 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 these signs of knee osteoarthritis should not be ignored by the patient. The disease can put a person in a hospital bed for a long time, and sometimes leads to disability.
Which doctor treats knee gonarthrosis?
To diagnose and treat knee gonarthrosis, it is necessary to visit an orthopedic traumatologist. If surgery is needed, you may need the help of a surgeon.
Diagnostic measures
In order to determine the cause of the disease, an integrated approach to patient examination is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination of the orthopedist and taking the anamnesis. The doctor determines if the patient has symptoms of acute osteoarthritis of the knee, touches the affected area of the foot, measures the bone, and performs angiometry - a test that can be used to assess joint mobility at different angles.
- Clinical blood test for ESR assessment.
- Blood biochemistry.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common examination methods for osteoarthritis. However, in the initial stages, the picture does not show any change - they can be observed only in the later stages of development. Radiography shows a narrowing of the joint cavity, sclerotic changes in the cartilage area, bone tissue damage, and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, complete examination results can be achieved if ultrasound is performed in conjunction with radiography.
- MRI allows you to thoroughly 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 major drawback - the procedure is quite expensive. But its high accuracy contributes to the formulation of the correct diagnosis 99, 9%.
Treatment
Treatment of acute knee osteoarthritis, as well as its diagnosis, requires an integrated approach. But, first of all, it is necessary to apply drug therapy, because the diseased joint can become inflamed at any time.
Medications
How to treat knee joint gonarthrosis with pharmacy medication, and which medications to choose? Only a traumatologist means about that. Often, drugs of the following groups are included in the therapy regimen:
- Non-steroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously damage the gastrointestinal tract, so they can not be used for a long time. The same can not be said for COX-2 group drugs, which are milder. They are administered intramuscularly or intravenously.
- Treatment of knee osteoarthritis also involves the use of hormonal medications. They help relieve inflammation and swelling in the knee. Their use is advisable if there is synovitis (inflammation in the synovial membrane).
- Treatment with chondroprotectors.
- Application of oils, gels, creams. They improve blood circulation, warm, relieve swelling and inflammation.
Method One
How to cure knee osteoarthritis using this technique? The main elements of the therapy scheme are:
- use of medicines (NSAIDs, chondroprotectants, pain relievers, ointments, creams, gels);
- light physiotherapy exercises;
- manual therapy;
- physiotherapy;
- heating anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in osteoarthritis. Due to a properly developed diet and the use of all the above techniques, you can achieve amazing results from therapy in the shortest time possible.
Method two
Often the treatment of knee osteoarthritis, like other joint pathologies, is performed using this method.
The development of a famous doctor is based on the application:
- medicine;
- surgical intervention;
- adhering to a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, going to the sauna and doing a massage. This will help improve the patient's health, especially if the disease has been ignored for a long time and left untreated.
Treatment according to the third method
Treatment of knee joint gonarthrosis using this technique completely eliminates dynamic loads, as they can significantly accelerate the deformation process. Exercise should be slow, with low amplitudes.
Example: sit in a chair "upstairs", that is, turning from the back. Spread your legs wide, but do not let them touch the floor. Gently shake 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 - surgery. There are several types of knee arthrosis surgery:
- Removal of deformed cartilage and diseased joint (arthrodesis). Extremely it is extremely rare.
- Removal of damaged cartilage tissue without removing the joint. This 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.
- Sawing and securing the diseased wrist at another angle. This is called a periarticular osteotomy. The technique is quite complicated, but makes it possible to forget the pathology for 3-5 years.
Surgical intervention is rarely used and only in the absence of a method that cures the disease, for at least 1-2 years. In the early stages of the disease, surgery is almost never performed.
Endoprosthetics
Endoprosthetics are considered the most common treatment for gonarthrosis. This 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. In addition, this can lead to quite serious consequences.The "real" patient site is planted with an artificial joint, which can serve for 20 years. Although, of course, everything depends on the material from which it is made. The procedure is not cheap, but quite effective, so 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 doing the exercises are the same for all cases:
- avoid intense stress on the knee joint;
- immediate and forced movements are prohibited;
- Do not perform exercises that require full load on the injured joint.
Allowed Exercises:
- Slight shaking of the legs while kneeling on a blanket lying on the floor;
- regular kneeling movements in the same position;
- in the same position, straighten your legs alternately, trying not to pull your 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 remission gonarthrosis. Among the most effective techniques, it should be noted:
- electrophoresis with medical solutions;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent a recurrence of the disease, physiotherapy courses should be taken at least twice a year. This will help prolong the forgiveness phase.
Massage
Knee massage is performed to improve blood circulation. It is performed along the lymphatic flow in the direction from the peripheral area to the central area. The popliteal fossa is not involved in this process.
Often, along with a massage, manual therapy sessions are performed, aimed at the gradual extension of the diseased joints. Such procedures stabilize the patient's condition, but can only be performed by a specialist.
Is gonarthrosis completely cured?
Is it possible to completely cure knee osteoarthritis? Probably no one, not even the most experienced traumatologist, will be able to give a clear 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 joint deformity.
However, if a pathology is found in the final stages, then even surgical intervention does not guarantee the complete disappearance of the unpleasant symptoms. Surgery helps cure for only a few years, after which the disease can still recall itself.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- exercise continuously (squatting, running, raising and lowering legs);
- enrich your diet with foods high in vitamins;
- restrict the use of salt, hot, fried, smoked, sweet spices;
- maintaining a normal physical shape;
- immediate medical attention in case of minor knee injuries;
- prophylactic use of chondroprotectors after reaching the age of 35;
- daily water intake (2 liters).
By following these simple recommendations, you will reliably protect yourself from osteoarthritis of the knee joints as well as other diseases that can reduce your quality of life for a long time.