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 carry out its function, which further leads to destruction in 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, especially those who are overweight, prone to frequent hypothermia, involved in active sports or due to injury.
Among all arthrosis, 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 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 bone elements in the body.
All articular surfaces: tibia, femur and the inner surface of the patella are lined with hyaline cartilage, which is very smooth in texture, has a high degree of strength and elasticity, the thickness of this dense and elastic structure reaches 5-6 mm. The 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 into primary, manifestation, which occurs without injury and secondary development, which is provoked by trauma, disease or developmental pathology and often occurs as one-sided. In this case, the first type of gonarthrosis, as a rule, occurs in elderly people and is rarely unilateral.
In its development, arthrosis of the knee joint goes through the following stages:
- The first stage of gonarthrosis- does not cause significant suffering to the patient, is characterized by intermittent aching or tightening pain, especially after heavy physical exercise, or direct load on the knee joint. The so-called symptom of "starting pain" appears, when the patient gets up abruptly, painful sensations arise, which gradually disappear, but if an increased load is applied to the limb, the pain resumes. There may be slight swelling that goes away on its own. Rarely, but it occurs, synovitis - fluid accumulates in the articular bag of the knee, due to which the knee area becomes spherical and swollen, movements in the limbs are limited. At this stage, there is no deformation of the joint yet.
- Second stage- the patient begins to be disturbed by long and rather severe pains on 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, disturbs for a longer time, proceeds with a large accumulation of fluid in the joint.
- Third stage- causes considerable suffering to the patient, pain is constant and disturbs not only while walking, but also during rest and even at night, preventing sleep. The joint is already significantly deformed, the position of the limb becomes X or O-shaped. A waddling gait appears, and often, due to significant deformation, a person cannot not only bend, but completely unbend his leg, as a result of which he has to use a cane or even crutches to walk.
Pathology of gonarthrosis of the knee joint
- At the initial, first stage of gonarthrosis, due to the development of a pathological process in the vessels supplying 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 cling to each other, increasing the defects on the surface. Hyaline cartilage degenerates, losing its shock-absorbing function due to constant microtraumas.
- At the second stage of gonarthrosis, degenerative-dystrophic manifestations increase: the joint space narrows, the articular 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 it, in the form of growth of bone tissue resembling spikes in 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, which impairs joint function even more. Due to malnutrition, the state of hyaline cartilage is further aggravated, it begins to disintegrate, and in some places completely disappears. As a result of increased friction, degeneration of the knee joint progressively increases, which leads to the third stage of gonarthrosis.
- At the third stage of gonarthrosis, a pronounced limitation of the range of motion in the joint occurs. The surfaces are significantly deformed, the hyaline cartilage is practically not present, the bones seem to be pressed into each other.
Reasons for the development of gonarthrosis
In essence, it is impossible to determine any one cause of gonarthrosis. Basically, its occurrence is due to a combination of a number of reasons and a variety of internal and external factors.
In 20-30% of cases, gonarthrosis is provoked by traumatic injuries of the knee joints or their components (ligaments, tendons, menisci), as well as fractures of the femur or tibia. The disease manifests, as a rule, 3-5 years after the injury. But there have been cases of development of gonarthrosis in the early period (2-3 months).
In some patients, gonarthrosis can be triggered by high physical exertion. Often, active physical activity can provoke a disease, especially after 40 years, when people begin to actively exercise 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 jumping and squatting.
Excessive 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 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 in order to ease the load on the joint.
Various types of arthritis (gouty, psoriatic, rheumatoid, reactive or Bechterew's disease), some neurological pathologies (injuries of the spinal column, craniocerebral injuries and other diseases that occur with impaired innervation of the lower extremities), as well as hereditary diseases, can provoke the development of gonarthrosis. causing connective tissue weakness.
Diagnosis of gonarthrosis
For the patient to be diagnosed with gonarthrosis, a combination of collecting complaints, examination, and x-ray studies is necessary.
Today, an X-ray image of a joint is the simplest and most easily accessible method of research, 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 further treatment. Among other things, the radiograph 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 only be made after a complete 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 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 subsides, 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 involves taking chondroprotectors that stimulate metabolic processes in the joint. Sometimes intra-articular injections with hormone-containing drugs are required. 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 orthoses for prevention.
If the patient is diagnosed with the third stage of gonarthrosis, in which its manifestations are most pronounced (pain, impaired or complete lack of functioning of the joint), surgical treatment may be required, which consists in knee arthroplasty. Rehabilitation measures until the joint function is fully restored, as a rule, take from 3 to 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, control body weight, and monitor the regime of rest and exercise.