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 arthrosis that deforms the knee joint, which is associated with chronic damage to the surfaces of the hyaline cartilage, as well as to the bones - femur and tibia. Symptoms of disease in the knee joint are pain that intensifies with movement. Due to the accumulation of fluids in it, movement is limited. Later, there is a limitation of the movements of the knee due to the violation of support on 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 examinations of the knee joint. Such age-related disorders of the musculoskeletal system appear in almost everyone in old age.

General information

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

The cause of arthrosis lies in the change in the structure of the cartilage within the joint and not in the deposition of salts there. With gonarthrosis, salt deposits occur where the tendons are attached to the ligamentous apparatus, but they cannot be the cause of pain symptoms. First, cracks appear in the cartilage, which reduce 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 synovial fluid in composition and quantity;
• damage to the bones in the knee due to friction;
• appearance of osteophytes;
• stiffness due to compression of the joint capsule;
• muscle spasm.

As a result, the knee joint is deformed, its mobility is limited, as a result of which this can lead to disability and loss of ability to work.

Osteoarthritis of the knee joint can be unilateral and affect only one knee of the right or left leg; in the case of bilateral arthrosis, both knee joints are affected.

Symptoms of arthrosis of the knee joint

Symptoms of knee arthrosis can be very different:

• At first, a slight discomfort appears when climbing the stairs, then the pain syndrome increases and hurts 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 crack occurs, which is already accompanied by pain in the second degree of damage;
• mobility is limited, it is difficult to bend and straighten the knee 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 the growth of the bones and changes in their shape, the appearance of an inflammatory process in the muscles and ligaments increases the swelling around the tissues of the joint;
• lameness as a result of the progression of the knee joint disease, in the later stages the patient is forced to walk 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 going up or down stairs. Possible tightness of the area below the knee. Characteristic are the initial sensations of pain arising from a sitting position during the beginning of ascent. When the patient leaves, the pain decreases, but with exertion it reappears.

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

In stage 2, intense pain appears with prolonged exercise and intensifies during walking. The pain is usually localized along the anterior surface within the joint. After rest, the pain disappears, but during movement it reappears.

As arthrosis progresses, the range of motion in the knee joint decreases; when you try to bend the leg as much as possible, pain and a sharp, sharp crack appear. The configuration changes, the node expands. Synovitis appears with an even greater accumulation of fluid in them.

In stage 3, the pain becomes constant and bothers you not only when walking, but also at rest. Painful sensations appear even at night; to fall asleep, 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 have valgus deformity of the legs; they become X- or O-shaped. As a result of leg deformation and limited movement, patients' gait becomes unstable and wobbles. In severe cases of gonarthrosis, patients move with crutches.

Causes of arthrosis of the knee joint

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

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

The process of developing gonarthrosis increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is genetic weakness in ligaments and damaged 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 when it moves between the grooves of the femur. The articular surfaces of the tibia and femur are covered with very hard, smooth and elastic hyaline cartilage up to six mm thick. When moving, cartilage reduces friction and acts as a shock absorber.

There are 4 stages of arthrosis:

• Phase 1.There is a disturbance in blood circulation in the vessels that feed the hyaline cartilage. Its surface becomes dry and small cracks appear on it, the cartilage gradually loses its softness, the cartilage tissue becomes thinner and, instead of sliding smoothly, sticks, losing its shock-absorbing quality. There are no visual symptoms of arthrosis; x-ray shows a slight deviation.
• 2nd phase.Changes occur in the bone structure and the joint area flattens to accommodate greater loads. The part of the bone under the cartilage becomes denser. Along the edges of the joint, manifestations of the initial calcification of the ligaments appear - osteophytes that resemble spikes on an x-ray; narrowing of the joint gap is also visible. The synovial capsule of the joint degenerates and becomes wrinkled. The fluid in the joint thickens, its viscosity increases and its lubricating properties deteriorate. The process of cartilage degeneration accelerates, it becomes thinner and in some places it disappears completely. After its disappearance, the friction in the joint increases and the degeneration progresses significantly. Patients experience pain during exercise, climbing stairs, sitting and standing for a long time.
• The 3rd phase.X-rays show a marked, sometimes asymmetrical narrowing of the joint space. Due to the 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. There is no cartilage. Constant pain follows the patient at rest; it is impossible to walk without support.
• The 4th stage.Movements in the knee joint are impossible; x-rays show complete deformation of the cartilage and destruction of the articular bones, many osteophytes, and the bones may fuse with each other.

