The knee joint experiences regular stress. Running and jumping, walking and climbing stairs or simply standing all affect the condition of the cartilage tissue in the knee. If the balance of the cartilage is disturbed, the development of osteoarthritis of the knee joint - gonarthrosis - begins.
Gonarthrosis is osteoarthritis that deforms the knee joint, which is accompanied by chronic damage to the surfaces of hyaline cartilage, as well as bones - the femur and tibia. Symptoms of knee joint disease are pain that worsens with movement. Due to fluid accumulation, movement is limited. Later, there is a limitation of knee movements due to a violation of leg support. The diagnosis of pathology is based on collecting the patient's anamnesis and complaints, the results of a visual examination and hardware examinations of the knee joint. Such age-related disorders of the musculoskeletal system appear in almost all elderly people.
general informations
Gonarthrosis (from the Latin genus articulatio - knee joint) is the most common osteoarthritis, which is a progressive degenerative-dystrophic lesion of the cartilage of the knee joint of a non-inflammatory nature. Women and the elderly generally suffer from knee osteoarthritis. But after injuries during intense sports, knee osteoarthritis occurs even in young people.
The cause of osteoarthritis lies in a change in the structure of the cartilage inside the joint, and not in the deposition of salts there. With gonarthrosis, salt deposits form where the tendons are attached to the ligamentous apparatus, but they cannot cause painful symptoms. First, cracks appear in the cartilage, which reduces the thickness in certain places. Gradually, the load is redistributed, the joint begins to come into contact with the bones, accelerating the painful process. As a result, the following changes occur in the knee joint:
- thinning of the knee cartilage until it disappears;
- changes in the composition and quantity of synovial fluid;
- damage to knee bones from friction;
- the appearance of osteophytes;
- stiffness due to compaction of the joint capsule;
- muscle spasm.
As a result, the knee joint becomes deformed, its mobility is limited, which can lead to disability and loss of working capacity.
Osteoarthritis of the knee joint can be unilateral and affect only one knee of the right or left leg; In case of bilateral osteoarthritis, both knee joints are affected.
Symptoms of osteoarthritis of the knee joint
The symptoms of knee osteoarthritis can be very different:
- At first, slight discomfort appears when climbing stairs, then the pain syndrome worsens and torments even at rest;
- stiffness occurs in the morning, it lasts a few minutes at first, then it can last up to half an hour;
- a sharp crunch occurs, which is accompanied by pain already at the second degree of damage;
- mobility is limited, it is difficult to bend and straighten the knee due to pain, bone friction and growth of osteophytes; the joint can become blocked in the later stages (ankylosis);
- unstable gait due to muscle atrophy (reduction in muscle volume);
- deformation of the knee joint due to the growth of bones and changes in their shape, the appearance of an inflammatory process in the muscles and ligaments increases swelling around the tissues of the joint;
- lameness resulting from progression of knee joint disease; in later stages the patient is forced to walk even with a walker.
Osteoarthritis disease begins gradually. In the 1st stage of knee osteoarthritis, patients experience mild sensations of stiffness and pain that occur when going up or down stairs. Possible tightening of the area below the knee. The initial painful sensations that arise while sitting at the beginning of the ascent are characteristic. When the patient moves away, the pain diminishes, but with effort it reappears.
There are no external changes to the knee. Sometimes swelling and the development of synovitis are possible - accumulation of fluid with hypertrophy, swelling of the joint, while heaviness is felt and movements are limited.
In stage 2, severe pain occurs during prolonged exercise and becomes worse when walking. The pain is usually localized along the anterior surface of the joint. After rest, the pain disappears, but during movement it reappears.
As osteoarthritis progresses, the number of movements of the knee joint decreases; when you try to bend your leg as much as possible, pain and a sharp sharp sharp crunch appear. The configuration changes, the joint enlarges. Synovitis appears with even greater accumulation of fluid.
In stage 3, the pain becomes constant and bothers not only when walking, but also when resting. Painful sensations appear even at night; To fall asleep, patients take a long time to find the position of their leg. Flexion and extension of the joint are limited. Sometimes the patient cannot straighten the leg completely. The joint is enlarged and deformed. Sometimes valgus deformity of the legs occurs in patients; they take the shape of an X or an O. Due to the deformity of the legs and limited movements, the patients' gait becomes unstable and waddles. In severe cases of knee osteoarthritis, patients move around using crutches.
Causes of osteoarthritis of the knee joint
Most cases of osteoarthritis occur for several reasons. These factors include:
- Injuries.25% of knee osteoarthritis are due to injuries: meniscal lesions, ligament ruptures. Gonarthrosis usually occurs three to five years after the injury, sometimes the disease can develop earlier - after two to three months.
