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 - gonarthrosis begins.

Gonarthrosis is an arthrosis that deforms the knee joint, accompanied by chronic damage to the hyaline cartilage surfaces, as well as bones - femur and tibia. Symptoms of the disease in the knee joint are pain that is aggravated by movement. Movement is limited due to the accumulation of fluid in it. Next, there is a limitation of knee movements due to a violation of support in the leg. The diagnosis of the pathology is based on the collection of the patient's anamnesis 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 articulatio - knee joint) is the most common arthrosis, which is a degenerative-dystrophic progressive damage to the cartilage of the knee joint of a non-inflammatory nature. Women and elderly people usually suffer from gonarthrosis. But after injuries during intense sports, gonarthrosis occurs even in young people.

The reason for arthrosis is not in the deposition of salts there, but in the change of the cartilage structure inside the joint. With gonarthrosis, salt deposits form where the tendons are attached to the ligamentous apparatus, but they cannot be the cause of pain symptoms. First, cracks are formed in the cartilage, which reduces the thickness in some places. Gradually, the load is redistributed, the joint comes 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 the composition and amount of synovial fluid;
• damage to the bones in the knee due to friction;
• the 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, which can lead to disability and loss of working capacity.

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, slight discomfort appears when climbing the stairs, then the pain syndrome increases and suffers even at rest;
• stiffness occurs in the morning, first lasts a few minutes, then can last up to half an hour;
• in secondary damage, an acute crisis accompanied by pain already occurs;
• mobility is limited, it is difficult to bend and straighten the knee due to pain, bone friction and the growth of osteophytes, in the last stage the joint may be blocked (ankylosis);
• unstable gait due to muscle atrophy (decreased muscle volume);
• deformation of the knee joint due to the growth of bones and changes in their shape, the occurrence of an inflammatory process in the muscles and ligaments increases the swelling around the joint tissues;
• lameness due to progression of knee joint disease; in the later stages, the patient is even forced to walk with a walker.

Osteoarthritis begins gradually. In the 1st stage of gonarthrosis, patients experience mild stiffness and pain when going up or down stairs. Possible compression of the area below the knee. Characteristic are initial pain sensations from a sitting position at the beginning of ascent. When the patient moves away, the pain subsides, but barely reappears.

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

In the 2nd stage, severe pain occurs with prolonged exercise and increases during walking. The pain is usually localized along the front surface inside the joint. The pain disappears after rest, but reappears when moving.

As arthrosis progresses, the number of movements in the knee joint decreases, pain and a rough, sharp crisis appear when you try to bend your leg as much as possible. The configuration changes, the combination expands. Synovitis appears with more fluid accumulation in them.

In stage 3, the pain is constant and bothers you not only when walking, but also at rest. Painful sensations appear even at night, patients take a long time to find a position for their legs to fall asleep. Flexion and extension of the joint is limited. Sometimes the patient cannot straighten the leg completely. The joint expands and deforms. Sometimes patients have valgus deformation of the legs, they are X or O shaped. As a result of leg deformation and limitation of movement, patients' gait becomes unstable and swings. In severe cases of gonarthrosis, patients move with the support of armrests.

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: damage to the meniscus, rupture of ligaments. Gonarthrosis usually occurs three to five years after the injury, sometimes the disease can develop earlier - after two to three months.
• Physical exercise.Often, gonarthrosis occurs 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 heavy squatting are especially dangerous for the joints.
• Excessive weight.Excess weight significantly increases the load on the knee joints, causing injury. Gonarthrosis is especially difficult if there are metabolic disorders and varicose veins.
• Sedentary lifestyle.

The development process of gonarthrosis increases with arthritis due to gout or ankylosing spondylitis. The risk of gonarthrosis is a genetic weakness in the ligaments and a violation of 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 as it moves between the grooves of the femur. The articular surfaces of the tibia and femur are covered with very strong, 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:

• 1st stage.There is a violation of blood circulation in the vessels that feed the hyaline cartilage. Its surface dries out and small cracks form on it, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner, and it loses its shock absorber quality by sticking instead of sliding smoothly. There are no visual symptoms of arthrosis, there is a slight deviation in the X-ray.
• 2nd stage.Changes occur in the structure of the bones and the joint space is adjusted to accept greater loads. The part of the bone under the cartilage is denser. Manifestations of initial calcification of ligaments are visible along the edges of the joint - osteophytes that look like spikes on X-ray; narrowing of the joint space is also seen. The synovial capsule of the joint degenerates and wrinkles. The fluid in the joint thickens, its viscosity increases, and its lubricating properties deteriorate. The degeneration process in the cartilage accelerates, it becomes thinner, and in some places it disappears completely. After its loss, friction in the joint increases and degeneration progresses sharply. Patients feel pain during exercise, climbing stairs, squatting and standing for long periods of time.
• 3rd stage.X-rays show marked, sometimes asymmetric narrowing of the joint space. Due to the deformation of the meniscus, the bones are deformed and pressed together. Movement in the joint is limited due to the large number of large osteophytes. No cartilage tissue. Constant pain haunts the patient at rest, it is impossible to walk without support.
• 4th stage.Movements in the knee joint are impossible, X-rays show the complete deformation of the cartilage and the destruction of the joint bones, many osteophytes, and the bones can fuse with each other.

