Gonarthrosisdeforming arthrosis 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 accumulation) in the joint. In the later stages, the support of the leg is disturbed and the movements are clearly restricted. The diagnosis is made on the basis of pathological anamnesis, complaints, physical examination and X-ray of the joint. Treatment is conservative: drug therapy, physiotherapy, exercise therapy. In case of significant destruction of the joint, endoprosthetics are indicated.
General Information
Gonarthrosis (from the Latin articulatio - knee joint) or deforming arthrosis of the knee joint is a progressive degenerative-dystrophic damage of intra-articular cartilage without inflammation. Gonarthrosis is the most common arthrosis. Usually middle-aged and elderly people, women are more affected. Gonarthrosis can occur at a younger age after an injury or constant intense stress (for example, during professional sports). Prevention plays the most important role in preventing the occurrence and development of gonarthrosis.
Contrary to popular belief, the reason for the development of the disease is not the deposition of salts, but changes in nutrition and the structure of intra-articular cartilage. With gonarthrosis, foci of calcium salt deposition may occur at the site of tendon attachment and ligament apparatus, but they are secondary and do not cause painful symptoms.
Causes of gonarthrosis
In most cases, it is impossible to determine any reason for the development of pathology. As a rule, the formation of gonarthrosis is caused by a combination of several factors, including:
- Injuries. About 20-30% of gonarthosis cases are associated with previous injuries: tibia fractures (especially intra-articular), meniscus damage, ligament tears or tears. Typically, gonarthrosis occurs 3-5 years after a traumatic injury, although earlier development of the disease is possible - 2-3 months after the injury.
- Physical exercise. Often, the manifestation of gonarthrosis is associated with joint overloads. The age after 40 is a period when many people realize that regular physical activity is necessary to keep the body in good condition. When they start exercising, they ignore 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 intense fast squats are especially dangerous for the knee joints.
- Excessive weight. With excessive body weight, the load on the joints increases, both microtrauma and serious injuries (meniscus tears or ligament tears) occur more often. 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 genetically determined weakness of the ligament apparatus, metabolic disorders and innervation disorders 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, when moving, there is a patella that slides along the depression between the condyles of the femur. The fibula is not involved in the formation of the knee joint. Its upper part is located on the side of the knee joint and slightly below it, and is connected to the tibia through the lower moving joint.
The articular surfaces of the tibia and femur, as well as the back surface of the patella, are covered with smooth, very strong and elastic dense elastic hyaline cartilage 5-6 mm thick. Cartilage reduces friction forces during movements and performs the function of shock absorption during shock loads.
In the first stage of gonarthrosis, blood circulation is disturbed in the small intraosseous vessels that feed the hyaline cartilage. The cartilage surface dries up and gradually loses its smoothness. Cracks appear on its surface. Instead of sliding smoothly, the cartilage "sticks" together. Due to constant microtraumas, the 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 adjusted to accommodate increased loads. The subchondral zone (the part of bone immediately below the cartilage) thickens. Bone growths appear along the edges of the articular surfaces - osteophytes, which look like spines on X-rays.
During gonarthrosis, the synovial membrane and joint capsule also degenerate and "wrinkle". The nature of the joint fluid changes - it thickens, its viscosity increases, which leads to the deterioration of lubrication and nutritional properties. Cartilage degeneration is accelerated due to lack of nutrition. Cartilage becomes thinner and in some places completely disappears. After the cartilage disappears, the 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 together, significantly limiting joint movement. Cartilage tissue is practically absent.
Classification
Considering the pathogenesis in traumatology and orthopedics, two types of gonarthrosis are distinguished: primary (idiopathic) and secondary gonarthrosis. Primary gonarthrosis occurs in elderly patients without previous trauma 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.
Considering the severity of pathological changes, three stages of gonarthrosis are distinguished:
- The first stage- initial manifestations of gonarthrosis. It is characterized by periodic dull pain, usually after a significant load on the joint. There may be a small swelling of the joint that goes away on its own. There is no deformation.
- The second stage- increased symptoms of gonarthrosis. The pain is longer and stronger. A creaking sound often appears. There is mild or moderate restriction of movement and mild deformity of the joint.
- The third stage- clinical manifestations of gonarthrosis reach their maximum. The pain is almost constant, the gait is disturbed. There is an obvious limitation of mobility and a noticeable deformation of the joint.