Distribution

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 to the knee joint. It can occur at any age and is usually unilateral.

Diagnosing

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

• The appointment begins with the collection of anamnesis - the main complaints and symptoms that concern the patient. The doctor reveals complaints, the presence of chronic diseases, past injuries, fractures and injuries and asks additional questions.
• After the examination, the characteristics of mobility, deformation and joint pain are revealed. In stage 1 of gonarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformations and thickening of the contours of the joints, limitation of movements and bending of the legs are detected. When the patella moves, a sharp cracking sound is heard. After palpation, the doctor detects pain in the inner part of the joint space. The link can grow in size. Joint swelling is detected. When palpating the joint, fluctuation is felt.
• The patient is referred for laboratory analysis. When taking a general blood test, inflammation is detected, while a biochemical test reveals possible causes of problems.
• Then, instrumental diagnosis of the patient is required. X-rays are used for this. X-rays are a diagnostic method that allows you to detect signs of knee arthrosis: narrowing of the joint gap, osteophytes and bone deformations. Radiography of the joint is a technique that clarifies the diagnosis of pathological changes and the dynamics of arthrosis. At the beginning of gonarthrosis, changes are not visible on X-rays. Then, a narrowing of the joint space and compression of the subchondral area is determined. Gonarthrosis can only be diagnosed with x-rays and clinical analysis.
• Nowadays, in addition to radiography, computerized tomography (CT) is used to diagnose arthrosis, which makes it possible to study bone changes in detail, as well as magnetic resonance imaging (MRI), which makes it possible to visually assess the state of the bone. joint and is used to identify changes in muscle tissue and ligaments.
• During an ultrasound examination (ultrasound), the condition of the tendons, muscles and joint capsule is evaluated.
• Fluid is drained from the affected joint to allow a camera to be inserted to view the inside of the joint (arthroscopy).

If necessary, the doctor prescribes additional studies and consultations with more specialized specialists.

Treatment of arthrosis of the knee joint

Treatments for arthrosis can be divided into three groups:

• medicinal;
• physiotherapy;
• surgical.

Arthrosis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins at an early stage. When arthrosis worsens, doctors recommend maximum rest for the joint. Patients are prescribed the necessary procedures: exercise therapy, massage, mud therapy.

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

Drug treatment

Proper administration of drugs can stop pain and inflammation, as well as slow down the process of cartilage tissue destruction. Therefore, it is important to immediately consult a doctor.

Important - do not self-medicate. The wrong medications, 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 medications:

• anti-inflammatory:relief of inflammation and relief of pain in the joints;
• 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 joints and help restore joint function, as well as drugs that replace synovial fluid;
• Medicines for improving microcirculation:improve 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 carried out 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 ease the load on the knee joint, individual orthoses or special insoles are used.

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

• physical therapy (physiotherapy)which is performed under the supervision of a specialist;
• whereas massagein the absence of an inflammatory process;
• osteopathic effectin the treatment of arthrosis, which aims not only at the affected area, but also at restoring the source of the entire organism, since the pathological process that occurs locally in the joint area is the result of many processes that occur in the body as a whole. . During the osteopathic session, the musculoskeletal system is worked on as a whole to achieve maximum restoration of innervation and mobility in the spine, pelvic bones, sacrum and elimination of 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 increase the medicinal 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:administration of chondroprotectors and analgesics using ultrasound and electric current;
• Ozone therapy:gas injection into the joint cavity.

Surgery

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

• endoprosthetics:replacement of the entire joint with a prosthesis;
• arthrodesis:fixation between the bones for their immobility, to reduce pain and to give a person the opportunity to stand on his feet;
• osteotomy:cutting a bone to place it at an angle in the joint to reduce stress.

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

Preventing

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

• engage in special physical activities: physical therapy and gymnastics without unnecessary joint loads;
• avoid heavy physical activity;
• choose comfortable orthopedic shoes;
• Monitor your weight and daily routine - alternate special exercises and time for rest.

diets

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

• carbonated drinks;
• alcoholic drink;
• fatty and excessively spicy foods;
• canned foods and semi-finished products;
• products with colors, 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 appear:

• deformity of the joint and change in the overall configuration of the knee due to the restructuring of the muscles and the curvature of the bone frame;
• shortening of the lower limbs;
• ankylosis - complete immobilization of the knee joint;
• damage to the musculoskeletal system.