Arthrosis (gonarthrosis) is a pathological change in the knee joint that has a chronic course and can progress over time. The disease extends to all components of the knee joint: cartilage, subchondral bone, menisci, synovial membranes, ligaments, capsules and periarticular muscles.
The knee joint, which connects the femur and tibia, is subject to heavy loads during life and is regularly injured. Sometimes minor damage goes unnoticed immediately, but is felt in the second half of life. In this regard, joint damage is often detected in older people. However, young people also suffer from pathologies of the knee joints that are the result of playing sports or an active lifestyle.
In order to maintain maximum mobility and a high standard of living, consult a doctor at the first problem with the knee joint. Experienced orthopedic traumatologists will diagnose your condition and prescribe the necessary treatment.
Types of arthrosis of the knee joint
Inside the joint, the bones are covered with cartilaginous tissue, which ensures shock absorption, smooth gliding, and also prevents the bones from rubbing against each other. Cartilage tissue receives nutrition thanks to the synovial fluid inside the joint and the blood flowing through the vessels.
Cartilage has a spongy structure, so it absorbs liquid at rest, and squeezes it out when it is loaded. At the same time, during movement, the cartilage constantly receives microtraumas, and during rest it is renewed.
If the result of mechanical injury exceeds the capacity of the joint to regenerate, then there is not enough food for the cartilage and as a result regeneration does not occur. Damage accumulates and changes the structure of the cartilage tissue. This is how arthrosis of the knee joint begins.
Depending on the reasons that caused it, arthrosis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
Degenerative changes that occur in the joint are associated with age. Among the reasons that cause it are the following:
- natural degeneration or degradation due to slowing down of metabolic processes in the body;
- excess body weight;
- sedentary lifestyle;
- malnutrition;
- genetic predisposition.
As a rule, primary gonarthrosis affects both knees at once and is called bilateral.
Secondary gonarthrosis
Secondary arthrosis of the knee joint can occur at any age, as it can be caused by:
- various injuries - bruises, fractures, dislocations, ruptures and strains of ligaments or meniscus;
- joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, gonitis, etc. ;
- regional vascular disorders;
- overloading of the knee joints during sports or due to specific work;
- endocrine diseases;
- O-shaped and X-shaped curvature of the legs.
Secondary arthrosis of the knee joint usually occurs only on one leg and is called unilateral.
In rare cases, idiopathic gonarthrosis is identified - a disease that occurs for no apparent reason.
Stages and symptoms of arthrosis of the knee joint
Regardless of how arthrosis of the knee joint appeared, experts distinguish three stages of its development, which are determined by X-ray examination. Each stage is accompanied by characteristic symptoms:
Phase 1- mild pain that occurs after prolonged exercise, when walking up stairs, after heavy exercise, and disappears after rest. There is no restriction in movement, but sometimes there may be subtle swelling of the joint. This condition, if nothing is done, can last for years - at this point, the cartilage is just starting to lose its smoothness due to the impaired blood supply. The X-ray will show a slight narrowing of the joint space and hardening of the bones.
- Phase 2– the pain becomes strong and lasts quite a long time even with light effort. A cracking sound is heard during flexion and extension of the joint. It becomes impossible to fully bend the leg due to severe pain. There is slight deformity, muscle wasting and limited movement. The pain can be relieved with painkillers or go away on its own after rest.
At this stage, the cartilaginous layer is already greatly thinned, in some places to the point of disappearing. Synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear - bone growths.
- Phase 3– the pain intensifies and worries constantly, even at night. Deformity of the joint becomes noticeable, the gait changes, and the lower part of the limb becomes bent. The range of motion in the knee joint is reduced - the leg cannot fully bend or straighten. When walking, you must use support in the form of a stick or crutch. Painkillers no longer help.
The cartilage is almost completely obliterated, the bones are compacted, the joint space is very narrowed or absent. The presence of many osteophytes was observed.
One common symptom of arthrosis of the knee joint can be identified - pain of varying intensity, localized along the front-inner surface of the joint.
Diagnostics
If you notice symptoms similar to the development of gonarthrosis, you should consult a doctor. At the first examination, the doctor will collect the medical history, check the biomechanical capabilities of the joint and prescribe the necessary examinations. Be sure to inform him about injuries and illnesses, lifestyle, diet, medications and work characteristics.
The most informative and simple way to confirm or refute the diagnosis is an X-ray of the knee joint - it allows you to carry out a differential diagnosis, determine the degree of development of arthrosis and monitor the treatment process.
However, radiological signs appear much later than morphological changes. Therefore, in the early stages, gonarthrosis is difficult to detect even on an X-ray. In such situations, the doctor can prescribe arthroscopy - a very precise method of diagnosing changes in the joints using special endoscopic equipment.
Additional research methods are ultrasound and MRI - they are prescribed when radiography is not sufficiently informative.
