A disease of non-infectious origin, in which the hyaline cartilage of the knee joint primarily suffers, which eventually collapses and ceases to perform its function, which further leads to the destruction of other joint components and leads to its deformation.
This degenerative dystrophic disease usually occurs in women after the age of 40, but men can also suffer from it, especially those who are overweight, prone to frequent hypothermia, actively participate in sports or due to injuries.
Of all osteoarthritis, gonarthrosis of the knee joint is the most common.
There is an opinion 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 tendons and ligaments. Prevention plays an important role in disease prevention.
Anatomy of the knee joint
The knee joint consists of two surfaces formed by the tibia and femur. In front, the knee joint protects the patella, which moves between the condyles of the femur. The fibula is not involved in the formation of the knee joint and essentially does not carry a 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. The cartilage absorbs the cushioning during physical activity, prevents friction and absorbs shock.
Classification of gonarthrosis
From the point of origin, osteoarthritis of the knee can be divided into a primary manifestation, which occurs without injury, and a secondary development, which is provoked by trauma, disease or developmental pathology and often occurs unilaterally. In this case, the first type of gonarthrosis, as a rule, occurs in the elderly and is rarely unilateral.
Arthrosis of the knee joint goes through the following stages in its development:
- The first stage of gonarthrosis- does not cause significant suffering to the patient, characterized by intermittent pain or aching pain, especially after heavy physical exertion or direct loading of the knee joint. The so-called symptom "initial pain" occurs when the patient gets up abruptly, painful sensations appear, which gradually disappear, but when an increased load is applied to the limb, the pain begins again. There may be a slight swelling, whichdisappears on its own. Rarely, but it happens that synovitis - fluid accumulates in the articular bag of the knee, as a result of which the knee area becomes spherical and swollen, movements in the limbs are restricted. At this stage there is still no deformation of the joint.
- Second floor- The patient begins to be bothered by long and rather severe pains in the front and inside of the joint, even with small loads, but after a long rest they usually disappear. When the joint moves, a crunch is heard, when the patient tries to bend the limb as much as possible, there is a sharp pain, the amplitude of movement of the joint is limited, and deformation is noted. Synovitis occurs often, bothers longer, proceeds with a large accumulation of fluid in the joint.
- Third section- causes significant suffering to the patient, the pain is constant and disturbs not only when walking, but also at rest and even at night, preventing sleep. The joint is already clearly deformed, the position of the limb becomes X or O-shaped. A waddling gait occurs, and often due to significant deformation, a person can not just bend his leg, but bend it completely, which requires the use of a cane or even crutches to walk.
Pathology of gonarthrosis of the knee joint
- In the initial first stage of gonarthrosis, due to the development of a pathological process in the vessels that feed the intraosseous hyaline cartilage, the articular surfaces gradually lose their inherent properties. They begin to dry out, lose their smooth texture, cracks appear, as a result of which the sliding of the articular surfaces is disrupted, they begin to stick to each other, increasing the defects on the surface. Hyaline cartilage degenerates and loses its shock-absorbing function from constant micro-trauma.
- In the second stage of gonarthrosis, degenerative-dystrophic manifestations increase: the joint space narrows, the articular surfaces flatten and adapt to increasing loads. The part of the bone adjacent to the hyaline cartilage of the joint becomes denser, and osteophytes appear at the edges in the form of growths of bone tissue, resembling spikes in shape. The capsule of the knee joint also changes and loses its elasticity. The fluid in the joint becomes thicker and more viscous, changing its nutritional and lubricating properties, further compromising joint function. Due to malnutrition, the condition of the hyaline cartilage continues to deteriorate, it begins to break down and in some places completely disappears. As a result of increased friction, the degeneration of the knee joint increases progressively, which leads to the third stage of gonarthrosis.
- In the third stage of gonarthrosis, there is a pronounced limitation of the range of motion in the joint. The surfaces are severely deformed, the hyaline cartilage is practically absent, the bones seem to be pressed into each other.
Reasons for the development of gonarthrosis
In essence, it is impossible to pinpoint a single cause of osteoarthritis of the knee. Basically, its occurrence is due to a combination of multiple reasons and a variety of internal and external factors.
In 20-30% of cases, gonarthrosis is provoked by traumatic injuries to the knee joints or their components (ligaments, tendons, menisci), as well as fractures of the femur or tibia. The disease usually manifests itself 3-5 years after the injury. But there were cases of development of gonarthrosis in the early stage (2-3 months).
In some patients, gonarthrosis can be triggered by high physical exertion. Often, active physical activity can provoke illness, especially after 40 years, when people begin to actively engage in sports to maintain their health and realize the need for a healthy lifestyle. The stress on the joints occurs primarily when running, jumping and squatting.
Obesity can also lead to the occurrence of gonarthrosis, especially in combination with varicose veins in the lower extremities. The load on the knee joints increases, microtraumas or even serious injuries to the menisci or the ligaments of the joint occur. In this case, healing is much more difficult because. It is impossible to lose excess weight quickly in order to relieve the joint.
Various types of arthritis (gout, psoriasis, rheumatoid, reactive or Bechterew's disease), some neurological pathologies (spinal injuries, craniocerebral injuries and other diseases that occur when there is impaired innervation of the lower extremities), as well as hereditary diseases can occur theProvoke development of gonarthrosis and cause connective tissue weakness.
Diagnosis of osteoarthritis of the knee
In order for the patient to be able to diagnose gonarthrosis, a combination of assessing symptoms, examination and X-ray examinations is necessary.
An x-ray of a joint today is the simplest and most accessible method of examination, with the help of which it is possible to diagnose a patient with sufficient accuracy, observe the development of the process in dynamics and determine the tactics of further treatment. Among other things, the X-ray enables you to make a differentiated diagnosis, for example to exclude a tumor process in the bone tissue of the upper or lower leg or an inflammation. Computed tomography and magnetic resonance imaging are also used to diagnose gonarthrosis, which can show changes not only in bone structures, but also in soft tissues.
In old age, everyone has certain signs of osteoarthritis of the knee, therefore the diagnosis can be made only after a full collection of anamnestic data, complaints and visual examination, as well as instrumental methods of research.
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 orthopedist as soon as possible. At the initial stage of the process, the doctor prescribes drug therapy and full recovery of the affected limb.
After the acute phase subsides, it is possible to appoint:
- exercise therapy course,
- Massage,
- as well as physiotherapeutic procedures (electrophoresis with analgesics, UHF therapy, magnet or laser therapy, phonophoresis with anti-inflammatory steroids, peat treatment, 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 required. If the patient has the opportunity to receive sanatorium and spa treatment, it is recommended to him. To relieve the joint, the patient is often advised to use a cane when walking. For prevention, you can use special orthopedic insoles or orthoses.
If the patient is diagnosed with the third stage of gonarthrosis, in which its manifestations are most pronounced (pain, limited or complete dysfunction of the joint), surgical treatment consisting in knee arthroplasty may be required. Rehabilitation measures until the joint function is fully restored usually last from 3 to 6 months, after which the patient can lead a normal life again.
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 regimen.