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 subjected to heavy loads throughout life and is regularly injured. Sometimes minor damage goes unnoticed right away, but is felt in the second half of life. In this regard, joint damage is often detected in the elderly. However, young people also suffer from knee joint pathologies that come from sports or an active lifestyle.
To maintain maximum mobility and a high standard of living, you should 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 cartilage tissue, which provides shock absorption, smooth sliding and also prevents the bones from rubbing against each other. Cartilage tissues receive nourishment thanks to the synovial fluid located inside the joint and the blood flowing through the vessels.
Cartilage has a spongy structure, so when it is at rest it absorbs fluid, and when it is loaded, it displaces it. At the same time, during movements, the cartilage constantly receives microtrauma, and during rest it is restored.
If the result of mechanical damage exceeds the restoration capacity of the joint, then there is not enough food for the cartilage, and as a result, regeneration does not occur. The damage accumulates and changes the structure of the cartilage tissue. This is how knee arthrosis 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 joints are related to age. Among the reasons that cause it are the following:
- degeneration or natural degradation due to a slowdown 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 sprains 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 the specifics of work;
- endocrine diseases;
- O-shaped and X-shaped bending of the legs.
Secondary arthrosis of the knee joint most often appears 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 knee arthrosis appeared, experts distinguish three stages of its development, which are determined during an X-ray examination. Each stage is accompanied by characteristic symptoms:
Phase 1- mild pains that appear after prolonged exercise, while walking up stairs, after heavy training and go away after rest. There are no restrictions on movement, but sometimes subtle swelling of the joint may occur. This condition, if nothing is done, can last for years - at this time the cartilage has just begun to lose its softness due to the impaired blood supply. An X-ray will show a slight narrowing of the joint space and stiffening of the bones.
- Phase 2- pains become strong and last long enough even with light efforts. A cracking sound is heard during flexion and extension of the joint. Full bending of the leg becomes impossible due to severe pain. There is a slight deformity, muscle loss and limited movement. The pain may be relieved with painkillers or go away on its own after rest.
At this stage, the cartilage layer is already thinning a lot, in some places to the point of disappearing. The synovial fluid becomes thicker and more viscous, which impairs its nourishing and lubricating properties. Osteophytes appear - bony growths.
- Phase 3– the pain increases and bothers constantly, even at night. Joint deformity becomes apparent, gait changes, and the lower limb bends. The range of motion in the knee joint is reduced - the leg cannot be fully bent or straightened. When walking, you should use support in the form of a stick or crutches. Painkillers no longer help.
The cartilage is almost completely obliterated, the bones are compressed, the joint space is greatly narrowed or absent. The presence of many osteophytes is noted.
A common symptom of arthrosis of the knee joint can be identified - pain of varying intensity, localized along the anterior-inner surface of the joint.
Diagnosing
If you notice symptoms similar to the development of gonarthrosis, you should consult a doctor. At the initial meeting, the doctor will collect the history, check the biomechanical abilities of the joint and prescribe the necessary examinations. Be sure to inform him about injuries and illnesses suffered, lifestyle, diet, medications taken and work characteristics.
The most informative and simple way to confirm or reject a diagnosis is an x-ray of the knee joint - it allows you to make a differential diagnosis, determine the rate 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 accurate method to diagnose changes in the joint using special endoscopic equipment.
Additional research methods are ultrasound and MRI - they are prescribed when radiography is not informative enough.
Treatment of arthrosis of the knee joint
After the diagnosis, the doctor chooses the optimal treatment, depending on the stage of the disease and individual characteristics. This solves three problems:
- pain relief;
- stopping the progression of the pathology;
- restoration of joint functionality.
The specialist chooses a comprehensive solution, which can be adjusted during the treatment process.
In modern medicine, there are many ways to treat joint diseases. All of them can be divided into three types: conservative, minimally invasive, surgical.
Conservative method of gonarthrosis treatment
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 must avoid excessive vertical load on the joint: jumping, running, etc. If necessary, it is recommended to lose excess weight. The doctor will recommend a diet and choose a gentle set of exercises that will reduce axial impacts and improve cartilage tissue nutrition.
Physiotherapy is prescribed to improve blood circulation in the joint area, to increase the range of motion and also to increase the effect of medication:
- Shock wave therapy - short-term impact on bones and connective tissue with acoustic impulses of significant low-frequency amplitude;
- electrotherapy - exposure of the affected area to electric current, magnetic or electromagnetic fields;
- laser therapy - exposure to optical radiation created by a laser;
- phonophoresis - exposure to the affected area with ultrasound and drugs applied to the skin;
- electrophoresis - exposure of the affected area to electricity.
Massage, compresses, wearing an orthosis and kinesiotaping have also proven themselves well in the treatment of arthrosis.
In addition, well-chosen drug therapy helps to relieve pain, stop inflammation and slow down the process of cartilage tissue destruction. For this purpose, anti-inflammatory, hormonal, antispasmodic and chondroprotective drugs are prescribed. They can be in the form of tablets, injectable or topical, depending on the situation.
Minimally invasive method of gonarthrosis treatment
If the above procedures have no effect, the doctor can prescribe intra-articular injections:
- Hyaluronic acid – as a synovial fluid replacement to improve friction, reduce pain and improve knee joint function. The average duration of the drug's 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 was ineffective, or you first turned to a specialist with the third stage of arthrosis of the knee joint, then the doctor can direct surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position to eliminate pain;
- arthroscopic debridement - drainage of joints using an arthroscope;
- corrective osteotomy - elimination of bone deformities with artificial fracture;
- endoprosthetics - replacement of a worn out joint with an artificially created implant from biocompatible materials.
The type of surgery is chosen by the doctor based on the characteristics of the arthrosis of the knee joint. But endoprosthetics is considered the gold standard, as it allows you to fully return to your normal lifestyle. At the same time, a good implant does not require replacement for 15-30 years. To fully recover after surgery, it is necessary to undergo a rehabilitation course lasting 3-4 months.
Complications
Gonarthrosis develops quite slowly, but it can be detected at the right 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 diseased 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.
Preventing
There is no preventive treatment for gonarthrosis. But people at risk are advised to adhere to certain rules:
- make sure your weight does not exceed the age norm;
- do not engage in sports that place great stress on the knee joint;
- if possible, completely cure infectious diseases without causing complications;
- don't get cold or overtired;
- avoid joint damage and overload;
- avoid stressful situations;
- do not forget about rest;
- engage in exercise therapy;
- wear orthopedic shoes.
Groups at risk include the elderly, athletes and dancers. Here you can also add those who lead a sedentary lifestyle, stay a lot at work or lift weights and are overweight.
Any change in the axis of the lower limbs or in the normal biomechanics of the joint, dysplasia, a decrease in the volume and strength of the leg muscles or trauma can also lead to arthrosis.
Get checked regularly and take preventive measures.
Question answer
- What is the difference between knee arthritis and knee osteoarthritis?
Arthritis is the collective name for joint inflammation, and arthrosis is a degenerative-dystrophic process.
- Which doctor treats arthrosis?
Traumatologist-orthopedic or rheumatologist.
- Is it possible to play sports with arthrosis of the knee joint?
Prolonged and heavy load on the joint, as well as axial impact, should be avoided. But you should not completely exclude sports from your life - when you move, your joints are "fed" and restored better. It is important to observe the measure and adhere to the recommendations of the doctor, who will choose the type and method of exercise.