Osteoarthritis of the knee joint (gonarthrosis)is a progressive chronic disease of the knee joints with damage, thinning and destruction of their cartilaginous part (articular surfaces of the femur and tibia) as well as damage to the subchondral bone.Studies (arthroscopy and MRI) have shown that, in addition to the damage to the articular cartilage, the menisci and the synovial membrane are also involved in the process.Gonarthrosis is one of the most common orthopedic diseases.There are its synonyms: osteoarthritis (OA), deforming osteoarthritis.The disease represents an important socio-economic problem because it is widespread and, due to constant pain, significantly worsens the quality of life of patients and, in addition, becomes a cause of high levels of disability.
Until the mid-1980s, there was no uniform definition of the disease.It was only in 1995 that the Osteoarthritis Committee of the American College of Rheumatology characterized the disease as a result of mechanical and biological factors that lead to an imbalance between the processes of degradation and synthesis of the extracellular matrix of articular cartilage.As a result, fiber breakdown and degeneration occurs, cracks, osteosclerosis and compaction of the cortical layer of the subchondral bone occur, osteophytes grow and subchondral cysts form.
Why does osteoarthritis of the knee joint occur?
Risk factors for osteoarthritis include:
- chronic traumatization (violation of physical activity, excess weight);
- endocrine, inflammatory, metabolic and ischemic diseases;
- the presence of congenital or acquired disorders of the relationships, shape or structural organization of the joint ends.
If you notice similar symptoms, contact your doctor.Do not self-medicate - it is dangerous to your health!
Symptoms of osteoarthritis of the knee joints
Osteoarthritis of the knee joint is characterized by:
- gradual onset;
- slight pain in the joint when moving, especially when going up and down stairs;
- “Tightness,” stiffness, and “initial pain,” which occur with the first steps and subside or disappear when the patient “deviates,” reappear after significant physical activity.
- The appearance of the knee remains the same.Sometimes there is slight swelling or fluid accumulation in the joint.At the same time, the knee increases in volume, swells, becomes flattened and restrictions in movement and feelings of heaviness are felt.
Painful sensations
As the disease progresses, the pain becomes more severe and occurs even with little exertion and long walking.Localized along the anterior inner surface of the joint.Prolonged rest usually helps relieve pain.
Limited mobility of the knee joint and characteristic crunching
With osteoarthritis, the range of motion of the joints may decrease, a crunch may occur, and stabbing pain may occur when the leg is flexed to the maximum.
Knee deformity
The configuration of the joint changes as if it were expanding.
Synovitis
Synovitis of the knee joint is an inflammation of the lining of the inner joint cavity.The disease is manifested by swelling of the knee, redness of the skin and limited mobility of the joint.When osteoarthritis develops, synovitis occurs more often, which lasts longer and involves a lot of fluid.
The final stage of gonarthrosis is characterized by the fact that pain becomes almost constant and causes anxiety not only when walking, but also at rest and even at night, when patients have to look for a comfortable sleeping position.Movement is more limited: it is difficult to fully bend and straighten the leg.The joint deforms and increases in volume.Valgus (X-shaped) or varus (O-shaped) deformity of the legs is often observed.The gait becomes unstable and waddles.In severe cases, a cane or crutches are required.
According to researchers, 76% of older people who complain of knee pain have gonarthrosis on X-ray.According to statistics, women after the age of 45 are more often affected by the disease, which is accompanied by hormonal changes.
Pathogenesis of arthrosis of the knee joints
There are primary and secondary osteoarthritis.
Primary osteoarthritis of the knee joint
- Articular cartilage is constantly being destroyed and renewed;Normally these processes are balanced.As we age, cartilage renewal slows down and destruction begins to predominate, which is known as the degradation or degeneration process.The weight of a person plays an important role, because with a mass of 70 kg in 20 steps we carry 700 kg on each leg (70 kg x 10 steps), with a mass of 120 kg we already carry 1200 kg on each leg.Therefore, weak cartilage wears out much more quickly;
- you must remember: the joint receives nutrients and is restored during movement;A sedentary lifestyle reduces metabolic processes and the necessary elements do not enter the cartilage;
- There is controversial evidence about the hereditary role in the development of the disease.If the parents had arthrosis, the likelihood of its occurrence in children increases;
- occurs due to autoimmune synovial inflammation.
