Osteoarthritis of the knee joint

The knee joint is under constant pressure. 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 changes the shape of the knee joint, which is accompanied by chronic damage to the surface of the hyaline cartilage, as well as the bones of the femur and tibia. Symptoms of knee joint disease are pain that increases with movement. Due to the accumulation of fluid in it, movement is limited. Then, there is limitation of knee movement due to violation of support in the legs. Pathological diagnosis is based on the collection of anamnesis and patient complaints, the results of visual examination and hardware examination 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 genus articulatio - knee joint) is the most common arthrosis, which is a degenerative-dystrophic progressive lesion of the cartilage of the knee joint that is not inflammatory in nature. Women and the elderly usually suffer from gonarthrosis. But after an injury during intense sports, gonarthrosis occurs even in young people.

The cause of arthrosis lies in changes in the structure of the cartilage in the joint, and not in the deposition of salt there. With gonarthrosis, salt deposits occur where the tendon is attached to the ligament apparatus, but it cannot be the cause of pain symptoms. First, cracks appear in the cartilage, which reduces the thickness in some areas. Gradually, the load is redistributed, the joint begins to come into contact with the bone, accelerating the painful process. As a result, the following changes occur in the knee joint:

• thinning of knee cartilage until it disappears;
• changes in synovial fluid in composition and quantity;
• damage to the bones in the knee due to friction;
• the appearance of osteophytes;
• stiffness due to compaction of the joint capsule;
• muscle cramp.

As a result, the knee joint becomes deformed, its mobility is limited, as a result this can cause disability and loss of ability to work.

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, a little discomfort appears when climbing the stairs, then the pain syndrome increases and torments even at rest;
• stiffness occurs in the morning, at first it lasts a few minutes, then it can last up to half an hour;
• sharp dryness occurs, which is already accompanied by pain at the second level of damage;
• limited mobility, difficult to bend and straighten the knee due to pain, bone friction and osteophyte growth; joints may be blocked in the final stage (ankylosis);
• unstable gait due to muscle atrophy (reduction in muscle volume);
• deformation of the knee joint due to bone growth and changes in its shape, the occurrence of inflammatory processes in the muscles and ligaments increases the swelling around the joint tissue;
• lameness due to the development of knee joint disease; at a later stage, the patient had to walk even with a walker.

Arthritis begins gradually. At the 1st stage of gonarthrosis, the patient experiences a slight sensation of stiffness and pain that occurs when going up or down stairs. Possible tightening of the area below the knee. Characteristic is the sensation of initial pain that arises from a sitting position during the start of ascent. When the patient moves away, the pain subsides, but with energy it reappears.

No external changes to the knee. Sometimes swelling and the development of synovitis are possible - fluid accumulation with enlargement, joint swelling, while heaviness is felt and movement is limited.

In stage 2, severe pain occurs with prolonged exercise and intensifies when walking. The pain is usually localized along the anterior surface of the joint. After resting, the pain disappears, but when moving it reappears.

When arthrosis develops, the number of movements in the knee joint decreases; when you try to bend your leg as much as possible, a sharp, sharp pain and cramp appears. The configuration changes, the joints expand. Synovitis appears with a larger accumulation of fluid in it.

In stage 3, the pain becomes constant and bothers you not only while walking, but also while resting. Painful sensations appear even at night; to fall asleep, patients take a long time to find a position for their legs. Flexion and extension of the joint is limited. Sometimes the patient cannot straighten the leg completely. Joints are enlarged and deformed. Sometimes foot valgus deformity occurs in patients; they become X-shaped or O-shaped. As a result of leg deformation and limited movement, the patient's gait becomes unstable and wobbly. In severe cases of gonarthrosis, the patient moves with the support of crutches.

Causes of arthrosis of the knee joint

Most cases of arthrosis occur for several reasons. These factors include:

• injury.25% of gonarthrosis occurs as a result of injury: meniscus damage, ligament rupture. Gonarthrosis usually occurs three to five years after the injury, sometimes the disease can develop earlier - after two to three months.
• Physical training.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 intense squats are especially dangerous for the joints.
• Overweight.Excess body weight significantly increases the load on the knee joint, 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 maintenance disorders in nerve 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 when moving 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:

• level 1.There is a disturbance in blood circulation in the vessels that feed the hyaline cartilage. The surface becomes dry and small cracks appear on it, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and, instead of sliding smoothly, clings, loses its shock-absorbing quality. No visual symptoms of arthrosis; X-rays show slight abnormalities.
• 2nd level.Changes occur in the bone structure, and the joint area is flattened to accommodate greater loads. The part of the bone that lies under the cartilage becomes denser. Along the edge of the joint, manifestations of initial calcification of ligaments appear - osteophytes that resemble spikes on x-ray; narrowing of the gap in the joint is also visible. The synovial capsule of the joint deteriorates, becomes wrinkled. 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 on the joints increases, and degeneration develops sharply. Patients experience pain during exercise, when climbing stairs, when squatting, and when standing for long periods of time.
• 3rd level.X-rays show significant narrowing of the joint space, sometimes asymmetric. Due to the deformation of the meniscus, the bones become deformed and press against each other. Movement in the joint is limited due to the large number of large osteophytes. No cartilage tissue. Constant pain haunts the patient while resting; impossible to walk without support.
• 4th stage.Movement in the knee joint is impossible; x-ray shows complete deformation of cartilage and destruction of articular bone, many osteophytes, and bones can fuse with each other.

Classification

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

Diagnostics

Diagnosis of joint arthrosis is carried out by an orthopedic or traumatologist at a medical clinic.

