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The disease is also known as gonarthrosis (from the Latin genu - knee), osteoarthrosis (as it was called before) and osteoarthritis (the term reflects the mechanism of development and modern understanding of the disease).Deforming arthrosis of the knee joint has a chronic course and develops over several years.Most patients are over 50 years old.Women prevail in 2/3 of cases.
How does the disease develop?
Under the influence of external and internal factors, blood supply and tissue nutrition are disrupted, degenerative-dystrophic damage to the articular cartilage develops, resulting in the involvement of the underlying bone in the inflammatory process.Destruction of the joint surfaces leads to loss of joint function, limits movement, and interferes with the patient's quality of life.
Causes and risk factors
The main reasons for the development of arthrosis:
- Hard physical work.Constant loads on the legs lead to microtraumas of the cartilage and the development of the inflammatory process.At risk are loaders, installers, miners and quarry workers.Deforming arthrosis often affects professional athletes (weightlifters, cyclists, tennis players, footballers, basketball players, hockey players, etc.).
- Injuries.Damage to ligaments, tendons, menisci, bruises and fractures lead to disruption of the biomechanics of the joint.If treated incorrectly, this leads to the development of post-traumatic arthrosis.
- Surgical operations on the knee can lead to the development of pathologies of the articular cartilage and surrounding tissues.
- Excess weight increases stress on the joints of the lower extremities.Up to 80-90% of the progression of all osteoarthritis is associated with joint overload.
- Old age.In people over 50-60 years of age, regenerative processes slow down, collagen production decreases and hormone levels suffer.This leads to the development of pathology.
- Hormonal changes in women.During menopause, estrogen production decreases, which disrupts calcium absorption, leads to weakening of the musculoskeletal system and makes bones brittle.Increases the risk of developing osteoporosis.
- Problems with the thyroid gland.Thyroid hormones are involved in the metabolic processes of calcium and phosphorus in the body.Their deficiency or excess can cause knee osteoarthritis.
- Genetic predisposition.Mutation of collagen can cause disorders in the connective tissue elements, which lead to a deterioration of the shock-absorbing function of the articular cartilage.
- Inheritance.There is a high probability of developing the disease if in the patient's family there are relatives diagnosed with gonarthrosis, mainly of the female line.
- Inflammatory diseases.Infectious arthritis, bursitis, synovitis caused by bacterial or viral infection are often complicated by the development of gonarthrosis.
- Vascular diseases.The tissues do not receive proper nutrition, the blood supply is impaired, which leads to the development of ischemia and degenerative-dystrophic changes in the articular cartilage.
- Poor nutrition and metabolic disorders.Eating foods rich in purines (proteins) contributes to the deposition of salts in the knee, for example in gouty arthritis.
- Specific diseases such as gonorrhea, tuberculosis, syphilis, chlamydia and influenza can cause serious damage to the joint.
- Intoxication of the body with various chemicals, including some drugs.
- Autoimmune diseases are associated with a violation of the body's immune defense when antibodies are produced against its own cells, for example, rheumatoid arthritis.
Symptoms of the disease
The main symptoms of gonarthrosis:
- Joint pain, aching in nature, sometimes at night, in case of exacerbation, strong stabbing;
- Creaks and clicks during movement are caused by a violation of the congruence of the articular surfaces, the presence of osteophytes and cartilage defects;
- Swelling and swelling are associated with the development of an inflammatory process in the joint and surrounding soft tissues;
- The deformation of the joint space and the axis of the limb indicates the progression of the disease;
- Atrophy and weakness of the thigh muscles, decreases the volume of the quadriceps and biceps muscles;
- Limitation of mobility and stiffness of the joint are caused by pain, the development of adhesions and the appearance of osteophytes (bone spurs).
The first signs of osteoarthritis that you should look out for are pain that occurs during or after exercise.The pain disappears with rest and does not require medication.Morning stiffness in the knee, onset of pain, before getting up and walking after sleep, it takes time to develop the joint.
Signs of exacerbation
As the pathology develops, the symptoms of arthrosis become brighter: the knees begin to hurt at rest, and at night, during flexion and extension of the joint, extraneous sounds appear: crackling, crunching, clicking.Lameness develops, stiffness of movements and soft tissue swelling appears.
The following facts indicate the progression of the disease:
- the appearance of deformation of the axis of the limbs in the form of O-shaped legs;
- constant nature of pain, pain at night and when the weather changes (meteosensitivity);
- further deterioration of joint mobility, with development of flexion contracture;
- weakness and atrophy of the thigh muscles.