Secondary osteoarthritis of the knee joint
- Injuries (fractures, torn meniscus and anterior cruciate ligament).Unfortunately, these injuries cause excessive stress on the cartilage in every person, regardless of age.A fracture of a part of the bone covered with cartilage is accompanied by the formation of an unevenness - a “step”.In this area, abrasion and osteoarthritis occur with movement;
- rheumatoid arthritis, König's disease (osteochondritis dissecans), consequences of purulent joint inflammation (gonitis), etc.;
- regional vascular diseases;
- chronic exudative-proliferative and cicatricial adhesion processes in the joint.
In osteoarthritis (osteoarthrosis), in addition to the progressive destruction of the cartilage, the loss of its elasticity and shock-absorbing properties, the bones also gradually become involved.Under stress, sharp edges (exostoses) arise, which are incorrectly viewed as “salt deposits” – in classic osteoarthritis there is no salt deposit.As osteoarthritis progresses, it continues to “eat” the cartilage.Then the bone deforms, cysts form, all structures of the joint are affected and the leg bends.
In addition to the inner or outer part of the knee, osteoarthritis can also affect the surfaces between the patella and the intercondylar groove of the femur.This option is calledPatellofemoral osteoarthritis.
The cause is usually a subluxation, fracture or lateralization of the patella.
Classification and stages of development of osteoarthritis of the knee joints
Regardless of the cause, there are three stages of gonarthrosis deforming arthrosis of the knee joint.
Gonarthrosis, stage I
The first stage of the disease is characterized by primary changes in the hyaline cartilage.Bone structures are not affected.The blood supply in intraosseous vessels and capillaries is disrupted.The surface of the cartilage becomes dry and loses its smoothness.If the disease is accompanied by constantly tense synovitis, a Baker's cyst (hernia bulging of the joint capsule of the popliteal region) develops.Dull pain occurs after heavy strain on the joint.There may be some slight swelling that goes away with rest.There is no deformation.
Gonarthrosis, stage II
In the second stage, the cartilage layer becomes significantly thinner and is completely missing in some places.Osteophytes appear on the edges of the articular surfaces.The qualitative and quantitative properties of the synovial fluid change - it becomes thicker, more viscous, which leads to a deterioration in its nutritional and lubricating properties.The pain is longer and more intense and a grinding sound is often heard when moving.There is a slight to moderate restriction of movement and slight deformation of the joint.Taking analgesics helps relieve pain.
Gonarthrosis, stage III
Lack of cartilage in most affected areas, severe sclerosis (hardening) of the bone, many osteophytes, and severe narrowing or absence of the joint space.The pain is almost constant and gait is impaired.Mobility is severely restricted and significant joint deformations occur.NSAIDs, physical therapy and other standard methods of treating knee osteoarthritis are ineffective.
Types of gonarthrosis
Depending on the number of joints affected, a distinction is made between unilateral and bilateral gonarthrosis.
Complications of osteoarthritis of the knee joints
The most common complication of stages II and III is tendovaginitis of the adductor muscle group of the thigh.This is manifested by pain along the inner surface of the joint, which increases with movement.The cause is an imbalance and deformation of the muscles.Long-term restriction of range of motion results in contracture.In addition, synovitis often occurs.
Consequences of advanced gonarthrosis
Gonarthrosis affects the entire musculoskeletal system and disrupts the biomechanics of the spine and other large joints of the lower extremities.This can lead to herniated discs and arthritis of other joints.The second knee joint is overloaded (if the disease is unilateral) because the patient protects the painful leg and shifts the weight to the other, healthy leg.
Diagnosis of osteoarthritis of the knee joints
Instrumental diagnostics of arthrosis of the knee joint
In the vast majority of cases, an examination and x-ray of the knee joint in two projections (direct and lateral) is sufficient.Clinical data and images help determine the stage of the disease.
In the early stages of the disease with minor changes in bone tissue, an X-ray examination is not so valuable.At this stage, gonarthrosis can be diagnosed through arthroscopy.The accuracy of the method is very high;Only its invasive nature and price can stop it.
Ultrasound does not allow clear visualization of changes in articular cartilage and intra-articular structures.MRI allows you to detect changes in the bone, cartilage and soft tissue structures of the joint, as well as the subchondral bone with an accuracy of 85%.Scintigraphy can be used to assess the metabolic activity of the periarticular bone tissue.
