Gonarthrosisis a deforming osteoarthritis of the knee joint. It is accompanied by damage to the hyaline cartilage of the articular surfaces of the tibia and femur and has a chronic progressive course. Clinical symptoms include pain that worsens with movement, limitation of movement, and synovitis (fluid buildup) in the joint. In later stages, leg support is impaired and a pronounced limitation of movements is observed. Pathology is diagnosed on the basis of history, complaints, physical examination and x-ray of the joint. Treatment is conservative: drug therapy, physiotherapy, exercise therapy. In case of significant destruction of the joint, endoprostheses are indicated.
general informations
Gonarthrosis (of the Latin genus articulatio - knee joint) or deforming osteoarthritis of the knee joint is a progressive degenerative-dystrophic lesion of the intra-articular cartilage of a non-inflammatory nature. Gonarthrosis is the most common osteoarthritis. Usually affects middle-aged and elderly people, women are more often affected. After an injury or intense and constant stress (for example during professional sport), knee osteoarthritis can occur at a younger age. Prevention plays the most important role in preventing the occurrence and development of gonarthrosis.
Contrary to popular belief, the cause of the development of the disease lies not in the deposition of salts, but in malnutrition and changes in the structure of intra-articular cartilage. With gonarthrosis, foci of calcium salt deposition may occur at the site of attachment of the tendon and ligamentous apparatus, but they are secondary and do not cause painful symptoms.
Causes of knee osteoarthritis
In most cases, it is impossible to identify a single reason for the development of pathology. Typically, the occurrence of knee OA is caused by a combination of several factors, including:
- Injuries. Approximately 20 to 30% of cases of knee osteoarthritis are associated with previous injuries: fractures of the tibia (especially intra-articular), meniscal injuries, tears or ruptures of ligaments. As a rule, gonarthrosis occurs 3-5 years after a traumatic injury, although earlier development of the disease is possible - 2-3 months after the injury.
- Physical exercise. Often the manifestation of gonarthrosis is associated with excessive loads on the joint. Age after 40 is a time when many people understand that regular physical activity is necessary to keep the body in good condition. When they begin to exercise, they do not take into account age-related changes and unnecessarily load the joints, which leads to the rapid development of degenerative changes and the appearance of symptoms of gonarthrosis. Intense running and fast squats are particularly dangerous for the knee joints.
- Overweight. With excess body weight, the load on the joints increases, microtrauma and serious injuries (meniscus tears or ligament tears) occur more often. Gonarthrosis is particularly difficult in obese patients with severe varicose veins.
The risk of knee osteoarthritis also increases after previous arthritis (psoriatic arthritis, reactive arthritis, rheumatoid arthritis, gouty arthritis or ankylosing spondylitis). In addition, risk factors for the development of gonarthrosis include genetically determined weakness of the ligamentous apparatus, metabolic disorders and impaired innervation in some neurological diseases, head injuries and spinal injuries.
Pathogenesis
The knee joint is formed by the articular surfaces of two bones: the femur and the tibia. On the anterior surface of the joint is the patella, which, when moving, slides along the depression between the condyles of the femur. The fibula does not participate in the formation of the knee joint. Its upper part is located to the side and just below the knee joint and is connected to the tibia by a low-motion joint.
The articular surfaces of the tibia and femur, as well as the posterior surface of the patella, are covered with densely elastic, smooth, very strong and elastic hyaline cartilage, 5-6 mm thick. Cartilage reduces friction forces during movements and performs a shock-absorbing function during shock loads.
In the first stage of knee osteoarthritis, blood circulation in the small intraosseous vessels supplying the hyaline cartilage is disrupted. The surface of the cartilage becomes dry and gradually loses its softness. Cracks appear on its surface. Instead of sliding smoothly and unhindered, the cartilages "cling" to each other. Due to constant microtrauma, cartilage tissue becomes thinner and loses its shock-absorbing properties.
In the second stage of gonarthrosis, compensatory changes occur in bone structures. The common platform is flattened, adapting to increased loads. The subchondral area (the part of the bone immediately below the cartilage) thickens. Bony growths appear along the edges of the joint surfaces - osteophytes, which in their appearance on the x-ray resemble thorns.
During gonarthrosis, the synovial membrane and the joint capsule also degenerate and become "wrinkled". The nature of the joint fluid changes: it thickens, its viscosity increases, which leads to a deterioration of its lubricating and nutritional properties. Due to the lack of nutrients, cartilage degeneration accelerates. The cartilage becomes even thinner and disappears completely in certain areas. After the disappearance of the cartilage, friction between the joint surfaces increases sharply and degenerative changes progress rapidly.
In the third stage of knee OA, the bones are significantly deformed and appear to be pressed against each other, significantly limiting the movement of the joint. Cartilaginous tissue is practically absent.
Classification
Taking into account the pathogenesis in traumatology and orthopedics, two types of knee osteoarthritis are distinguished: primary (idiopathic) and secondary knee osteoarthritis. Primary knee osteoarthritis occurs without prior trauma in elderly patients and is generally bilateral. Secondary gonarthrosis develops against the background of pathological changes (diseases, developmental disorders) or damage to the knee joint. Can occur at any age, usually unilateral.
Taking into account the severity of pathological changes, three stages of knee osteoarthritis are distinguished:
- First stage– first manifestations of gonarthrosis. Characterized by periodic dull pain, usually after significant load on the joint. There may be slight swelling in the joint that goes away on its own. There is no deformation.
- Second step– increased symptoms of knee osteoarthritis. The pain becomes longer and more intense. A cracking noise often appears. There is mild or moderate restriction of movement and slight deformity of the joint.
