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 fulfill 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 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 attachment points of the tendons and ligaments. Prevention plays an important role in disease prevention.
Anatomy of the knee joint.
The knee joint consists of two surfaces, which are formed by the tibia and the 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 essentially does not carry any functional load, therefore it is often used to reconstruct other bone elements in the body.
All articular surfaces: tibia, femur and the inner surface of the patella are lined with hyaline cartilage, which has a very smooth texture, has a high degree of strength and elasticity, the thickness of this dense and elastic structure reaches 5-6 mm. Cartilage absorbs shock during physical activity, prevents chafing and cushions shock.
Gonarthrosis classification
From the point of view of origin, gonarthrosis can be classified into primary manifestation, which 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, as a rule, occurs in older people and is rarely one-sided.
In its development, arthrosis of the knee joint passes through the following stages:
- The first stage of gonarthrosis.- does not cause significant suffering to the patient, is characterized by intermittent pain or oppressive pain, especially after intense physical exertion, or direct load on the knee joint. The so-called "initial pain" symptom appears, when the patient stands up sharply, painful sensations arise, which gradually disappear, but if a greater 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 happen, 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 bothered by long and rather intense 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 crunch is heard, if the patient tries to bend the limb as much as possible, a sharp pain appears, the amplitude in the movement of the joint is limited, and deformation begins to be detected. Synovitis occurs frequently, bothers for a longer time, continues with a large accumulation of fluid in the joint.
- third stage- 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 significant deformation, a person can not only bend, but also completely unbend the leg, as as a result of which he has to use a cane or even crutches to walk.
Pathology of gonarthrosis of the knee joint.
- In the early 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 stick together, 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 and adapt to increasing loads. The part of the bone adjacent to the hyaline cartilage of the joint becomes denser, and osteophytes appear along its edges, in the form of growths of bone tissue that resemble a spike shape. 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 state of hyaline cartilage is further aggravated, it begins to disintegrate, and in some places it completely disappears. As a result of increased friction, the degeneration of the knee joint progressively increases, leading 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, hyaline cartilage is practically not present, the bones seem to be pressed against each other.
Reasons for the development of gonarthrosis.
In essence, it is impossible to determine any cause of knee osteoarthritis. Basically, its appearance is due to a combination of various 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 have been cases of the development of gonarthrosis in the initial period (2-3 months).
In some patients, gonarthrosis can be triggered by great physical exertion. Active physical activity can often lead to disease, especially after the age of 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 when jumping and squatting.
Excessive weight can also lead to the appearance of gonarthrosis, especially in combination with varicose veins of the lower extremities. The load on the knee joints increases, and microtrauma or even severe 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 to relieve the load on the joint.
Various types of arthritis (gouty, psoriatic, rheumatoid, reactive or Bechterew's disease), some neurological pathologies (spinal injuries, cranioencephalic lesions and other diseases that cause impaired innervation of the lower extremities), as well as hereditary diseases , can cause the development of gonarthrosis, causing weakness of the connective tissue.
Diagnosis of gonarthrosis
For the patient to be diagnosed with gonarthrosis, a combination of complaints, examinations and X-ray studies is necessary.
Today, an X-ray image of a joint is the simplest and most accessible method of investigation, 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 additional treatment tactics. Among other things, radiography 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 certain signs of gonarthrosis, so the diagnosis can be made only after a full 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 knee joint disease appear, it is necessary to consult an orthopedic doctor 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 acute period passes, it is possible to appoint:
- exercise Therapy Course,
- massage,
- as well as physiotherapy procedures (electrophoresis with analgesics, UHF therapy, magnetic or laser therapy, phonophoresis with anti-inflammatory steroids, mud treatment, etc. )
At the next stage of treatment, the doctor may prescribe drug therapy, which consists in taking chondroprotectors that stimulate metabolic processes in the joint. Intra-articular injections with hormone-containing drugs are sometimes required. If the patient has the opportunity to receive sanatorium and spa treatment, it is recommended. Often, to unload the joint, the patient is recommended to use a cane when walking. You can use special orthopedic shoe inserts or orthotics for prevention.
If the patient is diagnosed with the third stage of gonarthrosis, in which its manifestations are more pronounced (pain, alteration or total lack of function of the joint), surgical treatment may be necessary, which consists of knee arthroplasty. Rehabilitation measures until joint function is fully restored, as a rule, take 3-6 months, after which the patient can return to a 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, monitor body weight and monitor the rest and exercise regimen.