gonarthrosisIt is 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 the later stages, the support of the leg is disturbed and a pronounced limitation of movements is observed. Pathology is diagnosed based on history, complaints, physical examination and x-ray of the joint. Treatment is conservative: pharmacotherapy, physiotherapy, exercise therapy. If there is significant destruction of the joint, endoprosthesis is indicated.
General information
Gonarthrosis (from 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. It usually affects middle-aged and elderly people, with women being the most affected. After an injury or intense and constant stress (for example, during professional sports), gonarthrosis may occur at an earlier 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 deposition of calcium salts may appear at the site of attachment of the tendon and ligamentous apparatus, but they are secondary and do not cause painful symptoms.
Causes of gonarthrosis
In most cases, it is impossible to identify a single reason for the development of pathology. As a rule, the appearance of gonarthrosis is caused by a combination of several factors, including:
- Injuries. Approximately 20-30% of cases of gonartosis are associated with previous injuries: tibia fractures (especially intra-articular), meniscus injuries, tears or ruptures of ligaments. Typically, gonarthrosis occurs 3-5 years after a traumatic injury, although earlier development of the disease is possible - 2-3 months after injury.
- Physical exercise. Often, the manifestation of gonarthrosis is associated with excessive loads on the joint. The age after 40 is a period when many people understand that regular physical activity is necessary to keep the body in good condition. When starting 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 gonarthrosis symptoms. Running and doing fast, intense squats are especially dangerous for your knee joints.
- Overweight. With excess body weight, the load on the joints increases, both microtrauma and serious damage (meniscus tears or ligament tears) occur more frequently. Gonarthrosis is especially difficult in obese patients with severe varicose veins.
The risk of gonarthrosis 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 genetic weakness of the ligamentous apparatus, metabolic disorders and disturbances in innervation in certain neurological diseases, traumatic brain injuries and spinal injuries.
Pathogenesis
The knee joint is formed by the articular surfaces of two bones: the femur and the tibia. On the front surface of the joint is the patella, which, when moved, 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 on the side and just below the knee joint and is connected to the tibia through a low-motion joint.
The articular surfaces of the tibia and femur, as well as the posterior surface of the patella, are covered with a very strong and elastic, densely elastic, smooth hyaline cartilage, 5-6 mm thick. Cartilage reduces friction forces during movements and performs a shock absorption function during impact loads.
In the first stage of gonarthrosis, blood circulation is disturbed in the small intraosseous vessels that feed the hyaline cartilage. The surface of the cartilage dries out and gradually loses its smoothness. Cracks appear on its surface. Instead of smooth, unimpeded sliding, the cartilages "stick" 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 joint platform is flattened, adapting to high loads. The subchondral area (the part of the bone immediately below the cartilage) thickens. Along the edges of the articular surfaces, bone growths appear - 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 lack of nutrients, cartilage degeneration is accelerated. The cartilage becomes even thinner and in some areas disappears completely. After the disappearance of cartilage, friction between the articular surfaces increases dramatically and degenerative changes progress rapidly.
In the third stage of gonarthrosis, the bones are significantly deformed and seem to be pressed against each other, which significantly limits movement in the joint. Cartilage tissue is practically absent.
Classification
Taking into account the pathogenesis in traumatology and orthopedics, two types of gonarthrosis are distinguished: primary (idiopathic) and secondary gonarthrosis. Primary gonarthrosis occurs without previous trauma in elderly patients and is usually bilateral. Secondary gonarthrosis develops against the background of pathological changes (diseases, developmental disorders) or injuries of the knee joint. It can occur at any age, usually unilateral.
Taking into account the severity of pathological changes, three stages of gonarthrosis are distinguished:
- First stage– initial manifestations of gonarthrosis. It is characterized by periodic dull pain, usually after significant loading on the joint. There may be slight swelling of the joint that goes away on its own. There is no deformation.
- Second stage– increased symptoms of gonarthrosis. The pain becomes longer and more intense. A crunching sound often appears. Mild or moderate restriction of movement and slight deformation of the joint occurs.
- Third stage– the clinical manifestations of gonarthrosis reach their maximum. The pain is almost constant, walking is altered. There is a pronounced limitation of mobility and noticeable deformation of the joint.