Classification

Taking into account the pathogenesis of the disease, two types are distinguished: primary - idiopathic and secondary gonarthrosis. It occurs without a primary lesion, usually in elderly patients, and is bilateral. It develops as a result of secondary diseases and developmental disorders or against the background of knee joint injuries. It can occur at any age and is usually unilateral.

Diagnostics

Joint arthrosis is diagnosed 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.
• During the examination, joint mobility, deformation and pain characteristics are revealed. In the 1st stage of gonarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformation and coarsening of joint contours, limitation of movements and curvature of the legs are detected. A sharp crackling sound is heard when the patella moves. During palpation, the doctor feels pain in the interior of the joint cavity. The joint may increase in size. Swelling of the joint is detected. When the joint is palpated, fluctuation is felt.
• The patient is sent for laboratory tests. When conducting a general blood test, inflammation is detected, and a biochemical test reveals possible causes of problems.
• Then instrumental diagnosis of the patient is required. X-rays are used for this. X-ray is a diagnostic method that allows you to detect signs of knee arthrosis: narrowing of the joint space, osteophytes and bone deformations. Joint radiography 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. Subsequently, narrowing of the joint space and compression of the subchondral zone is determined. Gonarthrosis can be determined only by X-ray and clinical tests.
• Currently, along with x-rays, computer tomography (CT) is used to diagnose arthrosis, which allows a detailed study of bone changes, as well as visual assessment of the condition with magnetic resonance imaging (MRI). used to identify changes in joint and muscle tissue and ligaments.
• When conducting an ultrasound examination (ultrasound), the condition of the tendons, muscles and joint capsule is evaluated.
• Fluid is drained from the affected joint so that a camera can be inserted to look inside the joint (arthroscopy).

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

Treatment of arthrosis of the knee joint

Treatment of arthrosis can be divided into three groups:

• medicine;
• physiotherapy;
• surgical.

Treatment of arthrosis is carried out 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 the patient is diagnosed with the disease in the 1st and 2nd stages, drugs and physiotherapy are used, and if the lesion is extensive, 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 consult a doctor immediately.

Important - do not self-medicate. The wrong drugs chosen independently and without consulting a doctor can only aggravate the condition and cause serious complications.

Drug treatment for arthrosis includes taking the following drugs:

• anti-inflammatory:eliminate inflammation and relieve joint pain;
• hormonal:prescribed when anti-inflammatory drugs are ineffective;
• antispasmodics:help get rid of muscle spasms and relieve the patient's condition;
• chondroprotectors:drugs that help to improve joint metabolic processes and restore joint function, as well as drugs that replace synovial fluid;
• Medicines to improve microcirculation:improve nutrition and oxygen supply.

Depending on each specific situation, tablets, intra-articular injections of steroid hormones and local forms of medicine are used. The choice of drugs is carried out by the attending physician. Sometimes a patient with arthrosis is sent to a sanatorium for treatment and is advised to walk with an ax or cane. Individual orthoses or special insoles are used to remove the load on the knee joint.

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

• physical therapy (physical therapy)carried out under the supervision of a specialist;
• massage coursesin the absence of an inflammatory process;
• osteopathic effectin the treatment of arthrosis aimed not only at the affected area, but also at restoring the resource of the whole body, because the pathological process occurring locally in the joint area is the result of many processes occurring in the body as a whole. . During an osteopathic session, work is done with the entire musculoskeletal system to achieve maximum restoration of innervation and mobility in the spine, pelvis, and sacrum, and to eliminate 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 therapeutic effect of drugs. The doctor may prescribe the following procedures:

• shock wave therapy:ultrasound removes osteophytes;
• magnetotherapy: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:application of chondroprotectors and analgesics using ultrasound and electric current;
• ozone therapy:injection of gas into the joint cavity.

Surgery

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

• endoprostheses:replacement of the entire joint with a prosthesis;
• arthrodesis:fixation between bones for immobility, reducing pain and allowing a person to lean on the leg;
• osteotomy:cutting a bone to place it at an angle in a joint to reduce stress.

If it is not possible to replace the endoprosthesis, then arthrodesis and osteotomy are applied.

Prevention

Preventive measures and adherence to doctor's recommendations play an important role in the occurrence of gonarthrosis. It is important to follow the rules to slow down joint degeneration processes:

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

Diet

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

• carbonated drinks;
• alcoholic beverages;
• fatty and excessively spicy foods;
• canned goods and semi-finished products;
• products with dyes, preservatives, artificial flavors.

The diet should include: protein, fatty acids, such as omega-3, collagen in gelatin. You need to eat without increasing body weight.

Consequences and complications

Osteoarthritis of the knee joints develops slowly, but if not treated, serious complications arise:

• joint deformation and a change in the general configuration of the knee due to muscle reconstruction and curvature of the bone frame;
• shortening of lower limbs;
• ankylosis - complete immobilization of the knee joint;
• damage to the musculoskeletal system.