Osteoarthritis of the knee joint

The knee joint experiences regular stress. Running and jumping, walking and climbing stairs or just standing all affect the condition of the cartilage tissue in the knee. If the balance in the cartilage is disturbed, then the development of arthrosis of the knee joint begins - gonarthrosis.

Gonarthrosis is an arthrosis that deforms the knee joint, which is accompanied by chronic damage to the surface of the hyaline cartilage, as well as to the bones - the femur and tibia. Symptoms of the disease in the knee joint are pain that increases with movement. Due to the accumulation of fluid in it, movement is limited. Later, there is a limitation of the movements of the knee due to a violation of the support in the leg. The diagnosis of the pathology is based on the collection of the patient's history and complaints, the results of a visual examination and hardware tests of the knee joint. Such age-related disorders of the musculoskeletal system appear in almost everyone in old age.

Main information

Gonarthrosis (from the Latin articulatio genus - knee joint) is the most common arthrosis, which is a degenerative-dystrophic progressive damage to the cartilage of the knee joint with a non-inflammatory nature. Women and the elderly usually suffer from gonarthrosis. But after injuries during intense sports, gonarthrosis occurs even in young people.

The cause of arthrosis lies in the change in the structure of the cartilage inside the joint, not in the deposition of salts there. In gonarthrosis, salt deposits appear at the places where the tendons are attached to the ligament apparatus, but they cannot be the cause of the pain symptoms. First, cracks appear in the cartilage, reducing the thickness in some areas. Gradually, the load is redistributed, the joint begins to come into contact with the bones, accelerating the painful process. As a result, the following changes occur in the knee joint:

• thinning of the knee cartilage until it disappears;
• changes in the composition and amount of synovial fluid;
• bone damage in the knee due to friction;
• the appearance of osteophytes;
• stiffness due to compaction of the joint capsule;
• muscle spasm.

As a result, the knee joint is deformed, its mobility is limited, as a result of which damage and loss of working capacity may occur.

Osteoarthritis of the knee joint can be unilateral and affect only one knee of the right or left leg, while bilateral arthrosis affects both knee joints.

Symptoms of arthrosis of the knee joint

Symptoms of knee arthrosis can be very different:

• At first, slight discomfort appears when climbing the stairs, then the pain syndrome increases and torments even at rest;
• stiffness appears in the morning, at first it lasts a few minutes, then it can last up to half an hour;
• a sharp crunch occurs, which is already accompanied by pain in the second degree of damage;
• mobility is limited, the knee is difficult to bend and straighten due to pain, bone friction and growth of osteophytes, the joint can be blocked in the final stages (ankylosis);
• unsteady gait due to muscle atrophy (reduction in muscle volume);
• deformation of the knee joint due to growth of the bones and changes in their shape, occurrence of an inflammatory process in the muscles and ligaments, swelling around the tissues of the joint increases;
• lameness as a result of the progression of the disease of the knee joint; in the later stages the patient is forced to walk even with a walker.

The disease of arthrosis begins gradually. In the first stage of gonarthrosis, patients experience mild sensations of stiffness and pain that occur when climbing or descending stairs. Possible tightening of the area below the knee. The initial pain sensations that arise from a sitting position at the beginning of the ascent are characteristic. When the patient moves away, the pain subsides, but with exertion it reappears.

There are no external changes in the knee. Sometimes swelling and development of synovitis is possible - fluid accumulation with enlargement, swelling of the joint, in which heaviness is felt and movement is limited.

In stage 2, intense pain occurs with prolonged exertion and is aggravated by walking. The pain is usually located on the anterior surface inside the joint. After rest, the pain disappears, but with movement it reappears.

As arthrosis progresses, the number of movements in the knee joint decreases, when you try to bend your leg as much as possible, pain and a harsh, sharp creak appear. The configuration changes, the joint expands. Synovitis occurs with an even greater accumulation of fluid in them.

At stage 3, the pain becomes constant and bothers you not only when walking, but also at rest. Painful sensations appear even at night to sleep, patients take a long time to find a position for their leg. Flexion and extension of the joint are limited. Sometimes the patient cannot straighten the leg completely. The joint is enlarged and deformed. Sometimes patients develop a valgus deformity of the legs, they become X-shaped or O-shaped. As a result of leg deformity and limited movement, patients' gait becomes unstable and wobbles. In severe cases of gonarthrosis, patients move with the help of crutches.

