Arthrosis (gonarthrosis) is a pathological change in the knee joint that has a chronic course and can progress over time. The disease involves all components of the knee joint: cartilage, subchondral bone, menisci, synovial membranes, ligaments, capsules and periarticular muscles.
The knee joint, which connects the femur and tibia, is subjected to heavy loads throughout life and is regularly injured. Sometimes minor damage goes unnoticed immediately, but is felt in the second half of life. In this regard, joint damage is often found in the elderly. However, young people also suffer from pathologies of the knee joints as a result of sports or an active lifestyle.
To maintain maximum mobility and a high standard of living, you should 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 with cartilage tissue, which provides shock absorption, smooth sliding and also prevents the bones from rubbing against each other. Cartilage tissue receives nourishment thanks to the synovial fluid located inside the joint and the blood that flows through the vessels.
Cartilage has a spongy structure, so at rest it absorbs fluid, and when it is loaded, it displaces it. At the same time, during movements, the cartilage constantly receives microtraumas, and during rest it recovers.
If the result of the mechanical injury exceeds the restorative capacity of the joint, then there is not enough nutrition for the cartilage and, as a result, regeneration does not occur. The damage accumulates and changes the structure of the cartilage tissue. This is how arthrosis of the knee joint begins.
Depending on the reasons that caused 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. Among the reasons that cause it are the following:
- natural degeneration or degradation due to slowing down of metabolic processes in the body;
- overweight;
- sedentary way of life;
- malnutrition;
- genetic predisposition.
As a 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, gout, etc. ;
- regional vascular disorders;
- overloading of the knee joints during sports or due to the specifics of work;
- endocrine diseases;
- O-shaped and X-shaped curvature of the legs.
Secondary arthrosis of the knee joint most often occurs only on one leg and is called unilateral.
In rare cases, idiopathic gonarthrosis is found - a disease that occurs for no apparent reason.
Stages and symptoms of arthrosis of the knee joint
Regardless of how the 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:
Stage 1- mild pain that appears after prolonged exertion, when walking up stairs, after heavy physical exertion and disappears after rest. There are no restrictions on movement, but sometimes a slight swelling of the joint may occur. This condition, if nothing is done, can last for years - at that time the cartilage is just beginning to lose its smoothness due to impaired blood supply. The X-ray will show slight narrowing of the joint space and hardening of the bones.
- Stage 2– the pain becomes severe and lasts for quite a long time even with a slight effort. A crunch is heard when bending and extending the joint. It becomes impossible to fully bend the leg due to severe pain. There is mild deformity, muscle loss and limited movement. The pain may be relieved with painkillers or go away on its own after rest.
At this stage, the cartilage layer is already very thinned, in places to the point of disappearance. The synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear - bone growths.
- Stage 3– the pain increases and is constantly worrying, even at night. Deformation of the joint becomes noticeable, the gait changes, the lower part of the limb bends. The range of motion in the knee joint is reduced - the leg cannot be fully bent or straightened. When walking, you should use a support in the form of a stick or crutch. Painkillers no longer help.
The cartilage is almost completely obliterated, the bones are compacted, the joint space is greatly narrowed or absent. The presence of many osteophytes is noted.
One common symptom of arthrosis of the knee joint can be identified - pain of varying intensity localized on the front-inner surface of the joint.
Diagnosis
If you observe symptoms similar to the development of gonarthrosis, you should consult a doctor. At the initial appointment, the doctor will collect anamnesis, check the biomechanical capabilities of the joint and prescribe the necessary tests. Be sure to inform him about the injuries and illnesses suffered, lifestyle, diet, medications taken and job characteristics.
The most informative and simple way to confirm or refute the diagnosis is an X-ray examination of the knee joint - this allows you to carry out a differential diagnosis, determine the degree of development of arthrosis and monitor the treatment process.
However, radiological signs appear much later than morphological changes. That is why, in the early stages, gonarthrosis is difficult to detect even on an X-ray. In such situations, the doctor can prescribe arthroscopy - a highly accurate method for diagnosing changes in the joints using special endoscopic equipment.
Additional research methods are ultrasound and MRI - they are prescribed when radiography is not sufficiently informative.
Treatment of arthrosis of the knee joint
After the diagnosis, the doctor chooses 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;
- restoration of joint functionality.
The specialist chooses a comprehensive solution that can be adjusted during 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 treatment of gonarthrosis
It is usually used in stages 1-2 of arthrosis of the knee joint. Treatment begins with reducing the load on the joint - the patient must avoid excessive vertical load on the joint: jumping, running, etc. If necessary, weight loss is recommended. The doctor will recommend a diet and choose a light set of exercises that will reduce axial impacts and improve the nutrition of cartilage tissue.
Physiotherapy is prescribed to improve blood circulation in the joint area, increase the range of motion, as well as enhance the effect of drugs:
- shock wave therapy - short-term impact on bones and connective tissue with acoustic pulses of significant amplitude and low frequency;
- 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 electricity.
Massage, compresses, wearing a brace and kinesio taping have also been shown to be effective in the treatment of osteoarthritis.
In addition, well-chosen drug therapy helps 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, injectable or topical form, depending on the situation.
A minimally invasive method for the treatment of gonarthrosis
If the above procedures have no effect, the doctor can prescribe intra-articular injections:
- Hyaluronic acid – as a synovial fluid replacement to improve friction, reduce pain and improve knee joint function. The average duration of action of the drug is 3-6 months;
- own plasma enriched with platelets - for nutrition and restoration of cartilage tissue;
- corticosteroids - to reduce inflammation.
Surgical method of treatment of gonarthrosis
If the conservative treatment proved ineffective or you first turned to a specialist with the third stage of arthrosis of the knee joint, then the doctor may resort to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position to eliminate pain;
- arthroscopic debridement - rehabilitation of a joint using an arthroscope;
- corrective osteotomy - removal of bone deformities through an artificial fracture;
- endoprosthetics - replacement of a worn joint with an implant artificially created from biocompatible materials.
The type of surgery is chosen by the doctor based on the characteristics of the arthrosis of the knee joint. But endoprosthetics 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 require replacement for 15-30 years. For full recovery after surgery, it is necessary to undergo a rehabilitation course, which takes 3-4 months.
Complications
Gonarthrosis develops rather slowly, but it can be detected 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 deformation of the joint and twisting of the legs;
- damage to other parts of the musculoskeletal system;
- leg shortening.
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 remember 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 are advised to adhere to certain rules:
- make sure that your weight does not exceed the age norm;
- do not engage in sports that put a lot of stress on the knee joint;
- if possible, completely cure infectious diseases without causing complications;
- do not overcool or overwork;
- avoid injury and overloading of the joint;
- avoid stressful situations;
- do not forget about rest;
- participate in exercise therapy;
- wear orthopedic shoes.
Risk groups include the elderly, athletes and dancers. Here you can also add 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, reduction in volume and strength of the leg muscles or trauma can also lead to arthrosis.
Check yourself 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, 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 heavy loading of the joint, as well as axial impact, should be avoided. But you should not completely exclude sports from your life - when you move, your joints are "fed" and recover better. It is important to observe the measure and adhere to the recommendations of the doctor who will choose the type and mode of exercise.