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 the destruction of other components ofthe joint and leads to its deformation.
This degenerative-dystrophic disease usually occurs in women after 40 years, but men can also suffer from it, especially those who are overweight, prone to frequent hypothermia, involved in active sports or due to injury.
Among 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.
Knee Joint Anatomy
The knee joint consists of two surfaces formed by the tibia and the femur. Forward, the knee joint protects the patella, which moves between the condyles of the femur. The fibula does not take part in the formation of the knee joint and, in essence, does not carry any functional load, due to which it is often used to reconstruct other bone elements in the body.
All articular surfaces: the tibia, femur and the inner surface of the patella are lined with hyaline cartilage, very smooth in texture, with a high degree of strength and elasticity, the thickness of this dense and elastic structure reaches5-6mm. Cartilage absorbs cushioning during physical activity, preventing friction and softening impacts.
Classification of knee osteoarthritis
From the point of view of origin, gonarthrosis can be classified as primary, a manifestation that occurs without injury and secondary development, which is caused by trauma, disease or developmental pathology and often occurs unilaterally. In this case, the first type of gonarthrosis usually occurs in older people and is rarely unilateral.
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 tightness, especially after intense physical exercise, or a direct load on the knee joint. The so-called "starting pain" symptom appears, when the patient stands up sharply, painful sensations appear, which gradually disappear, but if an increased load is applied to the limb, the pain resumes. There may be slight swelling that goes away on its own. Rarely, but it does happen, synovitis - fluid accumulates in the knee joint bag, due to which the knee area becomes spherical and swollen, limb movements are restricted. At this stage, there is still no deformation of the joint.
- Second step- the patient begins to be disturbed by long and rather severe pains in the anterior 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, sharp pain appears, the range of motion of the joint is limited, and the deformation begins to be detected. Synovitis occurs frequently, disturbs longer, leads to a large accumulation of fluid in the joint.
- Third step- 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 significantly deformed, the position of the limb becomes X-shaped or O-shaped. A waddling gait appears, and often, due to severe deformation, a person can not only bend, but completely unbend his leg, following which she has to use a cane or even crutches to walk.
Pathology of gonarthrosis of the knee joint
- At the first initial stage of gonarthrosis, due to the development of a pathological process in the vessels supplying the intraosseous hyaline cartilage, the articular surfaces gradually lose their inherent characteristics. They begin to dry out, lose their smooth texture, cracks appear, due to which the sliding of the articular surfaces is disturbed, they begin to cling to each other, increasing defects on the surface. Hyaline cartilage degenerates, losing its shock-absorbing function due to constant microtrauma.
- At the second stage of gonarthrosis, degenerative-dystrophic manifestations increase: the joint space narrows, the articular surfaces flatten, adapting to increasing loads. The part of the bone adjacent to the hyaline cartilage of the joint becomes more dense, and osteophytes appear along its edges, in the form of a spike-like growth of bone tissue. The capsule of the knee joint also undergoes changes, losing its elasticity. The fluid inside the joint becomes thicker and more viscous, changing its nutritional and lubricating properties, further impairing joint function. Due to malnutrition, the condition of hyaline cartilage is further aggravated, it begins to disintegrate and in some places completely disappears. Due to the increased friction, the degeneration of the knee joint gradually increases, which leads to the third stage of gonarthrosis.
- In the third stage of gonarthrosis, a pronounced limitation of the range of motion in the joint occurs. The surfaces are significantly deformed, the hyaline cartilage is practically absent, the bones seem to be pressed against each other.
Reasons for the development of gonarthrosis
In essence, it is impossible to determine a single cause of gonarthrosis. Basically, its appearance 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 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 manifests itself, as a rule, 3-5 years after the injury. But there were cases of the development of gonarthrosis at the beginning of the period (2-3 months).
In some patients, knee osteoarthritis can be triggered by intense physical exertion. Often, active physical activity can cause disease, especially after 40, when people begin to exercise actively to maintain health and realize the need for a healthy lifestyle. Most of all, the load on the joints is when 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 limbs. The load on the knee joints increases, and microtraumas or even serious injuries of the menisci or the ligamentous 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 ashereditary diseases, can cause the development of knee osteoarthritis causing connective tissue weakness.
Diagnosis of gonarthrosis
In order for the patient to be diagnosed with gonarthrosis, a combination of collecting complaints, examinations and X-ray studies is necessary.
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, to observe theevolution of the process in dynamics and to determine the tactics of further processing. Among other things, x-ray allows you 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 full collection of anamnestic data, complaints and visual examinations, 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 orthopedist as soon as possible. At the initial stage of the process, the doctor prescribes drug therapy and complete rest of the affected limb.
After the end of the acute period, it is possible to appoint:
- exercise therapy classes,
- massage,
- as well as physiotherapy procedures (electrophoresis with analgesics, UHF therapy, magnetic or laser therapy, phonophoresis with anti-inflammatory steroids, mud therapy, etc. )
At the next stage of treatment, the doctor can prescribe drug therapy, which consists of taking chondroprotectors that stimulate metabolic processes in the joint. Sometimes intra-articular injections of drugs containing hormones are necessary. If the patient has the opportunity to receive sanatorium and spa treatment, then this is recommended. Often, to unload the joint, the patient is recommended to use a cane when walking. You can use special orthopedic insoles or braces for prevention.
If the patient is diagnosed with the third stage of gonarthrosis, in which its manifestations are most pronounced (pain, impairment or complete lack of functioning of the joint), surgical treatment may be required, which consists of knee arthroplasty. Rehabilitation measures until full recovery of joint function usually takes 3-6 months, after which the patient can return to 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 regime andof exercise.