A disease of non-infectious origin, in which the hyaline cartilage of the knee joint suffers in the first place, which eventually breaks down and ceases to perform its function, which further 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, especially those who are overweight, prone to frequent hypothermia, participating 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 in the places of attachment of 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. In front, the knee joint protects the patella, which moves between the condyles of the femur. The fibula is not involved in the formation of the knee joint and essentially does not carry any functional load, which is why it is often used to restore other bony elements in the body.
All joint surfaces: the tibia, the 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. Cartilage absorbs cushioning during physical activity, prevents friction and cushions impacts.
Classification of gonarthrosis
From the point of view of origin, gonarthrosis can be classified as primary, manifest, occurring without injury, and secondary, which is provoked by trauma, disease or developmental pathology and often occurs unilaterally. 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 periodic pains or tightening pains, especially after heavy physical exertion or direct loading of the knee joint. The so-called "starting pain" symptom appears, when the patient stands up sharply, painful sensations arise, which gradually disappear, but if an increased load is applied to the limb, the pain resumes. There may be a slight swelling, which disappears by itselfRarely, but synovitis occurs - fluid accumulates in the joint 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 still no deformation of the joint.
- Second stage- the patient begins to worry about long and rather strong pains on the front and inside 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 range of motion of the joint is limited and deformity begins to appear. Synovitis appears often, bothers for a long time, proceeds with a large accumulation of fluid in the joint.
- Third stage- causes significant suffering to the patient, the pain is constant and disturbing not only when 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 wobbly gait appears, and often, due to a significant deformity, a person cannot not only bend, but also fully extend 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
- In the initial, first stage of gonarthrosis, due to the development of a pathological process in the vessels supplying 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 the joint surfaces is disturbed, they begin to adhere to each other, increasing surface defects. Hyaline cartilage degenerates, losing its cushioning function due to constant microtrauma.
- In the second stage of gonarthrosis, the degenerative-dystrophic manifestations increase: the joint gap narrows, the joint surfaces are leveled, they adapt to the increasing loads. The part of the bone adjacent to the hyaline cartilage of the joint becomes denser and osteophytes appear at its edges in the form of growth of bone tissue resembling the shape of spikes. 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 further impairs joint function. Due to malnutrition, the condition of hyaline cartilage deteriorates further, it begins to disintegrate and in some places completely disappears. As a result of the 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 is observed. The surfaces are significantly deformed, the hyaline cartilage is practically absent, the bones appear pressed into each other.
Reasons for the development of gonarthrosis
It is essentially impossible to determine one cause of gonarthrosis. Basically, its occurrence is due to a combination of a number of reasons and various internal and external factors.
In 20-30% of cases, gonarthrosis is provoked by traumatic damage to the knee joints or their components (ligaments, tendons, menisci), as well as fractures of the femur or tibia. The disease appears, as a rule, 3-5 years after the injury. But there are cases of the 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 illness, especially after 40 years, when people begin to actively play sports to maintain their 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.
Being overweight 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, microtraumas or even severe injuries occur to the menisci or the ligament apparatus of the joint. In this case, healing is much more difficult, becauseit is impossible to quickly lose excess weight to relieve the load on the joint.
Different types of arthritis (gouty, psoriatic, rheumatoid, reactive or Bekhterev's disease), some neurological pathologies (spinal injuries, craniocerebral injuries and other diseases occurring with impaired innervation of the lower limbs), as well as hereditary diseases, can provokethe development of gonarthrosis. causing connective tissue weakness.
Diagnosis of gonarthrosis
To diagnose the patient with gonarthrosis, a combination of collecting complaints, examination and X-rays is necessary.
Today, the X-ray image of the 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, monitor the development of the process in dynamics and determine the tactics of further treatmenttreatment. Among other things, radiography allows you to make a differential diagnosis, for example, to rule out a tumor process in the bone tissue of the thigh or lower leg, or inflammatory. Also, for the diagnosis of gonarthrosis, computed tomography and nuclear magnetic resonance 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 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 knee joint disease appear, it is necessary to consult an orthopedist as soon as possible. At the initial stage of the process, the doctor prescribes drug therapy and complete rest for the affected limb.
After passing the acute period, it is possible to appoint:
- a course of exercise therapy,
- massage,
- as well as physiotherapeutic procedures (electrophoresis with analgesics, UHF therapy, magnetic or laser therapy, phonophoresis with anti-inflammatory steroids, mud therapy, etc. )
At the next stage of treatment, the doctor may prescribe drug therapy, which includes taking chondroprotectors that stimulate metabolic processes in the joint. Intra-articular injections of drugs containing hormones are sometimes required. If the patient has the opportunity to receive sanatorium and balneotherapy, it is recommended. Often, to relieve the patient's joint, it is recommended to use a cane when walking. For prevention, you can use special orthopedic insoles or orthoses.
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 endoprosthetics of the knee joint. Rehabilitation measures until the joint function is fully restored usually take 3 to 6 months, after which the patient can return to 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 observe the regime of rest and exercise.