Osteoarthritis (gonarthrosis) is a pathological change in the knee joint that has a chronic course and can progress over time. The disease extends to 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 makes itself felt in the second half of life. In this regard, joint damage is often detected in elderly people. However, young people also suffer from knee joint pathologies resulting from playing sports or an active lifestyle.
To maintain maximum mobility and a high standard of living, you should consult a doctor at the first knee joint problem. Experienced orthopedic traumatologists will diagnose your condition and prescribe the necessary treatment.
Types of osteoarthritis of the knee joint
Inside the joint, the bones are covered with cartilaginous tissue, which provides shock absorption, smooth gliding, and also prevents the bones from rubbing against each other. Cartilaginous tissue receives nutrition thanks to the synovial fluid located inside the joint and the blood flowing through the vessels.
Cartilage has a spongy structure, therefore, when at rest, it absorbs liquid, and when loaded, it displaces it. At the same time, during movements, the cartilage constantly receives microtraumas, and during rest it is restored.
If the result of mechanical injury exceeds the restoration capacity of the joint, there will not be enough nutrition for the cartilage and, as a result, regeneration will not occur. Damage accumulates and alters the structure of cartilaginous tissue. This is how osteoarthritis of the knee joint begins.
Depending on the reasons that caused it, osteoarthritis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
The degenerative changes that occur in the joint are associated with age. Among the reasons that cause it are the following:
- natural degeneration or degradation due to a slowdown in the body's metabolic processes;
- excess body weight;
- sedentary lifestyle;
- 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, ruptures and sprains of ligaments or menisci;
- joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, gonitis, etc. ;
- regional vascular disorders;
- overload of the knee joints during sports or due to the specifics of the work;
- endocrine diseases;
- O- and X-shaped curvature of the legs.
Secondary arthrosis of the knee joint usually appears only on one leg and is called unilateral.
In rare cases, idiopathic gonarthrosis is identified - a disease that occurs for no apparent reason.
Stages and symptoms of arthrosis of the knee joint
Regardless of how arthrosis of the knee joint arose, 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 occurs after prolonged exercise, when climbing stairs, after heavy exercise and disappears after rest. There are no restrictions on movement, but subtle swelling of the joint may sometimes occur. This condition, if nothing is done, can last for years - at this time the cartilage is just beginning to lose its smoothness due to impaired blood supply. An x-ray will show a slight narrowing of the joint space and hardening of the bones.
- Stage 2– the pain becomes intense and lasts a long time even with small efforts. A crunching sound is heard during flexion and extension of the joint. It becomes impossible to bend the leg completely due to the intense pain. There is slight deformation, muscle loss and limited movement. The pain may be relieved with painkillers or disappear on its own after rest.
At this stage, the cartilaginous layer is already quite thin, in some points to the point of disappearing. Synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear - bone growths.
- Step 3– the pain increases and worries constantly, even at night. The deformity of the joint becomes noticeable, the gait changes and the lower part of the limb becomes flexed. The range of motion in the knee joint is reduced - the leg cannot be fully bent or straightened. When walking, it is necessary to use support in the form of a cane or crutch. Painkillers no longer help.
The cartilage is almost completely erased, the bones are compacted, the joint space is very narrowed or absent. The presence of many osteophytes is noted.
A common symptom of arthrosis of the knee joint can be identified - pain of varying intensity, localized along the antero-internal surface of the joint.
Diagnosis
If you notice symptoms similar to the development of gonarthrosis, see a doctor. At the initial consultation, the doctor will take 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, nutrition, medications taken and job features.
The most informative and simple way to confirm or refute a diagnosis is an x-ray of the knee joint - it allows you to make a differential diagnosis, determine the degree of development of arthrosis and monitor the treatment process.
However, radiological signs appear much later than morphological changes. Therefore, in the early stages, gonarthrosis is difficult to detect even on x-rays. In these situations, the doctor may prescribe arthroscopy - a highly accurate method of diagnosing joint changes using special endoscopic equipment.