Types and forms of the disease
There are:
- Primary.It develops as an independent disease.More often, such gonarthrosis of the knee is associated with age-related changes and heredity.
- Secondary.It occurs against the background of some diseases or injuries, for example, post-traumatic arthrosis.
Depending on the causes, the following types of osteoarthritis are distinguished:
- Ischemic, associated with problems with blood supply to tissues and vascular disorders;
- Post-infectious is caused by infections, viruses, autoimmune processes;
- The idiopathic nature of the development of the pathology remains unclear;
- Metabolism is associated with metabolic disorders: gout, hemochromatosis, chondrocalcinosis;
- Involutional, following age-related changes in the body;
- Post-traumatic, history of trauma;
- Dyshormonal: A consequence of hormonal imbalances in the body.
Development phases
I. 1st degree arthrosis - the initial stage is associated with a deterioration in the quality and quantity of synovial fluid (joint fluid, provides nourishment to the cartilage, has shock-absorbing properties, promotes the sliding of the joint surfaces).Malnutrition leads to wear and degradation of cartilage tissue and the appearance of the first signs of inflammation.In the initial phase, movements are not impaired.Patients feel mild pain, tingling, and sometimes the joints may crack during movement.Symptoms occur during and after physical activity.Externally, the knee looks quite healthy.
II.2nd degree osteoarthritis - leads to a thinning of the cartilage to 1.5-2.0 mm (normal 2.5-3.0 mm), narrowing of the joint space is observed and small single bone growths (osteophytes) appear.The inflammatory process is wave-like in nature, alternating phases of remission and exacerbation.Grade 1-2 gonarthrosis is accompanied by swelling and weakness of the thigh muscles.The pain bothers me at rest, when the weather changes, and after walking I feel tired.Movements become more rigid, morning stiffness and joint creaking appear.It is at this stage that patients most often consult a doctor.
III.3rd degree gonarthrosis is manifested by external deformation of the joint, curvature of the axis of the limb.The cartilaginous tissue is severely damaged, thinned to 1-1.5 mm, and exposed bone is visible in some places.The bony growths can be easily felt under the skin and the range of motion is significantly reduced.At 2-3 degrees of osteoarthritis, the joint space narrows, the joints cannot bend and unbend, all movements are accompanied by pain and crunching, and morning stiffness intensifies.A characteristic joint contracture develops.I am concerned about sharp pain in my knee, even at rest.Patients often suffer from insomnia because they are unable to assume a comfortable position that does not cause pain and they experience changes in the weather.
IV.Grade 4 gonarthrosis is characterized by complete destruction of the articular surfaces, the exposed bone is visible, and the cartilage is represented by rare "islands".The joint space is almost invisible.A pronounced O-shaped deformity of the lower extremities and swelling are noted.Mobility is almost completely lost.Treatment with non-surgical methods at this stage is ineffective;Joint replacement with an endoprosthesis is indicated.
An orthopedic doctor comments: To accurately determine the degree of arthrosis of the knee joint, in addition to examining the patient, it is extremely important to carry out an instrumental examination (ultrasound, radiography or magnetic resonance imaging of the joint).Bilateral gonarthrosis is very common, so it is recommended to examine both the left and right knee joints.This will help you choose the optimal treatment and thus prevent further progression of the disease.
Diagnostics
To make a diagnosis, it is usually sufficient to take an x-ray or ultrasound of the knee joint.In difficult cases, laboratory tests and magnetic resonance imaging (MRI) are prescribed.If pathological fluid accumulates in the joint, it may require a puncture and subsequent examination.
Ultrasound diagnostics
Helps identify the disease at an early stage.It allows you to measure the thickness of the cartilaginous layer, the relief of the joint, the presence of joint fluid, the size of osteophytes and ossifications.
X-ray
Carry out to evaluate the extent of the damage, the condition of the bone and cartilage tissue.It will show the presence of osteophytes, narrowing of the joint space and joint deformation.In the initial stages of the disease, the examination is not informative.
Analyses
General blood and urine tests and biochemical blood tests show signs of inflammation, the presence of infections and disorders in the bone and cartilage tissue.They allow you to evaluate the general condition of the body, determine the causes of the disease, gonarthrosis and exclude pathologies with similar symptoms.
magnetic resonance imaging
MRI A highly accurate diagnostic method that helps visualize the smallest changes.It will help make a diagnosis both at an early stage and in complex cases before surgical treatment.
Which doctor treats you?
