Gonarthrosis or deforming arthrosis of the knee joint is a degenerative-dystrophic disease of the hyaline cartilage of the knee covering the condyles of the tibia and femur.
The symptoms of arthrosis of the knee joint develop over years, gradually, and the main manifestation of the disease is stiffness of movements and pain.Among arthrosis of other joints (finger phalanges, shoulder and elbow joints, hip joints), gonarthrosis is the most common disease.
The population category most susceptible to arthrosis of the knee joint is women, as well as people over 40 years old.In some cases, gonarthrosis can develop in athletes (from increased stress) and young people (on the background of previous injuries).
Causes of gonarthrosis
Knee osteoarthritis does not develop from a single cause;in most cases, the development of the disease depends on a combination of several negative factors that worsen with age and can eventually lead to such a disorder.Medicine has identified the following mechanisms for the occurrence of arthrosis:
Primary - occurs in old age from the aging of body tissues, as well as against the background of some factors that provoke this disease (constant increased stress, heredity, obesity).
Secondary - accounts for 30% of all cases of gonarthrosis, occurring mainly after damage to the meniscus, rupture of ligaments, fracture of the tibia and other injuries.In most cases, the symptoms of arthrosis of the knee begin to appear after 3-4 years.However, if the injury is severe enough, it may take 2-3 months for symptoms to appear.
About 7-8% of cases of arthrosis of the knee joint appear when after forty years a person begins to actively engage in physical exercises, namely squats and running.But due to age, the weakening of the tissue tone of the knee joint and characteristic age-related changes in sudden loads can provoke the appearance of rapid degenerative and dystrophic changes in the joints.
Another reason for the development of gonarthrosis in a person can be concomitant diseases - varicose veins, overweight, ankylosing spondylitis, gout, psoriatic, rheumatoid or reactive arthritis.
Constant critical loads on the knees, regular long-term climbing of stairs in old age or lifting weights, as well as professional sports can lead to arthrosis of the knee joint.The risk of arthrosis of the knee joint significantly increases with genetically determined weakness of the ligament apparatus, diabetes mellitus and other metabolic disorders, neurological diseases and spinal injuries.
Spasm of the muscles of the front of the thigh is the cause of 50-60% of cases of arthrosis of the knee joint.Such a muscle spasm may not appear for a long time before the appearance of pain in the knees, while a person may feel heaviness in the legs, fatigue and pain in the lower back.When the iliopsoas and rectus femoris muscles are in a state of constant spasm, with age this leads to "tightening" of the knees, which limits their free movement.
Degrees of gonarthrosis
In most cases, the development of arthrosis of the knee joint occurs in one of the knees.Medicine distinguishes 3 degrees of gonarthrosis depending on the intensity of the pathological processes:
The first is that there is no deformity of the bones of the joint;periodic dull pain in the knee is characteristic after physical exertion of the joint.A small swelling of the joint may develop, which disappears on its own after a while.
The second degree is characterized by an increase in the symptoms of arthrosis.The pain is long-lasting and intense, occurs with minimal effort (lifting weights, walking), and crunching in the joint may occur.In the second degree of gonarthrosis, a deformity in the knee joint can develop, as well as a moderate restriction of movement.
Third degree – there are pronounced symptoms of arthrosis of the knee joint.The noticeable deformity of the joint and constant pain lead to disturbances in the patient's gait and there is limited mobility of the joint.In the third degree of gonarthrosis, the pain can increase depending on the time and reach such an intensity that the patient's sleep is disturbed, the limitation of mobility is reduced to a minimum, making it impossible to find a comfortable position for the leg.
Diseases and pathologies with which gonarthrosis is confused
Blockage of the knee joint with meniscus damage.
The disease develops after an unsuccessful movement, accompanied by a crunch in the knee, severe pain appears, which subsides after 15 minutes, and the next day, swelling of the knee appears.
Ankylosing spondylitis, gout, joint rheumatism, arthritis - psoriatic, reactive, rheumatoid.
To distinguish gonarthrosis from arthritis, it is necessary to do a general blood test.In arthritis, the test results will show the presence of an inflammatory process in the body, while in arthrosis, there are no changes in the blood test.
Inflammation of the tendons of the knee.
It develops in most cases in women over 40, when carrying heavy objects or going down stairs.The pain is localized on the inner surface, but the movement of the knee is not limited.
Vascular pain in the knees.
The pain is characterized by symmetry and occurs simultaneously in both knees.Characteristic of young people in a period of accelerated bone growth, they can appear with physical activity, a cold or a change in weather.To describe their own condition, patients use the term "twisted knees."
Stages of arthrosis of the knee joint
The disease is insidious due to its gradual development.Initially, the patient feels only mild discomfort, pain when moving, climbing or descending stairs.In some cases, the patient's sensations are reduced to a slight stiffness of the joint and tightness in the posterior region.A characteristic feature of arthrosis of the knee joint is considered to be an initial pain symptom, which consists in the fact that after a sharp transition from a sitting position to movement, a person begins to experience pain during the first steps, which gradually disappears, only to reappear after a heavy load.
The appearance of the knee joint with the first degree of arthrosis does not differ from a healthy knee, only in some cases patients note a slight swelling.Also, in some cases, fluid begins to accumulate in the knee joint, it swells and becomes spherical, synovitis begins to develop, which leads to a feeling of heaviness and limited movement of the joint.