Additional research methods are ultrasound and MRI - they are prescribed when radiography is not informative enough.
Treatment of osteoarthritis of the knee joint
After diagnosis, the doctor selects the optimal treatment depending on the stage of the disease and individual characteristics. This solves three problems:
- pain relief;
- stop the progression of pathology;
- restoration of joint functionality.
The specialist selects a comprehensive solution, which 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 treating gonarthrosis
Usually used in stages 1-2 of knee joint arthrosis. Treatment begins with reducing the load on the joint - the patient should avoid excessive vertical load on the joint: jumping, running, etc. If necessary, it is recommended to lose excess weight. The doctor will recommend a diet and select a gentle set of exercises that will reduce axial impacts and improve the nutrition of cartilaginous tissue.
To improve blood circulation in the joint area, increase the range of motion, and also enhance the effect of medications, physiotherapy is prescribed:
- shock wave therapy – short-term impact on bone and connective tissue with acoustic pulses of significant amplitude of 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 medication applied to the skin;
- electrophoresis - exposure of the affected area to electricity.
Massages, compresses, use of orthoses and kinesiotaping have also proven to be good in treating osteoarthritis.
In addition, well-chosen drug therapy helps to relieve pain, stop inflammation and slow down the process of destruction of cartilage tissue. For this purpose, anti-inflammatory, hormonal, antispasmodic and chondroprotective drugs are prescribed. They can be in tablet, injectable or topical form, depending on the situation.
Minimally invasive method of treating gonarthrosis
If the above procedures are not effective, the doctor may prescribe intra-articular injections:
- hyaluronic acid – as a synovial fluid substitute to improve friction, reduce pain and improve knee joint function. The average duration of action of the medication is 3 to 6 months;
- own plasma enriched with platelets - for nutrition and restoration of cartilage tissue;
- corticosteroids – to reduce inflammation.
Surgical method for treating gonarthrosis
If conservative treatment turned out to be ineffective or you turned to a specialist in the third stage of arthrosis of the knee joint, the doctor may resort to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position to eliminate pain;
- arthroscopic debridement - cleaning the joints with an arthroscope;
- corrective osteotomy – elimination of bone deformities by artificial fracture;
- endoprosthesis - replacement of a worn-out joint with an implant artificially created from biocompatible materials.
The type of operation is chosen by the doctor based on the characteristics of arthrosis of the knee joint. But endoprosthesis is considered the gold standard, as it allows you to completely return to your normal lifestyle. At the same time, a good implant does not require replacement for 15 to 30 years. To fully recover from surgery, it is necessary to undergo a rehabilitation course that lasts 3 to 4 months.
Complications
Gonarthrosis develops rather slowly, but it can be detected in a timely manner and the necessary treatment can be started. Ignoring the disease and its symptoms can lead to serious consequences:
- constant pain that is not relieved with medication;
- complete immobility of the diseased joint;
- inability to lean on the injured limb;
- severe joint deformity and curvature 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, up to the point of immobility.
It is important to remember that it is impossible to completely cure osteoarthritis. 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 practice sports that place great stress on the knee joint;
- if possible, completely cure infectious diseases without causing complications;
- do not become too cold or too tired;
- avoid injuries and joint overload;
- avoid stressful situations;
- don't forget to rest;
- engage in exercise therapy;
- wear orthopedic shoes.
Risk groups include the elderly, athletes and dancers. You can also add here 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 in the normal biomechanics of the joint, dysplasia, decreased volume and strength of the leg muscles or trauma can also lead to osteoarthritis.
Get tested regularly and take preventative 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 osteoarthritis?
Traumatologist-orthopedist or rheumatologist.
- Is it possible to play sports with arthrosis of the knee joint?
Prolonged and heavy loads on the joint, as well as axial impacts, must be avoided. But you shouldn't completely exclude sports from your life - when you move, your joints are better "nourished" and restored. It is important to observe the measure and follow the doctor's recommendations, who will select the type and modality of exercise.