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 also leads to the destruction of other components of the joint and leads to its deformation.
This degenerative-dystrophic disease, as a rule, occurs in women after the age of 40, but men can also suffer, especially those who are overweight, prone to frequent hypothermia, involved in active sports or due to injuries.
Among all arthrosis, knee joint gonarthrosis 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 a secondary process and causes pain during the development of the disease and is located at the attachment points of the tendons and ligaments. Prevention plays an important role in disease prevention.
knee joint anatomy
The knee joint consists of two surfaces, which are formed by the tibia and femur. Anteriorly, the knee joint protects the patella, which moves between the condyles of the femur. The fibula does not participate 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 bony elements of the body.
All joint surfaces: 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 reaches 5-6 mm. Cartilage absorbs cushioning during physical activity, prevents friction and softens impacts.
Classification of gonarthrosis
From the point of view of origin, gonarthrosis can be classified as primary, manifestation, which occurs without injury, and secondary development, which is provoked by trauma, disease or developmental pathology and often occurs as unilateral. In this case, the first type of gonarthrosis, as a rule, occurs in the elderly 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, it is characterized by intermittent pain or tightness, especially after intense physical exercise or direct load on the knee joint. The so-called "initial pain" symptom appears, when the patient stands up abruptly, painful sensations appear, which gradually disappear, but if an increased load is applied to the limb, the pain resumes. There may be a slight swelling that goes away on its own. Rarely, but it does occur, synovitis - fluid accumulates in the knee joint bag, due to which the knee area becomes spherical and swollen, movements in the limbs are limited. At this stage, there is still no deformation of the joint.
- second stage- the patient begins to be disturbed by long and quite intense pains on the anterior and internal side of the joint, even with small loads, but after a long rest, they usually disappear. When the joint moves, there is a popping sound, if the patient tries to bend the limb as much as possible, a sharp pain appears. The range of motion of the joint is limited and deformation begins to be detected. Synovitis occurs frequently, disturbs for a longer time, proceeds with a large accumulation of fluid in the joint.
- third stage- causes considerable suffering to the patient, the pain is constant and bothers 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 an X or O shape. A waddling gait appears, and often, due to a significant deformation, a person can not only bend, but fully unfold the leg, so he needs to use a cane or even crutches to walk.
Pathology of gonarthrosis of the knee joint
- In the initial stage of gonarthrosis, due to the development of a pathological process in the vessels that supply the intraosseous hyaline cartilage, the joint surfaces gradually lose their inherent characteristics. They begin to dry out, lose their smooth texture, cracks appear, due to which the sliding of joint surfaces is disturbed, they begin to cling, increasing surface defects. Hyaline cartilage degenerates, losing its shock-absorbing function due to constant microtrauma.
- In the second stage of gonarthrosis, degenerative-dystrophic manifestations increase: the joint space narrows, the joint surfaces flatten, adapting to increasing loads. The part of the bone adjacent to the hyaline cartilage of the joint becomes denser and osteophytes appear along the edges of the joint in the form of spike-like growths of bone tissue. The knee joint capsule also undergoes changes, losing its elasticity. The fluid within the joint becomes thicker and more viscous, changing its nutritional and lubricating properties, which further impairs joint function. Due to malnutrition, the state of hyaline cartilage is further aggravated, it begins to disintegrate, and in some places it disappears completely. As a result of increased friction, degeneration of the knee joint progressively increases, which leads to the third stage of gonarthrosis.
- In the third stage of gonarthrosis, there is a pronounced limitation of range of motion in the joint. The surfaces are significantly deformed, hyaline cartilage is practically absent, the bones appear to be pressed against each other.
Reasons for the development of gonarthrosis
In essence, it is impossible to determine any cause of gonarthrosis. Basically, its occurrence is due to a combination of several reasons and a variety of internal and external factors.
In 20-30% of cases, gonarthrosis is caused 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 gonarthrosis development in the initial period (2-3 months).
In some patients, gonarthrosis can be triggered by high physical exertion. Active physical activity can often lead to illness, particularly after age 40, when people begin to actively exercise to maintain health and realize the need for a healthy lifestyle. Above all, the load on the joints is during running, as well as jumping and squatting.
Excess weight can also lead to the occurrence of gonarthrosis, especially in combination with varicose veins of the lower extremities. The load on the knee joints increases and microtraumas or even serious injuries to 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 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 impairment of the innervation of the lower extremities), as well as hereditary diseases, can cause the development of gonarthrosis, causing connective tissue weakness.
diagnosis of gonarthrosis
For the patient to be diagnosed with gonarthrosis, a combination of collection, examination, and radiographic examination complaints is required.
Today, an X-ray image of a joint is the simplest and most accessible research method, with the help of which it is possible to diagnose a patient with a sufficient degree of accuracy, observe the development of the process in dynamics and determine the tactics of additional treatment. Among other things, radiography makes it possible to make a differentiated diagnosis, for example, to exclude a tumor process in the bone tissue of the thigh or leg or an inflammatory process. In addition, 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 only be made after a thorough collection of anamnestic data, complaints and visual examination, 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. In the initial phase 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:
- course in physiotherapy,
- massage,
- as well as physical therapy procedures (electrophoresis with analgesics, UHF therapy, magnetic or laser therapy, phonophoresis with anti-inflammatory steroids, mud treatment, etc. )
In the next stage of treatment, the doctor may prescribe drug therapy, which involves the use of chondroprotectors that stimulate metabolic processes in the joint. Sometimes intra-articular injections with hormone-containing drugs are needed. If the patient has the opportunity to receive sanatorium and spa treatment, it is recommended to him. Often, to unload the joint, the patient is recommended to use a cane when walking. You can use special orthopedic insoles or orthotics for prevention.
If the patient is diagnosed with the third stage of gonarthrosis, in which its manifestations are more pronounced (pain, impairment or complete lack of joint functioning), surgical treatment, which consists of knee arthroplasty, may be necessary. Rehabilitation measures until joint function is fully restored, as a rule, takes 3-6 months, after which the patient can return to normal life.
Prevention
To avoid degenerative-destructive changes of the knee joint with age, it is necessary to resort to physical education, wear orthopedic shoes, control body weight and monitor the regimen of rest and exercise.