Gonarthrosis, or deforming osteoarthritis of the knee joint, is a degenerative-dystrophic disease of the hyaline cartilage of the knee, covering the condyles of the tibia and femur.
Symptoms of osteoarthritis of the knee joint develop gradually over the years, and the main manifestation of the disease is stiffness of movements and pain.Among osteoarthritis of other joints (phalanges of the fingers, shoulder and elbow joints, hip joints), gonarthrosis is the most common disease.
The population category most susceptible to osteoarthritis of the knee joint is women, as well as people over 40 years old.In some cases, gonarthrosis can develop in athletes (due to increased stress) and young people (against the background of previous injuries).
Causes of knee osteoarthritis
Osteoarthritis of the knee joint does not develop due to a single cause;In most cases, the development of the disease depends on a combination of several negative factors, which worsen with age and can ultimately lead to such a disorder.Medicine identifies the following mechanisms for the occurrence of osteoarthritis:
Primary – occurs in older people due to aging of body tissues, as well as against the background of certain factors provoking this disease (constant increased stress, heredity, obesity).
Secondary – accounts for 30% of all cases of gonarthrosis, occurring mainly after damage to the meniscus, rupture of ligaments, fracture of the tibia and other injuries.In most cases, symptoms of knee osteoarthritis begin to appear after 3 to 4 years.However, if the injury is severe enough, it may take 2 to 3 months for symptoms to appear.
About 7-8% of cases of osteoarthritis of the knee joint occur when, after forty years, a person begins to actively engage in physical exercise, namely squats and running.But due to age, the weakening of the tone of the tissues of the knee joint and characteristic age-related changes under sudden loads can provoke the appearance of rapid degenerative and dystrophic changes in the joints.
Another reason for the development of gonarthrosis in a person may be concomitant diseases - varicose veins, excess weight, ankylosing spondylitis, gout, psoriatic, rheumatoid or reactive arthritis.
Constant critical loads on the knees, long-term regular climbing of stairs in old age or lifting heavy loads, as well as playing professional sports can lead to osteoarthritis of the knee joint.The risk of osteoarthritis of the knee joint increases significantly in cases of genetic weakness of the ligamentous apparatus, diabetes mellitus and other metabolic disorders, neurological diseases and spinal injuries.
Spasms of the muscles of the front of the thigh are the cause of 50 to 60% of cases of osteoarthritis of the knee joint.Such muscle spasms may not manifest themselves for long before knee pain appears, while the person may feel heaviness in the legs, fatigue and pain in the lower back.When the iliopsoas and rectus femoris muscles are in a state of constant spasm, this leads with age to a “tightening” of the knees, which limits their freedom of movement.
Degrees of knee osteoarthritis
In most cases, the development of osteoarthritis of the knee joint occurs in one of the knees.Medicine distinguishes 3 degrees of gonarthrosis depending on the intensity of the pathological processes:
The first is that there is no deformation of the bones of the joint;dull, periodic knee pain is characteristic after physical stress on the joint.A slight swelling of the joint may develop, which disappears on its own after a while.
The second degree is characterized by an increase in osteoarthritis symptoms.The pain is intense and long-lasting, and occurs with minimal effort (lifting heavy objects, walking), and a cracking sound may also appear in the joint.In the second degree of gonarthrosis, deformation of the knee joint as well as moderate limitation of movements may develop.
Third degree – has pronounced symptoms of osteoarthritis of the knee joint.Noticeable deformation of the joint and constant pain lead to impaired gait and limited joint mobility.In the third degree of gonarthrosis, the pain can intensify depending on the weather and reach such intensity that the patient's sleep is disturbed, the limitation of mobility is reduced to a minimum, which makes it impossible to find a comfortable position for the leg.
Diseases and pathologies with which gonarthrosis is confused
Blocking of the knee joint in case of meniscus injury.
The disease develops after unsuccessful movement, accompanied by cracking of the knee, severe pain appears, which disappears after 15 minutes, and the next day swelling of the knee occurs.
Ankylosing spondylitis, gout, rheumatoid arthritis, arthritis - psoriatic, reactive, rheumatoid.
To distinguish gonarthrosis from arthritis, it is necessary to take a general blood test.With arthritis, the test results will indicate the presence of an inflammatory process in the body, while with osteoarthritis, no changes in the blood test occur.
Inflammation of the knee tendons.
It develops in most cases in women over 40, when they carry heavy objects or go down stairs.The pain is localized on the inner surface, but the movement of the knee is not limited.
Vascular pain in the knees.
The pain is characterized by symmetry and occurs simultaneously in both knees.Characteristic of young people in a period of accelerated bone growth, they can occur during physical activity, a cold, or a change in the weather.To describe their own condition, patients use the term “twisted knees.”
Stages of osteoarthritis of the knee joint
The disease is insidious due to its gradual development.At first, the patient feels only minor discomfort, pain when moving, going up or down stairs.In some cases, the patient's sensations are reduced to slight stiffness in the joint and a feeling of tightness in the popliteal region.A characteristic feature of osteoarthritis of the knee joint is considered to be an initial pain symptom, which consists in the fact that after a sharp transition from a sitting position to movement, a person begins to feel pain during the first steps, which gradually disappears, only to reappear after a heavy load.
The appearance of the knee joint with the first degree of osteoarthritis is no different from a healthy knee, only in some cases patients note slight swelling.Additionally, in some cases, fluid begins to accumulate in the knee joint, it swells and becomes spherical, and synovitis begins to develop, which leads to a feeling of heaviness and limited movement of the joint.
