A disease of non-infectious origin, in which, first of all, the hyaline cartilage of the knee joint suffers, which eventually collapses and ceases to perform its function, which further leads to destruction in other components of the joint and leads to its deformation.
This degenerative-dystrophic disease, as a rule, occurs in women after the age of 40, but men can also suffer, especially those who are overweight, prone to frequent hypothermia, involved in sports activities or due to an injury.
Of all osteoarthritis, knee joint gonarthrosis is the most common.
It is believed that the cause of gonarthrosis is the deposition of salts in the joint. This opinion is absolutely wrong, and the deposition of salts is rather a secondary process and causes pain during the development of the disease and is localized at the points of attachment of the tendons and ligaments. Prevention plays an important role in disease prevention.
Anatomy of the knee joint
The knee joint consists of two surfaces, which are formed by the tibia and the femur. Anteriorly, the knee joint protects the patella, which moves between the condyles of the femur. The fibula does not participate in the formation of the knee joint and, in essence, does not carry any functional load, so it is often used to rebuild other bone elements in the body.
All articular surfaces: tibia, femur and the inner surface of the patella are lined with hyaline cartilage, which has a very smooth texture, has a high degree of strength and elasticity, the thickness of this dense and elastic structure reaches 5-6 mm . Cartilage absorbs cushioning during physical activity, prevents friction and softens impacts.
Classification of gonarthrosis
From the point of view of origin, gonarthrosis can be classified into primary, manifestation, which occurs without injury and secondary development, which is provoked by trauma, disease or developmental pathology and often occurs one-sided. In this case, the first type of gonarthrosis, as a rule, occurs in the elderly and is rarely one-sided.
In its development, osteoarthritis of the knee joint goes through the following stages:
- The first stage of gonarthrosis- does not cause significant suffering to the patient, is characterized by intermittent pain or stiffening pain, especially after intense physical exercise, or direct load on the knee joint. The so-called symptom of "initial pain" appears, when the patient abruptly stands up, painful sensations arise, which gradually disappear, but if a greater load is applied to the limb, the pain resumes. There may be a slight swelling that goes away on its own. Rarely, but occurs, synovitis - fluid accumulates in the knee joint bag, as a result of which the knee area becomes spherical and swollen, limb movements are limited. At this stage, there is still no deformation of the joint.
- Second phase- the patient begins to be disturbed by long and rather strong pains on the front and inner side of the joint, even with small loads, but after a long rest they usually disappear. When the joint moves, a creak is heard, if the patient tries to bend the limb as much as possible, severe pain appears. The range of motion of the joint is limited and deformation begins to be detected. Synovitis occurs frequently, disturbs for a longer time, proceeds with a large accumulation of fluid in the joint.
- Third stage- causes considerable suffering to the patient, the pain is constant and disturbs not only during walking, but also during rest and even at night, preventing sleep. The joint is already noticeably deformed, the position of the limb becomes X-shaped or O. A swaying gait appears, and often, due to significant deformation, a person can not only bend, but also fully straighten the leg , due to which he has to use a cane or even crutches to walk.
Pathology of gonarthrosis of the knee joint
- In the first initial stage of gonarthrosis, due to the development of a pathological process in the vessels supplying intraosseous hyaline cartilage, the articular surfaces gradually lose their intrinsic characteristics. They begin to dry out, lose their smooth texture, cracks appear, as a result of which the sliding of the joint surfaces is disturbed, they begin to cling to each other, increasing the defects on the surface. Hyaline cartilage degenerates, losing its cushioning function due to continuous microtraumas.
- In the second phase of gonarthrosis, degenerative-dystrophic manifestations increase: the joint space narrows, the joint surfaces flatten, adapting to increasing loads. The part of the bone adjacent to the hyaline cartilage of the joint becomes denser, and osteophytes appear along the edges of it, in the form of bone growth resembling the shape of spikes. The capsule of the knee joint also undergoes changes, losing its elasticity. The fluid inside the joint becomes denser and more viscous, changing its nutritional and lubricating properties, which further compromises joint function. Due to malnutrition, the state of the hyaline cartilage is further aggravated, it begins to disintegrate and in some places it completely disappears. As a result of increased friction, degeneration of the knee joint progressively increases, leading to the third stage of gonarthrosis.
