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 high loads throughout life and is periodically injured. Sometimes minor damage goes unnoticed immediately, but makes itself felt in the second half of life. In this sense, joint damage is often detected in older people. However, young people also suffer from knee joint pathologies resulting from sports or an active lifestyle.
To maintain maximum mobility and a high standard of living, you should consult a doctor at the first problem in the knee joint. 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 sliding, and also prevents the bones from rubbing against each other. The cartilage tissue is nourished by the synovial fluid located within the joint and the blood flowing through the vessels.
Cartilage has a spongy structure, so when it is at rest it absorbs liquid and when it is loaded it displaces it. At the same time, during movements, the cartilage constantly receives microtrauma, and during rest it recovers.
If the result of mechanical injury exceeds the restoration capacity of the joint, then there is not enough nutrition for the cartilage and, as a result, regeneration does not occur. The damage accumulates and changes the structure of the cartilage 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
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 of metabolic processes in the body;
- excess body weight;
- sedentary lifestyle;
- malnutrition;
- genetic predisposition.
As a rule, primary gonarthrosis affects both knees at once and is called bilateral.
secondary gonarthrosis
Secondary osteoarthritis of the knee joint can occur at any age, as it can be caused by:
- various injuries: bruises, fractures, dislocations, tears 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;
- Curvature of the legs in the shape of O and X.
Secondary osteoarthritis of the knee joint most often appears only in 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 osteoarthritis of the knee joint.
Regardless of how osteoarthritis of the knee joint appeared, experts distinguish three stages of its development, which are determined during an X-ray examination. Each stage is accompanied by characteristic symptoms:
Level 1– mild pain that appears after prolonged exercise, when climbing stairs, after intense exercise and disappears after rest. There are no restrictions on movement, but sometimes subtle swelling of the joint may occur. This condition, if nothing is done, can last for years; At this time, the cartilage is just beginning to lose its softness due to poor 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 quite a long time even with light exertion. A crunching sound is heard during flexion and extension of the joint. It is impossible to bend the leg completely due to the intense pain. There is slight deformity, muscle atrophy and limited movement. The pain can be relieved with pain relievers or go away on its own after rest.
At this stage, the cartilaginous layer already thins considerably, in some places to the point of disappearance. The synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear: bone growths.
- Stage 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 bends. The range of motion in the knee joint is reduced: the leg cannot be fully bent or straightened. When walking you must use support in the form of a cane or crutch. Painkillers no longer help.
The cartilage is almost completely erased, the bones become compacted and the joint space is considerably narrowed or missing. The presence of many osteophytes is observed.
A common symptom of osteoarthritis of the knee joint can be identified: pain of varying intensity, localized along the anterior-inner surface of the joint.
Diagnosis
If you notice symptoms similar to the development of gonarthrosis, you should consult a doctor. At the initial appointment, the doctor will collect a history, check the biomechanical capabilities of the joint and prescribe the necessary examinations. Be sure to tell them about injuries and illnesses sustained, lifestyle, nutrition, medications taken, and job characteristics.
The most informative and easiest 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 osteoarthritis 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 by x-ray. In such situations, the doctor may prescribe arthroscopy, a very precise method of diagnosing changes in the joints using special endoscopic equipment.
Additional research methods are ultrasound and MRI, which are prescribed when x-ray does not provide sufficient information.
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 that can be adapted 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 treatment of gonarthrosis.
It is generally used in stages 1-2 of osteoarthritis of the knee joint. Treatment begins by reducing the load on the joint; the patient should avoid excessive vertical loading on the joint: jumping, running, etc. If necessary, it is recommended to lose weight. The doctor will recommend a diet and select a gentle series of exercises that will reduce axial impacts and improve the nutrition of the cartilage tissue.
To improve blood circulation in the joint area, increase the range of motion, and also improve the effect of medications, physiotherapy is prescribed:
- shock wave therapy - short-term impact on bone and connective tissue with low-frequency acoustic pulses of significant amplitude;
- 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 to the affected area using ultrasound and application of medications to the skin;
- electrophoresis: exposure of the affected area to electricity.
Massages, compresses, the use of orthotics and kinesiotaping have also proven effective in the treatment of osteoarthritis.
In addition, well-chosen drug therapy helps relieve pain, stop inflammation and slow down the process of destruction of cartilage tissue. For this, anti-inflammatories, hormonal medications, antispasmodics and chondroprotectors are prescribed. They can be in tablet form, injectable or topical, depending on the situation.
Minimally invasive method to treat gonarthrosis.
If the above procedures have no effect, the doctor may prescribe intra-articular injections:
- Hyaluronic acid: as a substitute for synovial fluid to improve friction, reduce pain and improve knee joint function. The average duration of action of the drug is 3 to 6 months;
- own plasma enriched with platelets: to nourish and restore cartilage tissue;
- corticosteroids – to reduce inflammation.
Surgical method to treat gonarthrosis.
If conservative treatment turned out to be ineffective or you first turned to a specialist with the third stage of osteoarthritis 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 - healing of the joints using an arthroscope;
- corrective osteotomy – elimination of bone deformities by artificial fracture;
- Endoprosthesis: replacement of a worn joint with an artificially created implant from biocompatible materials.
The doctor chooses the type of operation based on the characteristics of osteoarthritis of the knee joint. But the stent is considered the gold standard, allowing you to completely return to your normal lifestyle. At the same time, a good implant does not require replacement within 15 to 30 years. To fully recover after surgery, it is necessary to undergo a rehabilitation course lasting 3-4 months.
Complications
Gonarthrosis develops quite slowly, but it can be detected in time and the necessary treatment can be started. Ignoring the disease and its symptoms can have serious consequences:
- constant pain that is not relieved by medication;
- complete immobility of the diseased joint;
- inability to support yourself on the injured limb;
- severe joint deformation and curvature of the legs;
- damage to other parts of the musculoskeletal system;
- shortening of the leg.
In particularly difficult situations and in the absence of timely treatment, osteoarthritis can lead to disability and impairment of motor activity, even to the point of immobility.
It is important to remember that it is impossible to completely cure osteoarthritis. But it is very possible to stop the progression of the disease and improve quality of life.
Prevention
There is no preventive treatment for gonarthrosis. But people at risk are recommended to follow certain rules:
- make sure your weight does not exceed the age norm;
- do not play sports that put a lot of pressure on the knee joint;
- if possible, completely cure infectious diseases without causing complications;
- don't get too cold or too tired;
- avoid injuries and overloads of the joint;
- avoid stressful situations;
- do not forget about rest;
- participate in exercise therapy;
- wear orthopedic shoes.
Risk groups include older people, 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 cause osteoarthritis.
Get regular checkups and take preventive measures.
Question answer
- What is the difference between knee arthritis and knee osteoarthritis?
Arthritis is the collective name for inflammation of the joint and osteoarthritis is a degenerative-dystrophic process.
- What doctor treats osteoarthritis?
Traumatologist-orthopedist or rheumatologist.
- Is it possible to play sports with osteoarthritis of the knee joint?
Heavy and prolonged loads on the joint, as well as axial impacts, should be avoided. But you should not completely exclude sports from your life: when you move, your joints are better "nourished" and restored. It is important to observe the measurement and follow the recommendations of the doctor, who will select the type and mode of exercise.