The following specialists treat gonarthrosis of the knee:
- Orthopedic doctor: diagnoses the disease, intra-articular injections, plasma therapy, provides high-tech care and surgical treatment.
- Physiotherapist - responsible for instrumental physiotherapy treatment.
- Rheumatologist - will help if the disease is associated with autoimmune disorders.
- Sports doctor: will be required in case of a history of sports illness.
- If the patient is overweight, a nutritionist is needed.
In the recovery phase, the attending physician may involve other specialists:
- Massager: Massage the lower limbs, restore muscle tone, thereby stimulating blood circulation and helping to restore joint mobility.
- Physiotherapist doctor: selects special exercises and monitors their implementation.
- Rehabilitation specialist: helps with the patient's social adaptation;the specialist is particularly in demand after serious reconstructive knee surgery.
What treatment is prescribed?
The earlier the disease is diagnosed and treatment of osteoarthritis symptoms is started, the greater the chance of recovery.Otherwise, the disease can lead to irreversible consequences and significantly worsen the quality of life.
Therefore, treatment of arthrosis of the knee joint by 1-2 degrees has a good chance of completely restoring the function of the knee joint.Unfortunately, patients do not always seek medical help in the early stages.
How to quickly relieve pain and how to treat it?
First of all, it is necessary to eliminate pain and inflammation.Prescribed:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and painkillers.Drugs allow you to quickly remove inflammation in arthrosis and help reduce pain and swelling.
- Corticosteroids are used when NSAIDs and analgesics do not help, for example, in the treatment of grade 3-4 arthrosis of the knee joint.The patient is given a pharmacological block: the drugs are injected directly into the joint cavity.this helps relieve pain and get relief within minutes of the injection.
- Special ointments and pain relief patches.
An orthopedic doctor comments: Treatment of arthrosis of the knee joint of 2-3 degrees is always complex, as a rule, it includes more than 15 (!) points of recommendations in the prescription sheet.It's not just about drugs and injections.This is a whole series of rehabilitation interventions aimed at correcting the biomechanics of the joint and the patient's lifestyle.Only this approach will help preserve the joint and stop the progression of the disease.
Preparations that strengthen bone and cartilaginous tissue:
- Chondroprotectors based on chondroitin and glucosamine constitute the nutritional basis of chondrocytes.
- Hyaluronic acid preparations serve as analogues of synovial fluid.
- Drugs that improve microcirculation and blood supply to the articular cartilage.
- Calcium and vitamin D supplements strengthen the bones that form the knee joint.
- Intra-articular injections of hyaluronic acid preparations, an artificial analogue of synovial fluid, help lubricate the joint surfaces.
- Pharmacological blocks help quickly relieve swelling, pain and inflammation.As a rule, the effect is noticeable the next day.
Treatment of arthrosis of the knee joint also includes physiotherapy:
- Electrophoresis.Using an electric current, the medicine penetrates the affected area.Electrophoresis is used to treat knee pain due to gonarthrosis.
- Phonophoresis.The medicine enters the area of inflammation under the influence of sound waves.An additional advantage of the method in the treatment of deforming gonarthrosis is the thermal effect.
- Shock wave therapy.The procedure improves blood circulation, stimulates tissue nutrition and is used to destroy osteophytes and scar tissue.
- Traction therapy (joint traction) - helps to unload the joint space, stretching it by several millimeters, thereby reducing the mutual pressure of the joint surfaces.
- Electromyostimulation: stimulates blood flow and muscle function using electric current, restores muscle tone.
- Mechanotherapy helps to develop joint movements and combat contractures using special robotic simulators.
- Laser therapy creates deep tissue heating and reduces the inflammatory response.
- Magnetotherapy.The therapeutic effect is based on the properties of the magnetic field to reduce pain, inflammation and tissue swelling.
Orthobiology methods aim to stimulate regeneration and replace defects in cartilage tissue:
- Plasmolifting is a plasma-based drug, obtained from the patient's blood, which triggers regeneration processes and contains growth factors.
- PRP Therapy: Plasma obtained from the patient's blood is used as a drug.Platelet-rich plasma stimulates the regeneration of chondrocytes and alleviates the inflammatory process.
- SVF therapy is based on the use of cells of the stromal vascular fraction obtained from the patient's adipose tissue.
- SVF Therapy + PRP Therapy: The simultaneous use of concentrated plasma and progenitor cells achieves the best results.
- Stem cell treatment.The method is based on the use of bone marrow cells and is currently under development.
Each case is individual and requires the development of a separate rehabilitation program for the treatment of arthrosis of the knee joint.
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