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 arthropathy of the knee joint begins - gonoarthrosis.

Gonarthrosis is an arthropathy that deforms the knee joint, which is accompanied by chronic damage to the surfaces of the hyaline cartilage, as well as to the bones - the femur and the tibia. Symptoms of knee joint disease are pain that worsens with movement. Due to the accumulation of fluid in it, movement is limited. Later, there is a limitation of the movements of the knee due to a violation of the support on the leg. The diagnosis of the pathology is based on the collection of the patient's memories and complaints, the results of a visual examination and material 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 arthropathy, which is a degenerative-dystrophic progressive damage of the cartilage of the knee joint of a non-inflammatory nature. Women and the elderly usually suffer from gonoarthrosis. But after injuries during intense sports, gonoarthrosis occurs even in young people.

The cause of arthrosis lies in the change in the structure of the cartilage within the joint and not in the deposition of calcium there. With gonoarthrosis, salt deposits occur where the tendons attach to the ligamentous apparatus, but they cannot be the cause of the pain symptoms. First, cracks appear in the cartilage, which reduce the thickness in certain 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 the knee cartilage until it disappears.
• changes in synovial fluid in composition and quantity.
• bone damage in the knee due to friction.
• the appearance of osteophytes.
• stiffness due to compression of the joint capsule.
• muscular spasm.

As a result, the knee joint is deformed, its mobility is limited, as a result of which this leads 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 arthritis, both knee joints are affected.

Arthritis symptoms of the knee joint

The symptoms of knee arthritis can be very different:

• At first, slight discomfort occurs 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.
• a sharp crease appears, 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 become blocked in the final stages (ankylosis).
• unsteady 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 tissues 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.

Arthritis begins gradually. In the 1st stage of gonoarthrosis, patients feel slight sensations of stiffness and pain that occur when going up or down stairs. Possible tightening of the area below the knee. Typical are the initial sensations of pain arising from a sitting position at the start of the ascent. When the patient moves away, the pain decreases, but with effort it reappears.

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

In stage 2, severe pain occurs with prolonged exercise and worsens with walking. The pain is usually localized along the anterior surface within the joint. After rest, the pain disappears, but during movement it reappears.

As the arthropathy progresses, the range of motion in the knee joint decreases; when you try to bend your leg as much as possible, pain and a rough, sharp sting appear. The configuration changes, the joint expands. Arthritis occurs with even greater accumulation of fluid in them.

In stage 3, the pain becomes constant and bothers you not only when you walk, but also when you rest. Painful sensations appear even at night; in order to fall asleep, patients need a long time to find a place 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 the deformity of the feet occurs in patients; they become X-shaped or O-shaped. As a result of the deformity of the foot and limited movement, the gait of patients becomes unstable and sways. In severe cases of gonoarthrosis, patients move with the support of crutches.

Arthritis causes of the knee joint

Most joint cases occur for a variety of reasons. These factors include:

• Injuries.25% of knee osteoarthritis occurs due to injuries: meniscus damage, ligament tears. Gonarthrosis usually appears three to five years after the injury, sometimes the disease can develop earlier - after two to three months.
• Physical exercise.Often, gonoarthrosis 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 particularly dangerous for the joints.
• Excess weight.Excess weight significantly increases the load on the knee joints, causing injury. Gonarthrosis is particularly difficult if there are metabolic disorders and varicose veins.
• Sedentary life.

The development process of the joint increases with arthritis, due to gout or ankylosing spondylitis. The risk of gonoarthrosis is the genetic weakness in the ligaments and the disruption 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 it moves, cartilage reduces friction and acts as a shock absorber.

There are 4 stages of arthritis:

• 1st stage.There is a disturbance in the blood circulation in the vessels that supply the hyaline cartilage. Its surface dries out and small cracks appear, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and, instead of sliding smoothly, it sticks, losing its absorbent property. There are no visual signs of arthrosis; the x-ray shows a slight deviation.
• 2nd stage.Changes occur in the bone structure and the joint area flattens to accommodate greater loads. The part of the bone that is under the cartilage becomes denser. Along the edges of the joint, manifestations of initial calcification of the ligaments appear - osteophytes that look like spikes on the X-ray; narrowing of the joint space is also visible. The articular capsule of the joint degenerates, wrinkling. 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 disappearance, friction in the joint increases and degeneration develops sharply. Patients feel pain during exercise, when climbing stairs, when squatting and when standing for a long time.
• 3rd stage.X-rays show a noticeable, sometimes asymmetrical narrowing of the joint space. Due to 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. There is 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 deformation of the cartilage and destruction of the articular bones, many osteophytes, and the bones can fuse together.