- Physical exercise.Often, gonarthrosis occurs after forty years due to professional sports and excessive physical stress on the knee joint, which leads to the development of degenerative-dystrophic changes. Fast running and intense squats are particularly dangerous for the joints.
- Overweight.Excess weight significantly increases the load on the knee joints, causing injuries. Gonarthrosis is particularly difficult in cases of metabolic disorders and varicose veins.
- Sedentary lifestyle.
The process of development of gonarthrosis increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is a genetic weakness of the ligaments and an alteration of innervation in neurological diseases.
Pathogenesis
The knee joint is formed by the surfaces of the femur and tibia. In front of the surface of the knee joint is the patella. It slides as it moves between the grooves of the femur. The articular surfaces of the tibia and femur are covered with very strong, smooth and elastic hyaline cartilage up to six mm thick. During movement, cartilage reduces friction and acts as a shock absorber.
There are 4 stages of osteoarthritis:
- 1st step. There is a disruption of blood circulation in the vessels that supply the hyaline cartilage. Its surface becomes dry and small cracks appear on it, the cartilage gradually loses its softness, the cartilage tissue becomes thinner and, instead of sliding smoothly, clings, losing its shock-absorbing quality. There are no visual symptoms of osteoarthritis, the x-ray shows a slight deviation.
- 2nd step.Changes occur in the structure of the bones and the joint area is flattened to support greater loads. The part of the bone located under the cartilage becomes denser. Along the edges of the joint, manifestations of initial calcification of the ligaments appear - osteophytes that look like spikes on an x-ray; a narrowing of the space in the joint is also visible. The synovial capsule of the joint degenerates and wrinkles. The fluid in the joint thickens, its viscosity increases and its lubricating properties deteriorate. The process of cartilage degeneration accelerates, it becomes thinner, and in some places it disappears completely. After its disappearance, friction in the joint increases and degeneration progresses sharply. Patients experience pain during exercise, climbing stairs, squatting, and standing for a long time.
- 3rd step.X-rays show a noticeable, sometimes asymmetrical, narrowing of the joint space. Due to the deformation of the meniscus, the bones become distorted and press against each other. Movement in the joint is limited due to the large number of large osteophytes. There is no cartilaginous tissue. Constant pain haunts the patient at rest, it is impossible to walk without support.
- 4th step.Movements of the knee joint are impossible; X-rays show complete deformation of the cartilage and destruction of the articular bones, many osteophytes and the bones can fuse with each other.
Classification
Taking into account the pathogenesis of the disease, two types are distinguished: primary gonarthrosis – idiopathic and secondary. Primary vaccination occurs without injury, usually in elderly patients and is bilateral. The secondary develops as a result of diseases and developmental disorders or against the background of injuries to the knee joint. It can occur at any age and is usually unilateral.
Diagnostic
The diagnosis of joint osteoarthritis is carried out by an orthopedist or traumatologist in a medical clinic.
- The appointment begins with collecting anamnesis - the main complaints and symptoms that worry the patient. The doctor finds out about complaints, the presence of chronic diseases, previous injuries, fractures and injuries, and asks additional questions.
- On examination, the characteristics of joint mobility, deformation and pain are revealed. At stage 1 of knee osteoarthritis, the patient does not have any external changes. In the 2nd and 3rd stages, deformation and enlargement of joint contours, limitation of movements and curvature of the legs are detected. When the kneecap moves, a sharp cracking sound is heard. On palpation, the doctor detects pain in the inner part of the joint space. The joint may increase in size. Swelling of the joint is detected. When palpating the joint, a fluctuation is felt.
- The patient is referred for laboratory tests. During a general blood test, inflammation is detected, while a biochemical test reveals possible causes of problems.
- Then an instrumental diagnosis of the patient is required. X-rays are used for this. X-ray is a diagnostic method that can detect signs of knee osteoarthritis: narrowing of the joint gap, osteophytes and bone deformities. Radiography of the joint is a technique that clarifies the diagnosis of pathological changes and dynamics of osteoarthritis. At the beginning of knee osteoarthritis, changes are not visible on x-rays. Subsequently, narrowing of the joint space and compaction of the subchondral zone are determined. Knee osteoarthritis can only be diagnosed with x-rays and clinical tests.
- Nowadays, in addition to radiography, to diagnose osteoarthritis, computed tomography (CT) is used, which allows us to study bone changes in detail, as well as magnetic resonance imaging (MRI), which allows us toVisually assess the condition of the joint and is used to identify changes in muscle tissue and ligaments.
- During an ultrasound (ultrasound), the condition of the tendons, muscles and joint capsule is assessed.
