Osteoarthritis of the knee joint

The knee joint experiences regular stress. Running and jumping, walking and climbing stairs or just standing 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, which is accompanied by chronic damage to the surfaces of the hyaline cartilage, as well as the bones - femur and tibia. Symptoms of disease in the knee joint are pain that increases with movement. Due to the accumulation of fluid in it, movement is limited. Later there is limitation of knee movement due to violation of support in the leg. The diagnosis of the pathology is based on the collection of the patient's history 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 genus - knee joint) is the most common arthrosis, which is a degenerative-dystrophic progressive lesion of the cartilage of the knee joint of a non-inflammatory nature. Women and the elderly most often suffer from gonarthrosis. But after injuries during intense sports, gonarthrosis occurs even in young people.

The cause of arthrosis lies in the change in the structure of the cartilage inside the joint, not in the deposition of salt there. In gonarthrosis, salt deposits occur where the tendons are attached to the ligament apparatus, but they cannot be the cause of pain symptoms. First, cracks appear in the cartilage, which reduce the thickness in some areas. Gradually, the load is redistributed, the joint begins to come into contact with the bones, accelerating the painful process. As a result, the following changes occur in the knee joint:

• thinning of knee cartilage until it disappears;
• changes in the composition and amount of synovial fluid;
• bone damage in the knee due to friction;
• appearance of osteophytes;
• stiffness due to compression of the joint capsule;
• muscle spasm.

As a result, the knee joint becomes deformed, its mobility is limited, which can lead to 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, while in 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 occurs when climbing stairs, then the pain syndrome increases and bothers even at rest;
• stiffness occurs in the morning, initially lasts a few minutes, and then can last up to half an hour;
• a sharp creaking occurs, which is already accompanied by pain in the second degree of damage;
• mobility is limited, it is difficult to bend and straighten the knee due to pain, bone friction and osteophyte growth, the joint may be blocked in the final stages (ankylosis);
• unstable gait due to muscle atrophy (reduction in muscle volume);
• deformation of the knee joint due to the growth of bones and changes in their shape, the appearance of an inflammatory process in the muscles and ligaments increases the swelling around the tissue of the joint;
• lameness as a result of the progression of the disease of the knee joint, in the later stages the patient is forced to walk even with a walker.

The disease of arthrosis begins gradually. In the 1st stage of gonarthrosis, patients feel mild sensations of stiffness and pain that occur when climbing or descending stairs. Possible tightening of the area below the knee. Initial feelings of pain arising from a sitting position at the beginning of the ascent are characteristic. When the patient moves away, the pain decreases, but after exertion, it reappears.

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

In the 2nd stage, intense pain occurs during long-term exercise and intensifies when walking. The pain is usually localized along the front surface inside the joint. After rest, the pain disappears, but it reappears when moving.

As arthrosis progresses, the range of motion in the knee joint decreases; when you try to bend your leg as much as possible, there is pain and a harsh, sharp crunching sound. The configuration changes, the joint expands. Synovitis occurs with an even greater accumulation of fluid in them.

In phase 3, the pain becomes constant and bothers you not only when walking, but also at rest. Painful sensations occur even at night, in order to fall asleep, patients need a lot of time to find a position for their leg. Flexion and extension of the joint are limited. Sometimes the patient cannot straighten the leg completely. The joint is enlarged and deformed. Sometimes patients develop valgus deformity of the legs, they become X or O-shaped. As a result of leg deformation and limited movement, the patient's gait becomes unstable and wobbles. In severe cases of gonarthrosis, patients move with the support of crutches.

Causes of arthrosis of the knee joint

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

• Injuries.25% of gonarthrosis is caused by 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 exercises.Gonarthrosis often occurs after the age of forty due to professional sports and excessive physical load on the knee joint, which leads to the development of degenerative-dystrophic changes. Fast running and intense squats are especially dangerous for the joints.
• Excess weight.Excess weight significantly increases the load on the knee joints, causing injuries. Gonarthrosis is especially difficult if there are metabolic disorders and varicose veins.
• Sedentary lifestyle.

