Arthrosis (gonarthrosis) is a pathological change in the knee joint that has a chronic course and can progress over time. The disease involves 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 damaged. Sometimes small damage is not immediately noticeable, but it makes itself felt in the second half of life. In this regard, joint damage is often detected in elderly people. However, young people also suffer from knee joint pathologies caused by sports or an active lifestyle.
In order to maintain maximum mobility and a high standard of living, you should consult a doctor at the first problem with your knee joint. Experienced orthopedic traumatologists will determine your condition and prescribe the necessary treatment.
Types of arthrosis of the knee joint
The bones in the joint are covered with cartilage tissue, which provides shock absorption, smooth sliding, and also prevents the bones from rubbing against each other. Cartilage tissue is nourished thanks to the synovial fluid located inside the joint and blood flowing through the vessels.
Cartilage has a spongy structure, so it absorbs fluid at rest and compresses it when loaded. At the same time, the cartilage constantly receives microtraumas during movements and recovers during rest.
If, as a result of mechanical damage, the regeneration capacity of the joint is exceeded, there is insufficient nutrition 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 arthrosis of the knee joint begins.
Depending on the causes that cause it, arthrosis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
Degenerative changes in the joint are related to age. Among the reasons for this, the following can be noted:
- natural degeneration or degradation due to slowing down of metabolic processes in the body;
- excess body weight;
- sedentary lifestyle;
- nutrition;
- genetic predisposition.
As a rule, primary gonarthrosis affects both knees at the same time and is called bilateral.
Secondary gonarthrosis
Secondary arthrosis of the knee joint can occur at any age, because it can be caused by:
- various injuries - bruises, fractures, dislocations, ruptures and sprains of ligaments or menisci;
- joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, gonitis, etc. ;
- regional vascular disorders;
- excessive loading of the knee joints during sports or due to the characteristics of work;
- endocrine diseases;
- O and X-shaped curvature of the legs.
Secondary arthrosis of the knee joint is most often seen only on one leg and is called unilateral.
Rarely, 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 looks, experts distinguish three stages of its development, which are determined during an X-ray examination. Each stage is accompanied by characteristic symptoms:
Stage 1- mild pain that occurs after long-term training, when climbing stairs, after heavy sports and after rest. There is no limitation in movement, but sometimes a subtle swelling of the joint may occur. This condition can last for years if nothing is done - when the cartilage begins to lose its smoothness due to the disruption of blood supply. X-ray examination will show some narrowing of the joint space and hardening of the bones.
- Stage 2– the pain is severe and lasts long enough even with light force. A crackling sound is heard during flexion and extension of the joint. Due to severe pain, it becomes impossible to bend the leg completely. There is mild 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 very thin, reaching the point of disappearing in some places. Synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear - bone growths.
- Stage 3- the pain increases and is constantly bothering even at night. Deformation of the joint is noticeable, the gait changes, the lower part of the 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. Pain meds no longer help.
The cartilage is almost completely removed, the bones are compressed, the joint cavity is very narrow 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 front-inner surface of the joint.
Diagnostics
If you observe symptoms similar to the development of gonarthrosis, you should consult a doctor. At the initial appointment, the doctor collects an anamnesis, checks the biomechanical capabilities of the joint and prescribes the necessary examinations. Be sure to inform him about his injuries and illnesses, lifestyle, diet, medications taken, and job characteristics.
The most informative and simple method to confirm or refute the diagnosis is X-ray of the knee joint - it allows you to make 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, it is difficult to detect gonarthrosis in the early stages even on X-ray. In such situations, the doctor can prescribe arthroscopy - a highly accurate 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 chooses the optimal treatment depending on the stage of the disease and individual characteristics. This solves three problems:
- painkiller;
- stopping the development of pathology;
- restoration of joint functionality.
The specialist chooses a comprehensive solution that 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 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, it is recommended to get rid of excess weight. The doctor will recommend a diet and choose a gentle set of exercises that will reduce axial effects and improve the nutrition of cartilage tissue.
Physiotherapy is prescribed to improve blood circulation in the joint area, increase the range of motion, and also increase the effect of drugs:
- shock wave therapy - short-term effect on bone and connective tissue with low-frequency significant amplitude acoustic pulses;
- electrotherapy - exposure of the affected area to electric current, magnetic or electromagnetic fields;
- laser therapy - exposure to optical radiation caused by a laser;
- phonophoresis - exposure to the affected area with ultrasound applied to the skin and medication;
- electrophoresis - exposure of the affected area to electricity.
In the treatment of arthrosis, massage, compresses, orthosis and kinesiotherapy have also proven themselves well.
In addition, properly selected drug treatment helps to 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. Depending on the situation, they can be in tablet, injection or local form.
A minimally invasive method of gonarthrosis treatment
If the above procedures have no effect, the doctor can prescribe 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 is 3-6 months;
- own plasma enriched with platelets - for cartilage tissue nutrition and regeneration;
- corticosteroids - to reduce inflammation.
Surgical method for treatment of gonarthrosis
If conservative treatment is ineffective, or if you first consulted a specialist with the third stage of arthrosis of the knee joint, the doctor may refer to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological state to relieve pain;
- arthroscopic debridement - joint sanitation using an arthroscope;
- corrective osteotomy - removal of bone deformations with an artificial fracture;
- endoprosthetics - replacing a worn out joint with an artificially created implant from biocompatible materials.
The type of operation is selected by the doctor based on the characteristics of knee joint arthrosis. But endoprosthetics is considered the gold standard because 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. After the operation, it is necessary to undergo a rehabilitation course lasting 3-4 months to fully recover.
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 diseased joint;
- inability to lean on the injured limb;
- severe joint deformation 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 function, or even immobility.
It is important to remember that it is impossible to cure arthrosis completely. However, 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. However, people at risk are advised to follow certain rules:
- ensure that your weight does not exceed the age norm;
- do not engage in sports that put a heavy load on the knee joint;
- if possible, treat infectious diseases completely without causing complications;
- do not overcool or overexert yourself;
- avoid damage and overloading of the joint;
- avoid stressful situations;
- do not forget about rest;
- engage in exercise therapy;
- wear orthopedic shoes.
At-risk groups include the elderly, athletes and dancers. You can also add here 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 extremity or the normal biomechanics of the joint, dysplasia, loss of volume and strength of the leg muscles, or trauma can also cause arthrosis.
Get checked regularly and take preventive measures.
Question and answer
- What is the difference between knee arthritis and knee arthrosis?
Arthritis is the general name of 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?
Long and heavy joint loading as well as axial impact should be avoided. But you shouldn't completely exclude sports from your life - when you move, your joints are better "fed" and regenerated. It is important to observe the event and follow the recommendations of the doctor who will choose the type and mode of exercise.