Laboratory diagnosis of osteoarthritis of the knee joint
An increased content of phosphorus and calcium in the dehydrated synovial fluid is an indication of the destruction of the osteochondral tissue of the joint and the accumulation of degradation products.Blood is also examined - general analysis and erythrocyte sedimentation rate (ESR);Determine the fibrinogen, urea and other biochemical parameters of blood and urine.
Is it possible to completely cure deforming osteoarthritis of the knee joint?
Complete healing of gonarthrosis is only possible in the earliest stages of the disease.
Which doctor treats deforming osteoarthritis of the knee joint?
A traumatologist, orthopedist or rheumatologist makes a diagnosis and prescribes treatment.
Treatment of arthrosis of the knee joints
Conservative — anti-inflammatory drugs, painkillers, muscle relaxants, vascular, chondroprotectors, compresses, kinesiotaping, physiotherapy, physiotherapy, orthoses.
Minimally invasive- paraarticular blocks (Novocaine + drugs relieve pain and inflammation), injection of artificial lubricant into the joint itself, plasma lifting.
Surgical — Arthroscopy (a low-traumatic method of treating intra-articular pathologies and removing damaged structures), endoprosthetics.
Drug treatment (medicines used to treat osteoarthritis of the knee joint)
Conservative methods are most effective in the early stages of the disease.They help relieve pain and temporarily slow cartilage destruction.In stage II, more effective methods are required.The introduction of hyaluronic acid preparations into the joint cavity serves to reduce friction and trauma to the cartilage.There is no clear evidence for cartilage restoration, but it works well for lubricating surfaces.“PRP therapy” (plasmolifting) involves the injection of platelet-rich plasma into the knee joint, which is obtained from the patient’s own blood by centrifugation.It nourishes cartilage and promotes its repair, since autoplasm platelets contain numerous growth factors and cytokines that promote the regeneration of damaged tissue.
Surgical treatment and endoprosthetics
Endoprosthesis replacement is a common and effective surgical method for treating severe gonarthrosis, allowing you to maintain limb mobility and the ability to subsequently lead a full life.This is a high-tech operation that takes about an hour and a half.In the postoperative period, long-term rehabilitation and development of the joint are required.After 25-30 years, when the artificial joint wears out, it needs to be replaced again.
Physiotherapy and exercise therapy
Methods of physiotherapy and exercise therapy for the treatment of arthrosis of the knee joint are ineffective.
Diet therapy
Dieting is only necessary to maintain a normal weight;There are no restrictions on the consumption of certain foods for gonarthrosis.
Does a block help with gonarthrosis?
For arthrosis of the knee joint, a paraarticular block is used - an injection of the drug into the soft tissue around the joint.During the procedure, the area of inflammation and pain points near the joint are determined, the skin is treated with alcohol and hydrocortisone with an anesthetic is injected into this area.
Therapeutic exercises for osteoarthritis
Therapeutic exercises are useful both for patients with gonarthrosis and for the prevention of this disease.Effective exercises:
- full flexion and extension of the leg, lying on the back;
- Raise one straight leg while lying on your back.
Forecast.Prevention
You must understand that if osteoarthritis begins, it must be treated immediately.If you are at risk for this disease, you can delay the onset.The following is recommended:
- reduce the load on the knee joint;
- swimming – water relieves stress;
- massage the muscles of the lower leg and thigh yourself;
- avoid hypothermia and overwork;
- maintain normal weight;
- quit smoking and alcohol;
- Women wear comfortable low-heeled shoes;
- Do physiotherapy
Before starting therapeutic exercises, you should definitely consult your doctor.The exercises are performed at a slow pace.If pain or discomfort occurs during gymnastics, the exercises should be stopped.
Only effective medications may be used.Rubbing, compresses and other folk methods are ineffective;They do not affect the cause of the disease, but only help to distract from the pain.Avoid injuries and overuse - jumping, carrying heavy objects, standing for long periods or sitting in an uncomfortable position.This accelerates the progression of the disease.
It is also necessary to timely diagnose and treat rheumatoid arthritis, gout and systemic diseases.
What factors influence the long-term prognosis of knee osteoarthritis?
The prognosis depends on the stage of the visit to the doctor and the correct therapy.The sooner you start proper treatment, the higher your chances of avoiding surgery.