Arthrosis (gonarthrosis) is a pathological change in the knee joint that has a chronic course and can progress over time. The disease extends to 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 subject to heavy loads throughout life and is regularly injured. Sometimes minor damage goes unnoticed right away, but 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 resulting from sports or an active lifestyle.
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 diagnose your condition and prescribe the necessary treatment.
Types of arthrosis of the knee joint
Inside the joint, the bones are covered with cartilage tissue, which provides shock absorption, smooth gliding, and also prevents the bones from rubbing against each other. Cartilage tissue receives nutrition thanks to the synovial fluid located inside the joint and blood flowing through the vessels.
Cartilage has a spongy structure, so when at rest it absorbs fluid, and when loaded, it displaces it. At the same time, during movements, the cartilage constantly receives microtraumas, and during rest it is restored.
If the result from mechanical injury exceeds the restoration capacity of the joint, then there is not enough nutrition for the cartilage, and as a result, regeneration does not occur. Damage accumulates and changes the structure of cartilage tissue. This is how arthrosis of the knee joint begins.
Depending on the reasons that caused it, arthrosis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
Degenerative changes occurring in the joint are associated with age. Among the reasons causing it are the following:
- natural degeneration or degradation due to a slowdown in metabolic processes in the body;
- excess body weight;
- sedentary lifestyle;
- malnutrition;
- genetic predisposition.
As a rule, primary gonarthrosis affects both knees at once and is called bilateral.
Secondary gonarthrosis
Secondary arthrosis of the knee joint can occur at any age, since 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;
- overload of the knee joints during sports or due to the specifics of work;
- endocrine diseases;
- O-shaped and X-shaped curvature of the legs.
Secondary arthrosis of the knee joint most often appears only on one leg and is called unilateral.
In rare cases, idiopathic gonarthrosis is identified - a disease that occurs without any apparent reason.
Stages and symptoms of arthrosis of the knee joint
Regardless of how arthrosis of the knee joint appeared, 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 prolonged exercise, when walking up stairs, after heavy exercise, and goes away after rest. There are no restrictions on movement, but sometimes subtle swelling of the joint may occur. This condition, if nothing is done, can last for years - at this time the cartilage is just beginning to lose its smoothness due to impaired blood supply. An x-ray will show a slight narrowing of the joint space and hardening of the bones.
- Stage 2– the pain becomes severe and lasts quite a long time even with light exertion. A crunching sound is heard during flexion and extension of the joint. It becomes impossible to bend the leg completely due to severe pain. There is a slight deformation, muscle wasting and limited movement. Pain can be relieved with painkillers or go away on its own after rest.
At this stage, the cartilaginous layer is already greatly thinning, in some places to the point of disappearing. The synovial fluid becomes thicker and more viscous, which impairs its nutritional and lubricating properties. Osteophytes appear - bone growths.
- Stage 3– the pain increases and constantly worries, even at night. The deformity of the joint becomes noticeable, the gait changes, and the lower part of the limb becomes bent. The range of motion in the knee joint is reduced - the leg cannot be fully bent or straightened. When walking, you have to use support in the form of a stick or crutch. Pain medications no longer help.
The cartilage is almost completely erased, the bones are compacted, the joint space is greatly narrowed or absent. The presence of many osteophytes is noted.
One common symptom of arthrosis of the knee joint can be identified - pain of varying intensity, localized along the anterior-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 will collect anamnesis, check the biomechanical capabilities of the joint, and prescribe the necessary examinations. Be sure to inform him about the injuries and illnesses suffered, lifestyle, nutrition, medications taken, and work characteristics.
The most informative and simple way to confirm or refute a diagnosis is an x-ray of the knee joint - it allows you to conduct 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, in the early stages, gonarthrosis is difficult to detect even on an x-ray. In such situations, the doctor may 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 informative enough.
Treatment of arthrosis of the knee joint
After diagnosis, the doctor selects the optimal treatment, depending on the stage of the disease and individual characteristics. This solves three problems:
- pain relief;
- stopping the progression of pathology;
- restoration of joint functionality.