Causes of arthrosis of the knee joint

Most cases of osteoarthritis occur for several reasons. These factors include:

• Injuries.25% of gonarthrosis occurs due to injuries: damage to the meniscus, rupture of ligaments. Gonarthrosis usually appears three to five years after the injury, sometimes the disease can develop earlier - after two to three months.
• Physical exercises.Often, gonarthrosis appears after forty years due to professional sports and excessive physical load on the knee joint, which leads to the development of degenerative-dystrophic changes. Fast running and intense squats are especially dangerous for the joints.
• Overweight.Excess weight significantly increases the load on the knee joints, which leads to injury. Gonarthrosis is especially difficult if there are metabolic disorders and varicose veins.
• Sedentary way of life.

The process of developing gonarthrosis is intensified in arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is genetic weakness of the ligaments and impaired innervation in neurological diseases.

Pathogenesis

The knee joint is formed by the surfaces of the femur and tibia. In front of the surface of the knee joint is the patella. It slides during movement between the grooves of the femur. The articular surfaces of the tibia and femur are covered with very strong, smooth and elastic hyaline cartilage up to 6 mm thick. During movement, cartilage reduces friction and acts as a shock absorber.

There are 4 stages of arthrosis:

• 1st stage.There is a violation of blood circulation in the vessels that feed the hyaline cartilage. Its surface dries out and small cracks appear on it, the cartilage gradually loses its smoothness, the cartilaginous tissue becomes thinner and instead of sliding smoothly, it adheres, losing its shock-absorbing qualities. There are no visual symptoms of arthrosis, the X-ray shows a slight deviation.
• 2nd stage.Changes occur in the bone structure and the joint area flattens to accommodate greater loads. The part of the bone that is under the cartilage becomes denser. At the edges of the joint, manifestations of initial calcification of the ligaments appear - osteophytes, resembling spikes on an X-ray, and a narrowing of the gap in the joint is visible. The synovial capsule of the joint degenerates, wrinkles. The fluid in the joint thickens, its viscosity increases and its lubricating properties deteriorate. The degeneration process in the cartilage accelerates, it thins, and in some places it disappears completely. After its disappearance, friction in the joint increases and degeneration progresses sharply. Patients experience pain during exercise, climbing stairs, squatting, and prolonged standing.
• 3rd stage.X-rays show marked, sometimes asymmetrical narrowing of the joint space. Due to deformation of the meniscus, the bones are deformed and pressed against each other. Movement in the joint is limited due to the large number of large osteophytes. No cartilage tissue. Constant pain haunts the patient at rest, it is impossible to walk without support.
• 4th stage.Movements in the knee joint are impossible, X-rays show complete deformation of the cartilage and destruction of the articular bones, numerous osteophytes, bones can fuse with each other.

Classification

Considering the pathogenesis of the disease, two types are distinguished: primary - idiopathic and secondary gonarthrosis. Primary occurs without injury, usually in elderly patients and is bilateral. Secondary develops as a result of diseases and developmental disorders or against the background of injuries in the knee joint. It can appear at any age and is usually unilateral.

Diagnosis

The diagnosis of joint arthrosis is carried out by an orthopedist or a traumatologist in a medical clinic.

• The appointment begins with the collection of anamnesis - the main complaints and symptoms that worry the patient. The doctor detects complaints, the presence of chronic diseases, past injuries, fractures and injuries and asks additional questions.
• On examination, mobility of the joint, deformity and pain characteristics are revealed. In stage 1 of gonarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformation and thickening of the joint contours, limitation of movements and distortion of the legs are detected. When the patella moves, a sharp crunch is heard. During palpation, the doctor finds pain in the inner part of the joint cleft. The joint can be increased in size. Swelling of the joint is detected. A fluctuation is felt when palpating the joint.
• The patient is referred for laboratory tests. Taking a general blood test detects inflammation, while a biochemical test reveals the possible causes of problems.
• After that, an instrumental diagnosis of the patient is necessary. X-rays are used for this. Radiography is a diagnostic method that allows you to detect signs of knee arthrosis: narrowing of the joint space, osteophytes and bone deformations. X-ray of the joint is a method that clarifies the diagnosis of pathological changes and the dynamics of arthrosis. At the beginning of gonarthrosis, the changes are not visible on X-rays. Subsequently, narrowing of the joint space and densification of the subchondral zone is determined. Gonarthrosis can only be diagnosed with X-rays and clinical examinations.
• Nowadays, in addition to x-rays, computed tomography (CT) is used to diagnose arthrosis, which allows a detailed study of bone changes, as well as nuclear magnetic resonance (MRI), which makes it possible to visually assess the state of the joint and is usedto identify changes in muscle tissue and ligaments.
• When performing an ultrasound examination (ultrasound), the condition of the tendons, muscles and joint capsule is assessed.
• Fluid is drained from the affected joint so a camera can be placed to view the inside of the joint (arthroscopy).