- Fluid is drained from the affected joint to allow the insertion of a camera to view the inside of the joint (arthroscopy).
If necessary, the doctor prescribes additional studies and consultations with more specialized specialists.
Treatment of osteoarthritis of the knee joint
Osteoarthritis treatments can be divided into three groups:
- medicinal;
- physiotherapy;
- surgical.
Osteoarthritis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins at an early stage. When osteoarthritis worsens, doctors recommend maximum rest for the joint. Patients are prescribed the necessary procedures: exercise therapy, massage, mud therapy.
When a patient is diagnosed with stage 1 and 2 disease, medications and physical therapy are used; if the lesion is extensive, then surgery and surgical intervention are used.
Medical treatment
Proper administration of medications can stop pain and inflammation, as well as slow down the process of cartilage tissue destruction. It is therefore important to consult a doctor quickly.
Important - do not self-medicate. The wrong medications, chosen independently and without consulting a doctor, can only aggravate the situation and lead to serious complications.
Drug treatment of osteoarthritis includes taking the following medications:
- anti-inflammatory:relieve inflammation and relieve pain in the joint;
- hormonal:prescribed when anti-inflammatories are ineffective;
- antispasmodics:help get rid of muscle spasms and alleviate the patient’s condition;
- chondroprotectors:improve metabolic processes in the joint and help restore joint function, as well as drugs that replace synovial fluid;
- drugs to improve microcirculation:improve nutrition and oxygen supply.
Depending on each specific situation, tablets, intra-articular injections of steroid hormones and local forms of drugs are used. The selection of drugs is carried out by the attending physician. Sometimes a patient suffering from osteoarthritis is sent for treatment to a sanatorium and is recommended to walk with crutches or a cane. To relieve the load on the knee joint, individual orthotics or special insoles are used.
Additionally, complex non-drug methods are used to treat osteoarthritis:
- physiotherapy (physiotherapy)which is carried out under the supervision of a specialist;
- massage classin the absence of an inflammatory process;
- osteopathic effectin the treatment of osteoarthritis, which is aimed not only at the affected area, but also at restoring the resources of the entire organism, since the pathological process occurring locally in the joint area is the result of numerous processes occurring in thewhole body. During the osteopathy session, work is carried out on the musculoskeletal system as a whole in order to obtain maximum restoration of the innervation and mobility of the spine, pelvic bones, sacrum andeliminate compression of nerves and blood vessels throughout the body!
Physiotherapy
Physiotherapeutic methods are used to improve blood circulation in the joint, increase its mobility and enhance the medicinal effect of drugs. The doctor may prescribe the following procedures:
- Shock wave therapy:ultrasound eliminates osteophytes;
- magnetotherapy:the magnetic field affects metabolic processes and stimulates regeneration;
- laser therapy:deep tissue laser heating;
- electrotherapy (myostimulation):electric shock to muscles;
- electrophoresis or phonophoresis:administration of chondroprotectors and analgesics using ultrasound and electric current;
- Ozone therapy:injection of gas into the joint cavity.
Surgery
Even with correctly selected treatment, in some cases treatment methods are ineffective. Then the patient suffering from severe pain syndrome is prescribed surgical treatment and operations for osteoarthritis of the knee:
- stents:replacement of the entire joint with a prosthesis;
- arthrodesis:fixation between bones for their immobility, to reduce pain and give a person the opportunity to lean on the leg;
- osteotomy:cutting a bone to place it at an angle in the joint to reduce stress.
If stent replacement is not possible, then arthrodesis and osteotomy are used.
Prevention
Preventive measures and compliance with doctor's recommendations play an important role in the occurrence of knee osteoarthritis. To slow down the processes of joint degeneration, it is important to follow the rules:
- practicing a particular physical activity: physiotherapy and gymnastics without unnecessary joint loads;
- avoid strenuous physical activity;
- choose comfortable orthopedic shoes;
- Monitor your weight and daily routine - alternate special exercises and rest times.
Diet
The condition of the affected cartilage largely depends on nutrition. In case of osteoarthritis, you must exclude:
- soft drinks;
- alcoholic beverages;
- fatty and spicy foods;
- canned and semi-finished products;
- products containing colorings, preservatives, artificial flavors.
The diet should contain: proteins, fatty acids, for example omega-3, collagen, which is contained in gelatin. It is necessary to eat without increasing body weight.
Consequences and complications
Osteoarthritis of the knee joints develops slowly, but if left untreated, serious complications occur:
- joint deformation and change in the overall configuration of the knee due to muscle restructuring and curvature of the bony framework;
- shortening of the lower limbs;
- ankylosis – complete immobilization of the knee joint;
- damage to the musculoskeletal system.