Gonarthrosisis deforming 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 on the leg is disturbed, and a pronounced limitation of movement is observed. Pathology is diagnosed on the basis of history, complaints, physical examination and radiography of the joint. Treatment is conservative: drug therapy, physiotherapy, exercise therapy. If there is significant destruction of the joint, endoprosthetics is indicated.
General information
Gonarthrosis (from the Latin articulatio genus - knee joint) or deforming arthrosis 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 arthrosis. It usually affects middle-aged and elderly people, more often women are affected. After an injury or constant intense stress (for example, during professional sports), gonarthrosis can appear at a younger age. Prevention plays the most important role in preventing the occurrence and development of gonarthrosis.
Contrary to popular opinion, the cause of the development of the disease does not lie in the deposition of salt, but in malnutrition and changes in the structure of the intra-articular cartilage. In gonarthrosis, foci of deposition of calcium salts may appear at the point of attachment of tendons and ligament apparatus, but they are secondary and do not cause painful symptoms.
Causes of gonarthrosis
In most cases, it is impossible to identify any 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 gonarthrosis cases are associated with previous injuries: tibial fractures (especially intra-articular), meniscus injuries, tearing or rupture of ligaments. Typically, gonarthrosis appears 3-5 years after a traumatic injury, although earlier development of the disease is possible - 2-3 months after the injury.
- Physical exercises. Often, the manifestation of gonarthrosis is associated with an excessive load on the joint. Age after 40 is the period when many people realize that regular physical activity is necessary to maintain the body in good condition. When starting exercise, they do not take into account age changes and unnecessarily burden 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.
- Excess weight. With excess body weight, the load on the joints increases, and microtraumas and serious damage (meniscus or ligament tears) occur more often. Gonarthrosis is particularly severe 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 occurrence of gonarthrosis include genetically determined weakness of the ligament apparatus, metabolic disorders and disturbed innervation in certain neurological diseases, traumatic injuries of the brain and spine.
Pathogenesis
The knee joint is formed by the joint surfaces of two bones: the femur and the tibia. On the front surface of the joint is the patella, which slides along the depression between the condyles of the femur during movement. 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 via a low-movable 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 densely elastic hyaline cartilage 5-6 mm thick. Cartilage reduces frictional forces during movement and performs the function of cushioning during shock loads.
In the first stage of gonarthrosis, the blood circulation in the small intraosseous vessels that feed the hyaline cartilage is disturbed. The cartilage surface becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of soft, smooth sliding, the cartilages "stick" to each other. Due to constant microtraumas, the cartilage tissue becomes thinner and loses its cushioning properties.
In the second stage of gonarthrosis, there are compensatory changes in bone structures. The articulated platform is flattened, adapting to increased loads. The subchondral zone (the part of the bone located just below the cartilage) thickens. Along the edges of the joint surfaces, bone growths appear - osteophytes, which look like spines on an X-ray.
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 the deterioration of its lubricating and nutritional properties. Due to the lack of nutrients, cartilage degeneration accelerates. The cartilage becomes even thinner and in some areas completely disappears. After the disappearance of the cartilage, the friction between the joint surfaces increases sharply, and degenerative changes progress rapidly.
In the third stage of gonarthrosis, the bones are significantly deformed and seem to be pressed into each other, which significantly limits movement in the joint. 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 without prior trauma in elderly patients and is usually bilateral. Secondary gonarthrosis develops against the background of pathological changes (diseases, developmental disorders) or injury to 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:
- 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 slight swelling of the joint that disappears on its own. No deformation.
- The second stage- increasing symptoms of gonarthrosis. The pain becomes longer and more intense. Creaking often occurs. There is mild or moderate limitation of motion and mild joint deformity.
- The third phase- clinical manifestations of gonarthrosis reach their maximum. The pain is almost constant, the gait is disturbed. There is a pronounced 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 less pain when moving, especially when going up or down stairs. There may be a feeling of stiffness in the joint and "tightness" in the popliteal area. A characteristic symptom of gonarthrosis is "initial pain" - painful sensations that occur during the first steps after standing up from a sitting position. When a patient with gonarthrosis "separates", the pain decreases or disappears, and after significant stress it reappears.
The outside of the knee has not been changed. Sometimes patients with gonarthrosis notice a slight swelling of the affected area. In some cases, in 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 becomes swollen, spherical), a feeling of heaviness and limitation of movement.
In the second stage of gonarthrosis, the pain becomes more intense, occurs even with light loads and increases with intensive or long walking. As a rule, the pain is localized along the front 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. A harsh grinding noise can be heard when moving. The configuration of the joint changes, as if expanding. Synovitis occurs more often than in the first stage of gonarthrosis and is characterized by a more persistent flow and accumulation of more fluid.
In the third stage of gonarthrosis, the pain becomes almost constant, disturbing patients not only while walking, but also at rest. In the evening, patients spend a long time trying to find a comfortable sleeping position. Often the pain occurs even at night.
Flexion in the joint is significantly limited. In some cases, not only flexion, but also extension is limited, which is why the patient with gonarthrosis cannot fully straighten the leg. The joint is enlarged and deformed. Some patients have hallux valgus or varus deformity - the legs become X- or O-shaped. Due to the limited movements and deformation of the legs, the gait becomes unstable and stomps. 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. During the examination of a patient with the first stage of gonarthrosis, usually no external changes can be detected. In the second and third stages of gonarthrosis, rough bone contours, joint deformation, limitation of movement and curvature of the limb axis are revealed. When the patella is moved in a transverse direction, a creak is heard. Palpation reveals a painful area inward from the patella, at the level of the joint space, as well as above and below it.
With synovitis, the joint increases in volume, its contours become smooth. A protrusion is detected along the anterolateral surfaces of the joint and above the patella. After palpation, fluctuation is determined.
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, repeating the images 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.
In the initial stage of gonarthrosis, changes on X-rays may be absent. After that, the narrowing of the joint space and compaction 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 radiography, it should be taken into account that in most elderly people, more or less pronounced changes characteristic of gonarthrosis are observed and are not always accompanied by pathological symptoms. The diagnosis of gonarthrosis is established only by a combination of radiological and clinical signs of the disease.
Currently, in addition to traditional radiography, modern techniques are used to diagnose gonarthrosis, such as computer tomography of the knee joint, which enables a detailed study of pathological changes in bone structures, and MRI of the knee joint, which is used to identify changes in soft tissues. .
Treatment of gonarthrosis
Conservative activities
Treatment is carried out by traumatologists and orthopedists. Gonarthrosis therapy should be started as soon as possible. During the period of exacerbation, the patient with gonarthrosis is recommended to rest for the maximum relief 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.
Treatment of 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. After that, the patient can be referred for sanatorium treatment.
A patient with gonarthrosis may be advised to walk with a cane to relieve the joint. Sometimes special orthoses or custom insoles are used. In order 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, monitor your weight, properly organize your daily routine (alternate load and rest, perform special exercises).
Operation
With pronounced destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. In cases of severe pain, joint dysfunction and limited working capacity, especially if a young or middle-aged patient suffers from gonarthrosis, surgery (knee replacement) is resorted to. After that, rehabilitation measures are implemented. The period of complete recovery after joint replacement surgery for gonarthrosis lasts from 3 months to six months.