If necessary, the doctor appoints tests and additional consultations with more specialized specialists.

Treatment of arthrosis of the knee joint

The treatment of arthrosis can be divided into three groups:

• medicinal
• physical therapy;
• surgically.

Arthritis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins at an early stage. In case of exacerbation of arthrosis, doctors recommend maximum rest of the joint. Patients are prescribed the necessary procedures: exercise therapy, massage, mud therapy.

When the patient is diagnosed with stage 1 and 2 of the disease, drugs and physical therapy are used; if the lesion is extensive, then surgery and surgical intervention are used.

Medication treatment

Proper medication can stop pain and inflammation, as well as slow down the process of cartilage tissue destruction. That is why it is important to consult a doctor in a timely manner.

Important - do not self-medicate. The wrong drugs, chosen independently and without consulting a doctor, can only worsen the situation and lead to serious complications.

Drug therapy for arthrosis includes taking the following drugs:

• anti-inflammatory:relief of inflammation and relief of pain in the joint;
• hormonal:prescribed when anti-inflammatory drugs are ineffective;
• antispasmodics:help to get rid of muscle spasms and relieve the patient's condition;
• chondroprotectors:improve metabolic processes in the joint and help restore joint function, as well as drugs that replace synovial fluid;
• drugs to improve microcirculation:improving nutrition and oxygen supply.

Depending on each specific situation, tablets, intra-articular injections of steroid hormones and local forms of drugs are used. The choice of drugs is made by the attending physician. Sometimes a patient with arthrosis is sent for treatment to a sanatorium and is recommended to walk with crutches or a cane. To relieve the load on the knee joint, individual orthoses or special insoles are used.

In addition, complex non-drug methods are used to treat arthrosis:

• physiotherapy (physical therapy)which is conducted under the supervision of a specialist;
• massage coursesin the absence of an inflammatory process;
• osteopathic effectin the treatment of arthrosis, which is aimed not only at the affected area, but also at restoring the resource of the entire organism, since the pathological process occurring locally in the joint area is the result of many processes occurring in the body as a whole. . During the osteopathic session, the musculoskeletal system as a whole is worked on to achieve maximum restoration of innervation and mobility of the spine, pelvic bones, sacrum and to eliminate compression of nerves and blood vessels throughout the body!

Physiotherapy

Physiotherapy methods are used to improve blood circulation in the joint, increase its mobility and enhance the healing effect of drugs. The doctor may prescribe the following procedures:

• shock wave therapy:ultrasound eliminates osteophytes;
• magnetic therapy:the magnetic field affects metabolic processes and stimulates regeneration;
• laser therapy:laser heating of deep tissues;
• electrotherapy (myostimulation):electric shock to the muscles;
• electrophoresis or phonophoresis:application of chondroprotectors and analgesics with ultrasound and electric current;
• ozone therapy:injection of gas into the joint cavity.

surgery

Even with correctly selected treatment, in some cases the treatment methods are ineffective. Then the patient with severe pain syndrome is prescribed surgical treatment and operations for arthrosis of the knee:

• arthroplasty:replacement of the entire joint with a prosthesis;
• arthrodesis:attachment between bones for their immobility, to reduce pain and enable a person to stand on the leg;
• osteotomy:cutting out one bone to angle it into the joint to reduce stress.

If endoprosthesis is not possible, then arthrodesis and osteotomy are used.

Prevention

Prevention measures and compliance with the doctor's recommendations play an important role in the occurrence of gonarthrosis. In order to slow down the processes of joint degeneration, it is important to follow the rules:

• engage in special physical activity: physical therapy and gymnastics without unnecessary loads on the joints;
• avoid strenuous physical activity;
• choose comfortable orthopedic shoes;
• Monitor your weight and daily routine - alternate special exercises and rest time.

Diet

The condition of the affected cartilage depends largely on nutrition. In the case of arthrosis, it is necessary to exclude:

• carbonated drinks;
• alcoholic beverages;
• fatty and excessively spicy foods;
• canned goods and semi-finished products;
• products with dyes, preservatives, artificial flavors.

The diet should contain: proteins, fatty acids, for example omega-3, collagen, which is contained in gelatin. It is necessary to eat without increasing body weight.

Consequences and complications

Osteoarthritis of the knee joints develops slowly, but if not treated, serious complications arise:

• deformation of the joint and change in the general configuration of the knee due to muscle restructuring and distortion of the bone frame;
• shortening of the lower limbs;
• ankylosis - complete immobilization of the knee joint;
• damage to the musculoskeletal system.