Arthrosis (gonarthrosis) is a pathological change in the knee joint, which has a chronic course and can progress over time. The disease affects all components of the knee joint: cartilage, subchondral bone, menisci, joint membranes, ligaments, capsules and periarticular muscles.
The knee joint, which connects the femur and tibia, is exposed to a lot of stress throughout its life and is regularly injured. Sometimes minor injuries go unnoticed right away, but they make themselves felt in the second half of life. In this regard, joint damage is often seen in elderly people. However, young people also suffer from knee joint pathologies resulting from sports or an active lifestyle.
In order to maintain maximum mobility and a high standard of living, consult a doctor at the first problem with the 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 by cartilage tissue, which provides shock absorption, smooth gliding, and prevents the bones from rubbing against each other. Cartilage tissue receives nourishment thanks to the synovial fluid inside the joint and the blood flowing through the blood vessels.
Cartilage has a spongy structure, so it absorbs fluid when it is at rest and expels it during stress. At the same time, during movements, the cartilage constantly receives microtraumas, and it recovers during rest.
If the result of mechanical damage exceeds the joint's ability to repair itself, the cartilage does not receive enough nutrients and, as a result, regeneration does not take place. The damage accumulates and changes the structure of the cartilage tissue. This is how arthrosis of the knee joint begins.
Depending on the causes that cause it, arthrosis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
Degenerative changes occurring in the joint are age-related. Reasons for this include:
- natural degeneration or degradation due to the slowing down of metabolic processes in the body;
- excessive body weight;
- sedentary lifestyle;
- malnutrition;
- genetic predisposition.
As a general rule, primary gonarthrosis affects both knees at the same time and is called bilateral.
Secondary gonarthrosis
Secondary arthrosis of the knee joint can occur at any age, as it can be caused by:
- various injuries - bruises, fractures, dislocations, tears and sprains of ligaments or menisci;
- joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, gonitis, etc. ;
- regional vascular disorders;
- overloading of the knee joints during sports or due to the specifics of work;
- endocrine diseases;
- O- and X-shaped curvature of the legs.
Secondary arthrosis of the knee joint most often appears only on one leg and is called unilateral.
In rare cases, idiopathic gonarthrosis is identified - a disease that occurs for no apparent reason.
Stages and symptoms of arthrosis of the knee joint
Regardless of how arthrosis of the knee joint appeared, experts distinguish three stages of its development, which are determined during an X-ray examination. Each stage is accompanied by characteristic symptoms:
Section 1– mild pain that occurs after prolonged exertion, walking up stairs, after vigorous exercise, and disappears after rest. There are no movement restrictions, but sometimes subtle swelling of the joint may occur. This condition, if nothing is done, can last for years - in this case, the cartilage is just starting to lose its smoothness due to the impaired blood supply. The X-ray shows a slight narrowing of the joint space and hardening of the bones.
- Section 2– the pain becomes strong even with light exertion and lasts quite a long time. A creaking sound can be heard when bending and extending the joint. Due to the severe pain, it becomes impossible to fully bend the leg. Slight deformation, muscle atrophy and limited mobility are observed. The pain can be relieved with painkillers, or it will go away on its own after rest.
In this stage, the cartilaginous layer is already becoming very thin, in some places to the point of disappearing. The synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear - bone growth.
- Section 3– the pain increases and worries me constantly, even at night. The deformity of the joint becomes noticeable, the gait changes, the lower part of the limb bends. The range of motion of the knee joint decreases - the leg cannot be fully bent or straightened. When walking, you must use a support in the form of a stick or crutches. Painkillers no longer help.
The cartilage is almost completely erased, the bones are compressed, the joint space is strongly narrowed or absent. The presence of numerous osteophytes is observed.
One of the common symptoms of arthrosis of the knee joint can be identified - pain of varying intensity, which is localized along the front-inner surface of the joint.
Diagnostics
If you notice symptoms similar to the development of gonarthrosis, you should consult a doctor. During the first appointment, the doctor collects an anamnesis, examines the biomechanical capabilities of the joint, and prescribes the necessary tests. Be sure to inform him about the injuries and illnesses you have suffered, your lifestyle, diet, medications you are taking, and the characteristics of your work.
The most informative and simple way to confirm or refute the diagnosis is to take an X-ray of the knee joint - this allows you to perform a differential diagnosis, determine the extent of the development of arthrosis and monitor the treatment process.
However, radiological signs appear much later than morphological changes. Therefore, in the early stages, gonarthrosis is difficult to detect even on X-rays. In such situations, the doctor may prescribe arthroscopy - this is an extremely accurate method of diagnosing changes in the joints using special endoscopic equipment.