- Third step– the clinical manifestations of knee osteoarthritis reach their maximum. The pain is almost constant, gait is impaired. There is a pronounced limitation of mobility and noticeable deformation of the joint.
Symptoms of knee osteoarthritis
The disease begins gradually, gradually. In the first stage of knee OA, patients experience minor pain with movement, especially going up or down stairs. There may be a feeling of stiffness in the joint and a "tightness" in the popliteal area. A characteristic symptom of gonarthrosis is "initial pain" - painful sensations that occur during the first steps after getting up from a sitting position. When a patient with gonarthrosis "diverges", the pain decreases or disappears, and after significant stress it reappears.
Externally, the knee is not modified. Sometimes patients with knee osteoarthritis notice slight swelling in the affected area. In some cases, at the first stage of gonarthrosis, fluid accumulates in the joint - synovitis develops, characterized by an increase in the volume of the joint (it becomes swollen, spherical), a feeling of heaviness andlimitation of movements.
In the second stage of gonarthrosis, the pain becomes more intense, occurs even with light loads and intensifies with intense or long walking. Typically, the pain is localized along the anterior inner surface of the joint. After a long rest, painful sensations usually disappear and reappear with movement.
As gonarthrosis progresses, the range of motion of the joint gradually decreases, and when you try to bend the leg as much as possible, sharp pain appears. There may be a harsh cracking noise when moving. The configuration of the joint changes, as if it is enlarging. Synovitis appears more often than in the first stage of gonarthrosis and is characterized by a more persistent course and greater accumulation of fluid.
In the third stage of gonarthrosis, pain becomes almost constant, bothering patients not only when walking, but also at rest. In the evening, patients spend a lot of time trying to find a comfortable position to sleep. The pain often appears even at night.
Flexion at the joint is significantly limited. In some cases, not only flexion, but also extension is limited, which is why the patient with gonarthrosis cannot fully straighten the leg. The joint is enlarged and deformed. Some patients have a hallux valgus or varus deformity: the legs take the shape of an X or an O. Due to the limited movements and deformity of the legs, the gait becomes unstable and waddles. In severe cases, patients with knee osteoarthritis can only move with the help of a cane or crutches.
Diagnostic
The diagnosis of gonarthrosis is made on the basis of the patient's complaints, objective data of the examination and radiological examination. When examining a patient with the first stage of gonarthrosis, external changes usually cannot be detected. In the second and third stages of gonarthrosis, enlargement of the contours of the bones, deformation of the joint, limitation of movements and curvature of the axis of the limb are detected. When the ball joint moves in the transverse direction, a cracking noise is heard. Palpation reveals a painful area towards the inside of the kneecap, at the joint line, as well as above and below it.
With synovitis, the joint increases in volume and its contours become smoother. A bulge is detected along the anterolateral surfaces of the joint and above the patella. On palpation, the fluctuation is determined.
X-ray of the knee joint is a classic technique that allows you to clarify the diagnosis, establish the severity of pathological changes in gonarthrosis and monitor the dynamics of the process, taking repeated photos after a certain time. Due to its availability and low cost, it remains to this day the main method of diagnosing knee osteoarthritis. In addition, this research method allows us to exclude other pathological processes (for example, tumors) in the tibia and femur.
At the initial stage of knee osteoarthritis, changes on radiographs may be absent. Subsequently, narrowing of the joint space and compaction of the subchondral zone are determined. The articular ends of the femur and especially the tibia dilate, the edges of the condyles become pointed.
When studying an x-ray, it should be borne in mind that more or less pronounced changes characteristic of gonarthrosis are observed in most elderly people and are not always accompanied by pathological symptoms. The diagnosis of knee osteoarthritis is made only when there is a combination of radiological and clinical signs of the disease.
Currently, in addition to traditional radiography, modern techniques such as CT scanning of the knee joint, which allows a detailed study of pathological changes in bone structures, and MRI of the knee joint, used to identify changes insoft tissues, are used to diagnose knee osteoarthritis. .
Treatment of knee osteoarthritis
Conservative activities
Treatment is carried out by traumatologists and orthopedists. Treatment of knee osteoarthritis should begin as early as possible. During the period of exacerbation, the patient with gonarthrosis is recommended to rest for maximum unloading of the joint. The patient is prescribed therapeutic exercises, massage, physiotherapy (UHF, electrophoresis with novocaine, phonophoresis with hydrocortisone, diadynamic currents, magnetic and laser therapy) and mud therapy.
Drug treatment of gonarthrosis includes chondroprotectors (drugs that improve metabolic processes in the joint) and drugs that replace synovial fluid. In some cases, in case of gonathrosis, intra-articular administration of steroid hormones is indicated. Subsequently, the patient may be referred for treatment in a sanatorium.
A patient with knee osteoarthritis may be advised to walk with a cane to unload the joint. Sometimes special orthotics or custom insoles are used. To slow down the degenerative processes in the joint affected by knee osteoarthritis, it is very important to follow certain rules: exercise, avoid unnecessary stress on the joint, choose comfortable shoes, monitor your weight, organize your routine well. daily (alternate load and rest, perform special exercises).
Surgery
In case of pronounced destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. In cases of severe pain, joint dysfunction and limited working capacity, especially if a young or middle-aged patient suffers from gonarthrosis, they resort to surgery (knee arthroplasty). Subsequently, rehabilitation measures are implemented. The complete recovery period after arthroplasty for knee osteoarthritis lasts from 3 months to six months.