Symptoms of gonarthrosis
The disease begins gradually, gradually. In the first stage of gonarthrosis, patients feel slight pain when moving, especially when going up or down stairs. There may be a feeling of stiffness in the joint and "pulling" in the popliteal area. A characteristic symptom of gonarthrosis is "starting pain" - painful sensations that occur in the first steps after getting up from a sitting position. When a patient with gonarthrosis is "diverged", the pain decreases or disappears and reappears after significant stress.
Externally, the knee is not replaced. Sometimes patients with gonarthrosis note a slight swelling of the affected area. In some cases, at the first stage of gonarthrosis, fluid collects in the joint - synovitis develops, which is characterized by an increase in the volume of the joint (it becomes swollen, spherical), a feeling of heaviness and limitation of movements.
In the second stage of gonarthrosis, the pain is stronger, occurs even with light loads and is intensified by intense or long walking. As a rule, the 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 sharp pain appears when trying to bend the leg as much as possible. There may be a rough grinding sound when moving. The joint configuration changes, as if it expands. Synovitis appears more often than the first stage of gonarthrosis and is characterized by a more persistent course and more fluid accumulation.
In the third stage of gonarthrosis, pain is almost constant, bothering patients not only when walking, but also at rest. In the evenings, patients spend a long time trying to find a comfortable position to sleep. Often the pain appears even at night.
Flexion at the joint is significantly limited. In some cases, not only bending, but also extension is limited, so the patient with gonarthrosis cannot fully straighten the leg. The joint expands and deforms. Some patients have hallux valgus or varus deformity - the legs are X or O shaped. Due to the limited movements and deformation of the legs, the gait becomes unstable and swings. In severe cases, patients with gonarthrosis can move only with the support of a cane or crutches.
Diagnostics
The diagnosis of gonarthrosis is made based on the patient's complaints, objective examination data and X-ray examination. When examining a patient with the first stage of gonarthrosis, usually external changes 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 limb axis are revealed. When the patella moves in the transverse direction, a crackling sound is heard. During palpation, a painful area is revealed from the patella inwards, at the level of the joint cavity, as well as above and below.
With synovitis, the joint volume increases, its contours are smoothed. A bulge is found along the anterolateral surfaces of the joint and above the patella. Fluctuation is determined during palpation.
X-ray of the knee joint is a classic technique that allows you to clarify the diagnosis, determine the severity of pathological changes in gonarthrosis and monitor the dynamics of the process, taking repeated pictures after a while. Due to its availability and low cost, it remains the main method of diagnosing gonarthrosis to this day. In addition, this research method allows to exclude other pathological processes (for example, tumors) in the tibia and femur.
At the initial stage of gonarthrosis, there may be no changes in X-ray. Subsequently, narrowing of the joint space and compression of the subchondral zone is determined. The articular ends of the femur and especially the tibia widen, the edges of the condyles become pointed.
When studying X-rays, it should be taken into account that more or less clear changes characteristic of gonarthrosis are observed in most elderly people and are not always accompanied by pathological symptoms. The diagnosis of gonarthrosis is made only by the combination of radiological and clinical signs of the disease.
At present, in addition to traditional x-rays, modern methods such as computed tomography of the knee joint, which allows detailed study of pathological changes in bone structures, and MRI of the knee joint, which is used to determine changes in soft tissues, are used in the diagnosis of gonarthrosis. .
Treatment of gonarthrosis
Conservative activities
Treatment is carried out by traumatologists and orthopedists. Therapy for gonarthrosis should be started as early as possible. In the period of exacerbation, the patient with gonarthrosis is recommended to rest for maximum relaxation of the joint. The patient is prescribed therapeutic exercises, massage, 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 synovial fluid replacement drugs. In some cases, with gonathrosis, intra-articular administration of steroid hormones is indicated. Later, the patient can be sent to sanatorium treatment.
A patient with gonarthrosis may be advised to walk with a cane to relieve the burden on the joint. Sometimes special orthoses or special insoles are used. In order to slow down 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, monitor your weight, organize your daily routine correctly (alternation of load and rest, performance-specific exercises).
Surgery
With obvious destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. In cases of severe pain, joint dysfunction and limitation of labor capacity, especially if a young or middle-aged patient suffers from gonarthrosis, they resort to surgical operation (knee replacement). Later, rehabilitation measures are implemented. After joint replacement surgery for gonarthrosis, the full recovery period lasts from 3 to six months.