Additional research methods are ultrasound and MRI - they are prescribed when radiography 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 the pathology;
- restoring the functionality of the joints.
The specialist chooses a comprehensive solution that can be modified during the treatment process.
In modern medicine, there are many methods of treating joint diseases. All can be divided into three types: conservative, minimally invasive, surgical.
Conservative treatment of gonarthrosis
Generally, arthrosis of the knee joint is 1-2. used in sectionTreatment begins with reducing the load on the joint - the patient must avoid excessive vertical load on the joint: jumping, running, etc. Losing excess weight is recommended if necessary. The doctor recommends a diet and chooses a gentle exercise routine that reduces axial effects and improves cartilage tissue nutrition.
In order to improve blood circulation in the joint area, increase the range of motion, and increase the effect of drugs, physiotherapy is prescribed:
- shock wave therapy - short-term effect on bones and connective tissue with significant low-frequency acoustic impulses;
- electrotherapy - exposure of the affected area to electric current, magnetic or electromagnetic fields;
- laser therapy - exposure to optical radiation generated by a laser;
- phonophoresis - exposure of the affected area with ultrasound and medicine applied to the skin;
- electrophoresis - exposure of the affected area to electric current.
Massage, poultices, wearing an orthosis and kinesiotaping are also well proven in the treatment of arthrosis.
In addition, well-chosen drug therapy helps to relieve pain, stop inflammation and slow down the destruction of cartilage tissue. For this purpose, anti-inflammatory, hormonal drugs, antispasmodics and chondroprotectors are prescribed. Depending on the situation, they can be in tablet, injectable or topical form.
A minimally invasive method for the treatment of gonarthrosis
If the above procedures are ineffective, the doctor may prescribe intra-articular injections:
- Hyaluronic acid – as a substitute for synovial fluid, it improves friction, reduces pain and improves the functioning of the knee joint. The average duration of the drug's effect is 3-6 months;
- own plasma enriched with platelets - to nourish and restore cartilage tissue;
- corticosteroids – to reduce inflammation.
Surgical method for the treatment of gonarthrosis
If the conservative treatment proved to be ineffective, or if you first consulted a specialist in the third stage of arthrosis of the knee joint, the doctor may resort to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position in order to eliminate pain;
- arthroscopic debridement - joint disinfection using an arthroscope;
- corrective osteotomy – elimination of bone deformities by artificial fracture;
- endoprosthetics - replacement of the worn out joint with an implant artificially created from biologically compatible materials.
The type of surgery is selected by the doctor based on the characteristics of the arthrosis of the knee joint. But endoprosthesis is considered the gold standard, as it allows you to fully return to your normal lifestyle. At the same time, a good implant does not need to be replaced for 15-30 years. In order to fully recover after surgery, you must undergo a rehabilitation course lasting 3-4 months.
Complications
Gonarthrosis develops rather slowly, but it can be recognized in time and the necessary treatment can be started. Ignoring the disease and its symptoms can lead to serious consequences:
- persistent pain that is not relieved by medication;
- complete immobility of the diseased joint;
- inability to lean on the injured limb;
- severe joint deformation and curvature of the legs;
- damage to other parts of the musculoskeletal system;
- short for leg.
In particularly difficult situations and in the absence of timely treatment, arthrosis can lead to disability and deterioration of motor activity, even to immobility.
It is important to note that it is impossible to completely cure arthrosis. But it is quite possible to stop the progression of the disease and improve the quality of life.
Prevention
There is no preventive treatment for gonarthrosis. But people at risk must follow certain rules:
- ensure that your weight does not exceed the norm for your age;
- do not participate in sports that cause a strong load on the knee joint;
- if possible, it completely cures infectious diseases without causing complications;
- don't get cold or overworked;
- avoid injury and overload of the joint;
- avoid stressful situations;
- don't forget to rest;
- participate in exercise therapy;
- wear orthopedic shoes.
Groups at risk include the elderly, athletes and dancers. You can also include 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 limb or the normal biomechanics of the joint, dysplasia, loss of leg muscle volume and strength, or trauma can also lead to arthrosis.
Check regularly and take preventive measures.
Question answer
- What is the difference between knee osteoarthritis and knee osteoarthritis?
Arthritis is the collective term for joint inflammation, and arthrosis is a degenerative-dystrophic process.
- Which doctor treats arthrosis?
Traumatologist-orthopedic or rheumatologist.
- Is it possible to play sports with arthrosis of the knee joint?
Prolonged and strong loading of the joint, as well as axial impact, should be avoided. However, you should not completely exclude sports from your life - during exercise, the joints are better "fed" and restored. It is important to follow the measure and follow the recommendations of the doctor who chooses the type and method of training.