Symptoms of gonarthrosis
The disease begins gradually, gradually. In the first stage of gonarthrosis, patients experience mild pain when moving, especially when going up or down stairs. There may be a feeling of stiffness in the joint and "tension" in the popliteal area. A characteristic symptom of gonarthrosis is "initial pain" - painful sensations that arise 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 gonarthrosis notice slight swelling of the affected area. In some cases, at the first stage of gonarthrosis, fluid accumulates in the joint: synovitis develops, which is characterized by an increase in the volume of the joint (it swells, becomes spherical), a feeling of heaviness and limitation 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. As a rule, 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 in the joint gradually decreases, and when trying to bend the leg as much as possible, sharp pain appears. There may be a harsh creak when moving. The configuration of the joint changes, as if it were expanding. Synovitis appears more frequently than in the first stage of gonarthrosis and is characterized by a more persistent course and the accumulation of more fluid.
In the third stage of gonarthrosis, the pain becomes almost constant and bothers patients not only when walking, but also at rest. At night, patients spend a lot of time trying to find a comfortable sleeping position. Often the pain appears even at night.
Flexion of the joint is significantly limited. In some cases, not only flexion, but also extension is limited, so the patient with gonarthrosis cannot fully straighten the leg. The joint is enlarged and deformed. Some patients experience hallux valgus or varus deformity: the legs become X or O shaped. Due to limited movements and deformation of the legs, gait becomes unstable and waddles. In severe cases, patients with gonarthrosis can move only with the support of a cane or crutches.
Diagnosis
The diagnosis of gonarthrosis is based on the patient's complaints, objective examination data 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, thickening 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 kneecap moves in the transverse direction, a crunching sound is heard. Palpation reveals a painful area on the inside of the kneecap, at the level of the joint space, as well as above and below it.
With synovitis, the joint increases in volume and its contours become smoother. A lump is detected along the anterolateral surfaces of the joint and above the kneecap. After 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 photographs after some time. Due to its availability and low cost, it remains the main method for diagnosing gonarthrosis to this day. 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 gonarthrosis, there may be no changes on x-rays. Subsequently, a narrowing of the joint space and a compaction of the subchondral area are determined. The articular ends of the femur and especially the tibia expand, the edges of the condyles become pointed.
When studying an x-ray, it should be taken into account that in most older people more or less pronounced changes characteristic of gonarthrosis are observed and are not always accompanied by pathological symptoms. The diagnosis of gonarthrosis is made only with a combination of radiological and clinical signs of the disease.
Currently, along with traditional radiography, modern techniques such as computed tomography of the knee joint are used to diagnose gonarthrosis, which allows a detailed study of pathological changes in bone structures, and magnetic resonance imaging of the knee joint. knee, used to identify soft tissue changes. .
Gonarthrosis treatment
Conservative activities
Treatment is carried out by traumatologists and orthopedists. Therapy for gonarthrosis should begin as soon as possible. During the exacerbation period, the patient with gonarthrosis is recommended to rest to achieve maximum unloading of the joint. The patient is prescribed therapeutic exercises, massages, physiotherapy (UHF, electrophoresis with novocaine, phonophoresis with hydrocortisone, diadynamic currents, magnetic and laser therapy) and mud therapy.
Drug therapy for gonarthrosis includes chondroprotectors (drugs that improve metabolic processes in the joint) and drugs that replace synovial fluid. In some cases, with gonatrosis, intra-articular administration of steroid hormones is indicated. Subsequently, the patient may be referred for treatment in a sanatorium.
A patient with gonarthrosis may be recommended 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 with gonarthrosis, it is very important to follow certain rules: exercise, avoid unnecessary stress on the joint, choose comfortable shoes, control your weight, properly organize your daily routine (alternate load and rest, perform special exercises ).
Surgery
With pronounced destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. In cases of severe pain, joint dysfunction and limited ability to work, especially if a young or middle-aged patient suffers from gonarthrosis, surgery (knee replacement) is resorted to. Afterwards, rehabilitation measures are carried out. The full recovery period after joint replacement surgery for gonarthrosis lasts 3 to six months.