The process of developing gonarthrosis increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonarthrosis is genetic weakness of ligaments and disturbed 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 when it moves between the grooves of the femur. The articular surfaces of the tibia and femur are covered with 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 disturbance of blood circulation in the vessels that feed the hyaline cartilage. Its surface becomes dry and small cracks appear on it, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and instead of soft gliding, adheres, it loses its cushioning quality. There are no visual symptoms of arthrosis, the X-ray shows a slight deviation.
• 2nd phase.Changes occur in the bone structure, and the joint area is flattened to withstand greater loads. The part of the bone that is under the cartilage becomes denser. Manifestations of the initial calcification of the ligaments appear along the edges of the joint - osteophytes that resemble spikes on an X-ray; narrowing of the gap in the joint is also visible. The synovial capsule of the joint degenerates, becomes wrinkled. The fluid in the joint thickens, its viscosity increases, and its lubricating properties deteriorate. The process of degeneration in the cartilage accelerates, it becomes thinner, and in some places it disappears completely. After its disappearance, friction in the joint increases, and degeneration progresses rapidly. Patients feel pain during exercise, climbing stairs, squatting and standing for long periods of time.
• 3rd phase.X-rays show noticeable, sometimes asymmetrical narrowing of the joint space. Due to the deformation of the meniscus, the bones are deformed and pressed 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 at rest, it is impossible to walk without support.
• 4th stage.Movements in the knee joint are impossible; x-rays show complete cartilage deformation and destruction of joint bones, many osteophytes, and bones may fuse with each other.

Classification

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

Diagnostics

Arthritis of the joints is diagnosed by an orthopedist or a traumatologist in a medical clinic.

• The appointment begins with the collection of anamnesis - the main complaints and symptoms that worry the patient. The doctor notes complaints, the presence of chronic diseases, previous injuries, fractures and injuries, and asks additional questions.
• The examination reveals joint mobility, deformation and pain characteristics. In stage 1 gonarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformation and roughness of joint contours, limitation of movement and curvature of the legs are revealed. When the patella moves, a sharp crunching sound is heard. After palpation, the doctor detects pain in the inner part of the joint space. The joint may increase in size. Swelling of the joint is detected. Fluctuation is felt when palpating the joint.
• The patient is referred for laboratory tests. When taking a general blood test, inflammation is detected, and a biochemical test reveals possible causes of the problem.
• 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 gap, osteophytes and bone deformation. X-ray of the joint is a technique used to clarify the diagnosis of pathological changes and the dynamics of arthrosis. At the beginning of gonarthrosis, changes are not visible on X-rays. After that, the narrowing of the joint space and compaction of the subchondral zone is determined. Gonarthrosis can only be diagnosed by X-ray and clinical tests.
• Today, in addition to radiography, computed tomography (CT) is used to diagnose arthrosis, which enables a detailed study of bone changes, as well as magnetic resonance imaging (MRI), which enables a visual assessment of the state of the joint and is used to identify changes in muscle tissue and ligaments.
• During 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 view the inside of 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:

• medical;
• physiotherapy;
• surgical.

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

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

Drug treatment

Proper use of drugs can stop pain and inflammation, as well as slow down the process of cartilage tissue destruction. This is why 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 worsen the situation and lead to serious complications.

Drug therapy for arthrosis includes taking the following drugs:

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

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

In addition, complex methods without drugs are used to treat arthrosis:

• physical therapy (physical therapy)which is carried out under the supervision of a specialist;
• massage coursesin the absence of an inflammatory process;
• osteopathic effectin the treatment of arthrosis, which is aimed not only at the affected area, but also at restoring the resources of the entire organism, because the pathological process that occurs locally in the joint area is the result of many processes that take place in the body as a whole. During an osteopathic session, work is done with the musculoskeletal system as a whole in order to achieve maximum restoration of innervation 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 joint, increase its mobility and improve the medicinal 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 for muscles;
• electrophoresis or phonophoresis:administration of chondroprotectors and analgesics by ultrasound and electric current;
• ozone therapy:gas injection into the joint cavity.

Operation

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

• endoprosthetics:replacing the entire joint with a prosthesis;
• arthrodesis:fixing between bones to immobilize them, to reduce pain and enable the person to lean on the leg;
• osteotomy:cutting one bone to place it at an angle in the joint to reduce stress.

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

Prevention

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

• engage in special physical activity: physical therapy and gymnastics without unnecessary burden on the joints;
• avoid heavy physical activities;
• choose comfortable orthopedic shoes;
• Track your weight and daily routine - alternate special exercises and rest time.

Diet

The condition of the affected cartilage largely depends on diet. In the case of arthrosis, it is necessary to rule out:

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

The diet should contain: proteins, fatty acids, for example, omega-3, collagen, which is found in gelatin. It is necessary to eat without gaining weight.

Consequences and complications

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

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