Such changes in the joint in the first degree of osteoarthritis occur due to disruption of blood circulation in small intraosseous vessels that nourish hyaline cartilage.This leads to changes in the surface of the cartilage, dryness, loss of smoothness and the appearance of cracks.For this reason, smooth, unhindered movement between the cartilages is difficult and is accompanied by constant microtrauma when the cartilages cling to each other.Cartilage tissue, being in a constant state of microtrauma, begins to lose its shock-absorbing properties and becomes thinner.
The development of pathological processes leads to changes in bone structures.The joint area is flattened and growths in the form of thorns (osteophytes) appear along the edges.The joint capsule degenerates, the joint fluid thickens, and the synovial membrane shrinks.This leads to a significant deterioration in the nutritional process of cartilage and accelerates its degeneration.
As the disease progresses to the second stage, the symptoms begin to intensify, pain occurs even with light loads and is localized along the anterior inner side of the joint.Rest brings relief, but resuming movement causes severe pain.
The mobility of the joint is significantly reduced, attempts to bend the leg as much as possible cause sharp pain, and a distinct rough crunch is heard when moving.Synovitis is more common;the joint enlarges and changes configuration due to significant fluid accumulation.
The third degree of osteoarthritis of the knee joint is accompanied by significant deformation of the bones, in which they seem to be pressed against each other.There is practically no cartilage tissue and limitation of joint movements increases.Straightening the joints becomes quite problematic and the pain begins to bother the patient around the clock, both when walking and at rest.Due to severe deformation of the joints, the legs acquire an O- or X-shaped shape, the gait becomes unstable, waddles, and quite often the patient cannot do without a cane or crutches.
Diagnosis and treatment of knee osteoarthritis
During a routine examination, it is impossible to determine whether a patient has first-degree osteoarthritis of the knee.If there is a degree 2 or 3, on examination there is swelling, edema (with synovitis), a crunch is heard, stiffness of movements is observed, a change in the axis of the limbs and deformation of the joints is noticeable.
Today, in addition to X-ray, CT and MRI methods are widely used to diagnose osteoarthritis, thanks to which it is possible to study disorders of bone structures in more detail and examine pathological changes in soft tissues.
Treatment of the disease involves a set of orthopedic procedures and drug therapy.An orthopedist prescribes mud therapy, therapeutic exercises, massage and physiotherapy.
Drug treatment involves the use of chondoprotectors, these are drugs that replace synovial fluid.In some cases, an intra-articular injection of steroid hormones is performed.Patients are also recommended to undergo sanatorium treatment.
If the treatment of a young patient with severe limitation of movements and pain is ineffective, a joint replacement method can be used, which provides for a rehabilitation period of 3-6 months.
What happens to the knee joint in osteoarthritis?
Articular cartilage plays an important role in human movement and is a smooth, elastic and durable lining, thanks to which the articulated bones move smoothly relative to each other, and also absorbs and distributes the load when walking.
But with regular excessive loads, genetic predisposition, metabolic disorders in the body, spasms and prolonged muscle injuries, the cartilage loses its softness and begins to thin out.The gentle sliding of the articulated bones is replaced by strong friction and the first degree of gonarthrosis develops, in which the cartilage loses its shock-absorbing properties.
The degradation process continues to progress and poor shock absorption leads to flattening of bone surfaces with the formation of osteophytes in the form of bony growths.In this case, the disease already has a second degree and is accompanied by degeneration of the synovial membrane and the joint capsule.Lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the process of cartilage nutrition is disrupted, which leads to an even greater deterioration in the patient's condition.
Thinning cartilage results in a reduction in the distance between articulating bones by up to 80%.When walking, due to abnormal friction and the absence of a shock absorber, destructive processes in the joint increase rapidly, which quickly leads to the development of the third degree of osteoarthritis with pronounced symptoms:
Pain when moving, especially going up or down stairs.
Pain both during exercise and at rest, morning stiffness.
The patient begins to limp, trying to spare the painful joint.
Severe cases of the disease require the use of crutches or a cane.
The third degree of osteoarthritis of the knee joint is characterized by an almost complete absence of cartilage tissue, which leads to a minimal decrease in joint mobility.Therefore, no magic methods, super drugs or ointments can restore worn-out cartilage tissue, and given the degree of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.
Gymnastics for osteoarthritis of the knee joint
Any treatment options for osteoarthritis of the knee joint should only be carried out as prescribed by a doctor.Therapeutic gymnastics involves slow, measured exercises that exclude squats, joint twists and jumps.It is best to do gymnastics in the morning, sitting or lying down, for 20 minutes, repeating each exercise 10 times.
The main goals of therapeutic exercises are to relax muscle spasms that cause pain, increase blood supply to the joint, slow the progression of the disease, and prevent further destruction of cartilage.During the period of exacerbation of the disease, physical exercise is prohibited.
Lying on your back, you can perform the bicycle exercise, but you need to straighten your legs parallel to the floor, make circular movements with your feet, move your legs to the sides, sliding them alternately on the floor, straighten your feet to a count of 10.
Sitting on a chair with your legs down, straighten your legs while bending your feet and hold this position for a count of 10, alternately pull each knee towards your stomach with your hands and slowly return to the starting position.
Focusing on the wall, standing on the floor, alternately swing your legs back and forth.
Placing your straight leg on a chair, perform inclined movements of an elastic nature, while placing your hands on your thigh, as if trying to straighten your leg further.
Lying on your stomach, alternately lift your straight leg and hold it for 3 counts.
Sitting on the floor, spread your legs to the sides, move them across the floor, bring your knees toward your stomach as you inhale and return them to their starting position as you exhale.