Such changes in the joint in the first degree of arthrosis occur due to disruption of blood circulation in the small intraosseous vessels that nourish the hyaline cartilage.This leads to changes in the surface of the cartilage, dryness, loss of smoothness and the appearance of cracks.Because of this, the unhindered and soft movement between the cartilages is difficult and is accompanied by constant microtraumas when the cartilages adhere to each other.Cartilage tissue, being in a constant state of microtrauma, begins to lose its cushioning properties and become thinner.
The development of pathological processes leads to changes in bone structures.The joint area is flattened, and growths in the form of spikes (osteophytes) appear at the edges.The joint capsule degenerates, the synovial fluid thickens and the synovial membrane shrinks.This leads to a significant deterioration of the nutritional process of the cartilage and accelerates its degeneration.
As the disease progresses in the second stage, the symptoms begin to intensify, the pain appears even with light loads and is localized on the inner face of the joint.Rest brings relief, but resuming movement causes severe pain.
The mobility of the joint is significantly reduced, attempts to maximally bend the leg cause sharp pain, and when moving, a distinct coarse crunch is heard.Synovitis is more common;the joint enlarges and changes its configuration due to a large accumulation of fluid.
The third degree of arthrosis of the knee joint is accompanied by a significant deformation of the bones, in which they appear pressed into each other.Cartilage tissue is practically absent and the limitation of joint movement increases.Straightening the joints becomes quite problematic, and pain begins to bother the patient around the clock, both when walking and at rest.Due to a severe deformation of the joints, the legs become O- or X-shaped, the gait becomes unstable, jerking, and quite often the patient cannot do without a cane or crutches.
Diagnosis and treatment of gonarthrosis
During a routine examination, it is impossible to determine whether the patient has the first degree of arthrosis of the knee joint.If it is 2 or 3 degrees, on examination there is swelling, edema (with synovitis), crunching is heard, stiffness of movements, changes in the axis of the limbs and deformation of the joints are observed.
Today, in addition to radiography, CT and MRI methods are widely used to diagnose arthrosis, thanks to which it is possible to examine in more detail the disorders of bone structures and to examine pathological changes in soft tissues.
Treatment of the disease includes a complex of orthopedic procedures and drug therapy.The orthopedist prescribes mud treatment, therapeutic gymnastics, massage and physiotherapy.
Drug treatment includes the use of chondroprotectors, these are drugs that replace synovial fluid.In some cases, an intra-articular injection of steroid hormones is performed.Sanatorium-resort treatment is also recommended to patients.
If the treatment of a young patient with severe limitation of movement and pain is ineffective, a joint replacement method can be used, which provides for a 3-6 month rehabilitation period.
What happens to the knee joint in osteoarthritis?
Articular cartilage plays an important role in human movement and is a smooth, elastic and durable lining that allows joint bones to move smoothly relative to each other and also absorbs and distributes the load when walking.
But with excessive regular loads, genetic predisposition, metabolic disorders in the body, prolonged muscle spasms and injuries, the cartilage loses its smoothness and begins to thin.The soft sliding of the articular bones is replaced by strong friction and the first degree of gonarthrosis develops, in which the cartilage loses its shock-absorbing properties.
The degradation process continues to progress and poor shock absorption leads to flattening of the bone surfaces with the formation of osteophytes in the form of bone growths.In this case, the disease already has the second degree and is accompanied by degeneration of the synovial membrane and joint capsule.The lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the process of cartilage nutrition is disturbed, which leads to an even greater deterioration of the patient's condition.
The thinning of the cartilage leads to a reduction in the distance between the articular bones by up to 80%.When walking, due to abnormal friction and lack of a shock absorber, destructive processes in the joint rapidly increase, which quickly leads to the development of third degree arthrosis with pronounced symptoms:
Pain when moving, especially going up or down stairs.
Pain both during exercise and at rest, morning stiffness.
The patient begins to limp, trying to spare the diseased joint.
Severe cases of the disease require the use of crutches or a cane.
The third degree of arthrosis of the knee joint is characterized by an almost complete absence of cartilage tissue, which leads to a reduction in joint mobility to a minimum.Therefore, no magical methods, supermedicines or ointments can restore the worn cartilage tissue, and given the degree of bone deformation, the normal functioning of the joint is impossible.In this case, only surgery can help.
Gymnastics for arthrosis of the knee joint
Any treatment option for arthrosis of the knee joint should be carried out only according to a doctor's prescription.Therapeutic gymnastics includes slow, measured exercises that exclude squats, twisting the joint and jumping.It is best to do gymnastics in the morning, sitting or lying down, for 20 minutes, repeating each exercise 10 times.
The main goals of therapeutic exercises are to relax the muscle spasms that cause pain, increase blood supply to the joint, slow the progression of the disease and prevent further destruction of the cartilage.During the period of exacerbation of the disease, physical exercises are prohibited.
Lying on your back, you can perform the exercise with a bicycle, but you need to straighten your legs parallel to the floor, make circular movements with your legs, move your legs to the sides, alternately slide them on the floor, tense your legs, counting to 10.
Sitting in a chair with your legs down, straighten your legs while simultaneously bending your legs and holding this position, counting to 10, alternately pull each knee towards your stomach with your hands and slowly return to the starting position.
Focusing on the wall, standing on the floor, alternately swing your legs back and forth.
Placing your straight leg on a chair, perform oblique movements of a springy nature, while leaning with your hands on your thigh, as if trying to straighten your leg more.
Lying on your stomach, alternately raise your straight leg and hold it for 3 counts.
Sitting on the floor, spread your legs to the sides, moving them along the floor, pull your knees to the stomach while inhaling and return them to the starting position while exhaling.