- At the third stage of gonarthrosis, pronounced limitation of the range of motion of the joint occurs. The surfaces are noticeably deformed, hyaline cartilage is practically absent, the bones seem pressed into each other.
Reasons for the development of gonarthrosis
Basically, it is impossible to determine any cause of gonarthrosis. Basically, its occurrence is due to a combination of a number of reasons and a variety of internal and external factors.
In 20-30% of cases, gonarthrosis is caused by traumatic injuries of the knee joints or their components (ligaments, tendons, menisci), as well as fractures of the femur or tibia. The disease manifests itself, as a rule, 3-5 years after the injury. But there were cases of the development of gonarthrosis in the first period (2-3 months).
In some patients, gonarthrosis can be triggered by high physical exertion. Often, active physical activity can cause illness, especially after the age of 40, when people begin actively exercising to maintain health and realize the need for a healthy lifestyle. Most importantly, the load on the joints is during running, as well as jumping and squatting.
Excessive weight can also lead to the occurrence of gonarthrosis, especially in combination with varicose veins of the lower extremities. The load on the knee joints increases and microtrauma or even severe injuries of the menisci or ligament apparatus of the joint occur. In this case, healing is much more difficult, because. it is impossible to quickly lose excess weight in order to lighten the load on the joint.
Various types of arthritis (gouty, psoriatic, rheumatoid, reactive or Bechterew's disease), some neurological pathologies (spinal injuries, craniocerebral injuries and other diseases that occur with impaired innervation of the lower limbs), as well as hereditary diseases, can cause development of gonarthrosis causing weakness of the connective tissue.
Diagnosis of gonarthrosis
In order for the patient to be diagnosed with gonarthrosis, a combination of collecting complaints, examination and radiographic studies is required.
Today, an X-ray image of a joint is the simplest and most easily accessible method of research, with the help of which it is possible to diagnose a patient with a sufficient degree of accuracy, observe the development of the process in dynamics and determine the tactics of further treatment. Among other things, radiography allows to make a differentiated diagnosis, for example to exclude a tumor process in the bone tissue of the thigh or lower leg or inflammatory. Also, for the diagnosis of gonarthrosis, computed tomography and magnetic resonance imaging are used, which can show changes not only in bone structures, but also in soft tissues.
In old age, everyone has some signs of gonarthrosis, so the diagnosis can be made only after a complete collection of anamnestic data, complaints and visual examination, as well as instrumental research methods.
Treatment of gonarthrosis of the knee joint
When the first signs of a disease of the knee joint appear, it is necessary to consult an orthopedic doctor as soon as possible. At the initial stage of the process, the doctor prescribes drug therapy and the complete rest of the affected limb.
After the acute period has subsided, it is possible to appoint:
- physical therapy course,
- massage,
- as well as physiotherapeutic procedures (electrophoresis with analgesics, UHF therapy, magnetic or laser therapy, phonophoresis with anti-inflammatory steroids, mud baths, etc. )
At the next stage of treatment, the doctor may prescribe drug therapy, which involves taking chondroprotectors that stimulate metabolic processes in the joint. Sometimes intra-articular injections with hormone-containing drugs are needed. If the patient has the opportunity to receive sanatorium and spa treatment, he is recommended. Often, to unload the joint, the patient is advised to use a cane when walking. Special orthopedic insoles or orthoses can be used for prevention.
If the patient is diagnosed with the third stage of gonarthrosis, in which its manifestations are more pronounced (pain, impairment or complete lack of functioning of the joint), surgical treatment may be required, which consists of knee arthroplasty. Rehabilitation measures until the complete restoration of joint function, as a rule, takes from 3 to 6 months, after which the patient can return to a normal life.
Prevention
In order to avoid degenerative-destructive changes in the knee joint with age, it is necessary to resort to physical education, wear orthopedic shoes, control body weight and monitor the rest and exercise regime.