Treatment of arthrosis of the knee joint
After the diagnosis, the doctor selects the optimal treatment, depending on the stage of the disease and individual characteristics. This solves three problems:
- pain relief;
- stopping the progression of pathology;
- restoration of joint functionality.
The specialist selects a comprehensive solution that can be adapted during the treatment process.
In modern medicine, there are many ways to treat joint diseases. All can be divided into three types: conservative, minimally invasive, surgical.
Conservative method of treatment of gonarthrosis
It is usually used in stages 1-2 of arthrosis of the knee joint. Treatment begins with reducing the load on the joint - the patient should avoid excessive vertical load on the joint: jumping, running, etc. If necessary, weight loss is recommended. The doctor will recommend a diet and select a gentle set of exercises that will reduce axial impacts and improve cartilage tissue nutrition.
In order to improve blood circulation in the joint area, increase the range of motion, and also enhance the effect of drugs, physiotherapy is prescribed:
- shock wave therapy – short-term impact on bone and connective tissue with acoustic pulses of significant amplitude and low frequency;
- electrotherapy – exposure of the affected area to electric current, magnetic or electromagnetic fields;
- laser therapy - exposure to optical radiation created by a laser;
- phonophoresis - exposing the affected area to ultrasound and applying the medicine to the skin;
- electrophoresis - exposing the affected area to electricity.
Massage, compresses, wearing orthotics and kinesio taping have also been shown to be effective in the treatment of arthrosis.
In addition, well-chosen drug therapy helps relieve pain, stop inflammation and slow down the process of cartilage tissue destruction. For this purpose, anti-inflammatory, hormonal drugs, antispasmodics and chondroprotectors are prescribed. They can be in the form of tablets, injections or topical, depending on the situation.
Minimally invasive method of treatment of gonarthrosis
If the above procedures have no effect, the doctor can prescribe intra-articular injections:
- hyaluronic acid – as a substitute for synovial fluid to improve friction, reduce pain and improve knee joint function. The average duration of drug action is 3-6 months;
- own plasma enriched with platelets - for nutrition and restoration of cartilage tissue;
- corticosteroids – to reduce inflammation.
Surgical method for the treatment of gonarthrosis
If conservative treatment proved ineffective or you first consulted a specialist with the third stage of arthrosis of the knee joint, then the doctor may resort to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position to eliminate pain;
- arthroscopic debridement - repair of joints using an arthroscope;
- corrective osteotomy – removal of bone deformity by artificial fracture;
- endoprosthetics - replacement of a worn joint with an implant artificially made of biocompatible materials.
The type of surgery is chosen by the doctor based on the characteristics of knee joint arthrosis. But endoprosthetics is considered the gold standard, as it allows you to completely return to your normal lifestyle. At the same time, a good implant does not require replacement for 15-30 years. For complete recovery after surgery, it is necessary to undergo a rehabilitation course lasting 3-4 months.
Complications
Gonarthrosis develops quite slowly, but it can be detected in time and the necessary treatment can be started. Ignoring the disease and its symptoms can lead to serious consequences:
- persistent pain that is not relieved by medication;
- complete immobility of the affected joint;
- inability to lean on the injured limb;
- severe deformation of the joints and curvature of the legs;
- damage to other parts of the musculoskeletal system;
- leg shortening.
In particularly difficult situations and in the absence of timely treatment, arthrosis can lead to disability and deterioration of motor activity, even to immobility.
It is important to remember that it is impossible to completely cure arthrosis. But it is quite possible to stop the progression of the disease and improve the quality of life.
Prevention
There is no preventive treatment for gonarthrosis. But people at risk are advised to follow certain rules:
- make sure that your weight does not exceed the age norm;
- do not engage in sports that cause a lot of stress on the knee joint;
- if possible, to completely cure infectious diseases without causing complications;
- don't get too cold or tired;
- avoid injury and overloading of the joint;
- avoid stressful situations;
- don't forget to rest;
- engage in exercise therapy;
- wear orthopedic shoes.
Risk groups include the elderly, athletes and dancers. Here you can also add those who lead a sedentary lifestyle, stand a lot at work or lift weights and are overweight.
Any change in the axis of the lower limb or the normal biomechanics of the joint, dysplasia, reduction in the volume and strength of the leg muscles or trauma can also lead to arthrosis.
Check yourself regularly and take preventive measures.
The answer to the question
- What is the difference between knee arthritis and knee osteoarthritis?
Arthritis is a collective name for joint inflammation, and arthrosis is a degenerative-dystrophic process.
- Which doctor treats arthrosis?
Traumatologist-orthopedic or rheumatologist.
- Is it possible to do sports with arthrosis of the knee joint?
Long-term and heavy loading of the joint, as well as axial impact, should be avoided. But you should not completely exclude sports from your life - when you move, the joints are better "fed" and renewed. It is important to observe the measure and follow the recommendations of the doctor, who will choose the type and method of exercise.