A disease of non-infectious origin, in which the hyaline cartilage of the knee joint suffers first of all, which eventually collapses 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 usually occurs in women after the age of 40, but men can also get it, especially those who are overweight, prone to frequent hypothermia, engage in active sports or due to injuries.
Of all arthrosis, gonarthrosis of the knee joint is the most common.
There is an opinion that the cause of gonarthrosis is the deposition of salt in the joint. This opinion is absolutely wrong and salt deposition is a rather secondary process and causes pain during the development of the disease and is localized at the points 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 that make up the tibia and the femur. In front, 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, which is why it is often used for the reconstruction of other bony elements in the body.
All joint surfaces: tibia, femur and the inner surface of the patella are coated 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 cushioning during physical activity, prevents friction and cushions 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 caused by trauma, disease or developmental pathology and often occurs unilaterally. In this case, the first type of gonarthrosis usually 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, it is characterized by occasional pain that aches or tightens, especially after heavy physical exercise, or direct load on the knee joint. The so-called symptom of "initial pain" appears, when the patient suddenly stands up, painful sensations appear that gradually disappear, but if the load on the extremity increases, the pain continues. There may be mild swelling that goes away on its own. Rarely, but occurs, synovitis - 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 no deformation of the joint yet.
- The second stage- the patient begins to be bothered by long and rather strong pains on the front and inside of the joint, even with light loads, but usually disappear after a long rest. When the joint is moved, 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, the deformation begins to be detected. Synovitis occurs often, disturbs for a long time, proceeds with a large accumulation of fluid in the joint.
- The third phase- causes considerable suffering to the patient, the pain is constant and interferes not only during walking, but also during rest and even at night, preventing sleep. The joint is already significantly deformed, the position of the extremity becomes X or O-shaped. A walking gait appears, and often, due to significant deformation, a person cannot not only bend, but also completely separate the leg, which is why he has to use a stick 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 that supply the intraosseous hyaline cartilage, the joint surfaces gradually lose their inherent characteristics. They begin to dry, lose their smooth texture, cracks appear, due to which the gliding of the joint surfaces is disturbed, they begin to stick to each other, increasing the defects on the surface. Hyaline cartilage degenerates, loses its cushioning function due to constant microtraumas.
- In the second stage of gonarthrosis, degenerative-dystrophic manifestations increase: joint space narrows, joint surfaces flatten, adapting to growing loads. The part of the bone next to the hyaline cartilage of the joint becomes denser, and osteophytes appear at the edges in the form of growths of bone tissue that resemble spikes in shape. The capsule of the knee joint also changes, loses 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 the hyaline cartilage further deteriorates, it begins to disintegrate, and in some places it even 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 the range of motion in the joint. The surfaces are significantly deformed, hyaline cartilage is practically not present, the bones seem to be pressed into each other.
Reasons for the development of gonarthrosis
Basically, it is impossible to determine any cause of gonarthrosis. Basically, its appearance is the result of a combination of a number of reasons and a number of internal and external factors.
In 20-30% of cases, gonarthrosis is caused 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 itself, as a rule, 3-5 years after the injury. But there were cases of the development of gonarthrosis in the early period (2-3 months).
In some patients, gonarthrosis can be caused by heavy physical exertion. Often, active physical activity can cause disease, especially after 40 years, 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.
Excess weight can also lead to gonarthrosis, especially in combination with varicose veins of the lower extremities. The load on the knee joints increases, microtrauma or even severe injuries to the meniscus 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.
Different types of arthritis can occur (gout, psoriatic, rheumatoid, reactive or Bechterew's disease), some neurological pathologies (spinal column injuries, craniocerebral injuries and other diseases that occur with damaged innervation of the lower extremities), as well as hereditary diseases. cause the development of gonarthrosis. cause weakness of the connective tissue.
Diagnosis of gonarthrosis
In order to diagnose a patient with gonarthrosis, a combination of collecting complaints, examination and X-ray studies is necessary.
Today, the X-ray image of the joint is the simplest and most easily available research method, with the help of which it is possible to diagnose the 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, 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 an inflammatory one. Also, for the diagnosis of gonarthrosis, computer tomography and 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 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 knee joint disease 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:
- 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. )
In the next phase of treatment, the doctor can prescribe drug therapy, which includes taking chondroprotectors that stimulate metabolic processes in the joint. Sometimes intra-articular injections of drugs containing hormones are required. If the patient has the option of sanatorium-spa treatment, it is recommended. Often the patient is advised to use a cane when walking to relieve the joint. 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, damage or complete lack of joint functioning), surgical treatment consisting of knee arthroplasty may be necessary. Rehabilitation measures usually last from 3 to 6 months until the joint function is completely restored, 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, monitor rest and exercise regime.