Classification

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

Diagnostics

Arthropathy is diagnosed by an orthopedist or traumatologist in a medical clinic.

• The appointment begins with the collection of memories - the main complaints and symptoms that concern the patient. The doctor ascertains complaints, the presence of chronic diseases, previous injuries, fractures and injuries and asks additional questions.
• On examination, features of joint mobility, deformity and pain are revealed. In stage 1 of gonoarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformation and roughness of the contours of the joint, limitation of movements and curvature of the legs are found. When the kneecap moves, a sharp snapping sound is heard. During palpation, the doctor detects pain in the inner part of the joint space. The joint can increase in size. Swelling of the joint is detected. When palpating the joint, the fluctuation is felt.
• The patient is referred for laboratory tests. When taking a general blood test, inflammation is detected, while a biochemical test reveals possible causes of problems.
• Then, the organic 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 deformations. X-ray of the joint is a technique that clarifies the diagnosis of pathological changes and the dynamics of the joint. At the onset of gonoarthrosis, the changes are not visible on radiographs. Then, narrowing of the joint space and compression of the subchondral zone is determined. Gonarthrosis can only be diagnosed by X-rays and clinical examinations.
• Today, in addition to x-rays, for the diagnosis of arthropathy, 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 visually assess thecondition 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 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 qualified specialists.

Treatment of arthropathy of the knee joint

Treatments for arthritis can be divided into three groups:

• medical;
• physiotherapy;
• surgical.

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

When a patient is diagnosed with stage 1 and 2 disease, drugs and physical therapy are used; if the damage is extensive, then surgery and surgery are used.

Pharmaceutical treatment

Proper medication 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 worsen the condition and lead to serious complications.

Drug therapy for arthropathy includes taking the following drugs:

• anti-inflammatory:relieves inflammation and relieves joint pain.
• hormonally:prescribed when anti-inflammatory drugs are ineffective.
• anticonvulsants:help get rid of muscle spasms and relieve 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:improving nutrition and oxygen supply.

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

In addition, complex non-pharmacological methods are used to treat arthropathy:

• physical therapy (physical therapy)which is carried out under the supervision of a specialist.
• massage lessonsabsence of inflammatory process.
• osteopathic effectin the treatment of arthropathy, which is aimed not only at the affected area, but also at the restoration of the resource of the entire organism, since the pathological process that occurs locally in the joint area is the result of many processes that occur in the body as a whole. During the osteopathic session, work is carried out with the musculoskeletal system as a whole, in order to achieve the maximum restoration of innervation and mobility in the spine, pelvic bones, sacrum and to eliminate the compression of nerves and blood vesselsvessels throughout the body!

Physiotherapy

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

• Shockwave Therapy:Ultrasound eliminates osteophytes.
• magnetotherapy:the magnetic field affects metabolic processes and stimulates regeneration.
• laser treatment:deep tissue laser heating.
• electrotherapy (myostimulation):electric shock to the muscles.
• electrophoresis or phonophoresis:administration of chondroprotectors and analgesics using ultrasound and electric current.
• Ozone therapy:gas injection into the joint cavity.

Surgery

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

• endoprosthetic:replacement of the entire joint with a prosthesis.
• arthrodesis:fixation between the bones for their immobility, to reduce pain and give a person the opportunity to rest on the leg.
• osteotomy:cut a bone to place at an angle in the joint to reduce stress.

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

Prevention

Preventive measures and compliance with the doctor's recommendations play an important role in the occurrence of gonoarthrosis. 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 loads on the joints.
• Avoid vigorous physical activity.
• choose comfortable orthopedic shoes.
• Monitor your weight and daily routine - alternate between specific exercises and time for rest.

Diet

The condition of the affected cartilage depends largely on the diet. In case of arthropathy, it is necessary to exclude:

• fizzy drinks;
• alcoholic beverage;
• fatty and overly spicy foods.
• canned food and semi-finished products.
• products with dyes, preservatives, artificial fragrances.

The diet should contain: protein, fatty acids, for example, omega-3, collagen, which is contained 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 bony framework.
• shortening of the lower limbs;
• ankylosis - complete immobilization of the knee joint.
• damage to the musculoskeletal system.