The specialist selects a comprehensive solution, which 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 method of treatment of gonarthrosis
Usually used at 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 lose excess weight. The doctor will recommend a diet and select a gentle set of exercises that will reduce axial impacts and improve the nutrition of cartilage tissue.
To improve blood circulation in the joint area, increase the range of motion, and also enhance the effect of medications, physiotherapy is prescribed:
- shock wave therapy – short-term impact on bone and connective tissue with acoustic pulses of significant amplitude of low frequency;
- electrotherapy – exposure of the affected area to electric current, magnetic or electromagnetic fields;
- laser therapy - exposure to optical radiation generated by a laser;
- phonophoresis - exposure to the affected area with ultrasound and medicine applied to the skin;
- electrophoresis - exposure of the affected area to electricity.
Massage, compresses, wearing an orthosis, and kinesiotaping have also proven themselves well in the treatment of arthrosis.
In addition, well-chosen drug therapy helps relieve pain, stop inflammation, and slow down the process of destruction of cartilage tissue. For this purpose, anti-inflammatory, hormonal drugs, antispasmodics, and chondroprotectors are prescribed. They can be in tablet, injectable or topical form, depending on the situation.
Minimally invasive method of treating gonarthrosis
If the above procedures have no effect, the doctor may prescribe intra-articular injections:
- hyaluronic acid – as a replacement for synovial fluid to improve friction, reduce pain and improve function of the knee joint. The average duration of action of the drug is 3-6 months;
- platelet-enriched own plasma - for nutrition and restoration of cartilage tissue;
- corticosteroids – to reduce inflammation.
Surgical method for treating gonarthrosis
If conservative treatment turned out to be ineffective, or you first turned to a specialist with the third stage of arthrosis of the knee joint, then the doctor may resort to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position to eliminate pain;
- arthroscopic debridement - joint sanitation using an arthroscope;
- corrective osteotomy – elimination of bone deformities by artificial fracture;
- endoprosthetics - replacing a worn-out joint with an implant artificially created from biocompatible materials.
The type of operation is chosen by the doctor based on the characteristics of arthrosis of the knee joint. But endoprosthetics is considered the gold standard, as 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. To fully recover after surgery, it is necessary to undergo a rehabilitation course that takes 3-4 months.
Complications
Gonarthrosis develops quite slowly, but it can be detected in a timely manner and the necessary treatment can begin. Ignoring the disease and its symptoms can lead to serious consequences:
- constant 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;
- shortening of the leg.
In particularly difficult situations and in the absence of timely treatment, arthrosis can lead to disability and deterioration in motor activity, even to the point of immobility.
It is important to remember that it is impossible to completely cure arthrosis. But 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. But people at risk are advised to adhere to certain rules:
- ensure that your weight does not exceed the age norm;
- do not engage in sports that place heavy stress on the knee joint;
- if possible, completely cure infectious diseases without causing complications;
- do not become overcooled or overtired;
- avoid injury and overload of the joint;
- avoid stressful situations;
- do not forget about rest;
- engage in exercise therapy;
- wear orthopedic shoes.
At-risk groups include older people, 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 limb or the normal biomechanics of the joint, dysplasia, a decrease in the volume and strength of the leg muscles, or trauma can also lead to arthrosis.
Get checked regularly and take preventive measures.
Question answer
- What is the difference between knee arthritis and knee arthrosis?
Arthritis is the collective name for inflammation of the joint, and arthrosis is a degenerative-dystrophic process.
- Which doctor treats arthrosis?
Traumatologist-orthopedist or rheumatologist.
- Is it possible to play sports with arthrosis of the knee joint?
Prolonged and heavy load on the joint, as well as axial impact, should be avoided. But you shouldn’t exclude sports from your life completely - when you move, your joints are better "nourished" and restored. It is important to observe the measure and adhere to the recommendations of the doctor, who will select the type and mode of exercise.