• The appointment begins with collecting the anamnesis - the main complaints and symptoms that concern the patient. The doctor finds out the complaints, the presence of chronic diseases, past injuries, fractures and injuries, and asks additional questions.
• After examination, joint mobility, deformation and pain characteristics are revealed. At the 1st stage of gonarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformation and roughness of the joint contour, limitation of movement and curvature of the foot are detected. When the patella moves, a sharp hum is heard. After palpation, the doctor detects pain in the interior of the joint space. Joint size may increase. Joint swelling is detected. When palpating the joints, fluctuations are felt.
• The patient is referred for laboratory tests. When taking a general blood test, inflammation is detected, while biochemical tests reveal possible causes of the problem.
• Next, instrumental diagnostics 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 defects. X-ray of the joint is a technique that explains the diagnosis of pathological changes and the dynamics of arthrosis. At the beginning of gonarthrosis, changes cannot be seen on x-ray. After that, narrowing of the joint space and compaction of the subchondral zone are determined. Gonarthrosis can be diagnosed only with x-rays and clinical tests.
• Nowadays, in addition to radiography, to diagnose arthrosis, computed tomography (CT) is used, which makes it possible to study bone changes in detail, as well as magnetic resonance imaging (MRI), which makes it possible to assess the condition visually. joints and is used to identify changes in muscle tissue and ligaments.
• When performing an ultrasound examination (ultrasound), the condition of the tendons, muscles, and joint capsule is assessed.
• Fluid is drained from the affected joint to allow a camera to be inserted to look inside the joint (arthroscopy).

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

Treatment of arthrosis of the knee joint

Treatment for arthrosis can be divided into three groups:

• medicine;
• physiotherapy;
• surgery.

Arthrosis is treated by traumatologists, rheumatologists and orthopedics. Conservative treatment begins at an early stage. When arthrosis worsens, doctors recommend maximum rest for the joints. Patients are prescribed the necessary procedures: exercise therapy, massage, mud therapy.

When patients are diagnosed with stage 1 and 2 disease, drugs and physical therapy are used; if the lesion is extensive, then surgery and surgical intervention are used.

Drug treatment

Giving the right medication can stop pain and inflammation, as well as slow down the process of cartilage tissue destruction. Therefore, it is important to see a doctor immediately.

Important - do not self-medicate. The wrong drugs, chosen independently and without consulting a doctor, can only worsen the condition and lead to serious complications.

Drug therapy for arthrosis includes taking the following drugs:

• anti-inflammatory:relieves inflammation and relieves pain in the joints;
• hormones:prescribed when anti-inflammatory drugs are ineffective;
• antispasmodic:helps relieve muscle spasms and ease the patient's condition;
• chondroprotectors:improve metabolic processes in the joints and help restore joint function, as well as drugs that replace synovial fluid;
• drugs to improve microcirculation:increase nutrition and oxygen supply.

Depending on each specific situation, tablets, intra-articular injections of steroid hormones and local forms of medicine are used. The selection of drugs is carried out by the attending physician. Sometimes patients with arthrosis are sent for treatment to a sanatorium and are recommended to walk with crutches or crutches. To relieve the load on the knee joint, individual orthoses or special insoles are used.

In addition, complex non-drug methods for treating arthrosis are used:

• physical therapy (physical therapy)which is carried out under the supervision of experts;
• massage courseif there is no inflammatory process;
• osteopathic effectin the treatment of arthrosis, which aims not only in the affected area, but also to restore the resources of the whole organism, because the pathological processes that occur locally in the joint area are the result of many processes that occur in the body as a whole. . During an osteopathic session, work is carried out with the musculoskeletal system as a whole to achieve maximum restoration of conservation and mobility in the spine, pelvic bones, sacrum and eliminate compression of nerves and blood vessels throughout the body!

Physiotherapy

Physiotherapy methods are used to improve blood circulation in the joints, increase their mobility, and increase the medicinal effect of drugs. The doctor may prescribe the following procedures:

• shock wave therapy:ultrasound eliminates osteophytes;
• magnetotherapy:magnetic fields affect metabolic processes and stimulate regeneration;
• laser therapy:deep tissue laser heating;
• electrotherapy (myostimulation):electric shock to muscles;
• electrophoresis or phonophoresis:administration 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, the treatment method is not effective. Then patients with severe pain syndrome are prescribed surgical and operative treatment for knee arthrosis:

• endoprosthetics:replacement of the entire joint with a prosthesis;
• arthrodesis:binding between the bones for their immobility, to reduce pain and give a person the opportunity to lean on the leg;
• osteotomy:cut one bone to place it at an angle on the joint to reduce pressure.

If endoprosthesis replacement is not possible, then arthrodesis and osteotomy are used.

Prevention

Preventive measures and compliance with doctor's recommendations play an important role in the occurrence of gonarthrosis. To slow down the process of joint degeneration, it is important to follow the rules:

• engage in special physical activities: physical therapy and gymnastics without unnecessary joint load;
• avoid strenuous physical activity;
• choose comfortable orthopedic shoes;
• Monitor your weight and daily routine - alternate special exercises and time to rest.

Diet

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

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

The diet should contain: protein, fatty acids, for example, omega-3, collagen, which is contained in gelatin. Need to eat without gaining weight.

Consequences and complications

Osteoarthritis of the knee joint develops slowly, but if it is not treated, serious complications arise:

• deformation of the joint and changes in the overall configuration of the knee due to reorganization of the muscles and curvature of the bone skeleton;
• shorten the lower limbs;
• ankylosis - complete immobilization of the knee joint;
• damage to the musculoskeletal system.