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 chronically progressive course. Clinical symptoms include pain that worsens with movement, limitation of movement, and synovitis (fluid build-up) in the joint. In the later stages, the support of the leg is impaired and a pronounced limitation of movements is observed. Pathology is diagnosed on the basis of history, complaints, physical examination and X-ray of the joint. The treatment is conservative: drug therapy, physiotherapy, exercise therapy. If there is significant destruction of the joint, arthroplasty is indicated.
Main information
Gonarthrosis (from the Latin articulatio genus - knee joint) or deforming arthrosis of the knee joint is a progressive degenerative-dystrophic damage of the intra-articular cartilage of a non-inflammatory nature. Gonarthrosis is the most common arthrosis. It usually affects middle-aged and elderly people, women are more often affected. After an injury or constant high 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 belief, the cause of the development of the disease does not lie in the deposition of salts, but in malnutrition and changes in the structure of the intra-articular cartilage. With gonarthrosis, foci of deposition of calcium salts may appear at the place of attachment of the tendons and ligamentous apparatus, but they are secondary and do not cause painful symptoms.
Causes of gonarthrosis
In most cases, it is impossible to identify a single reason for the development of the 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, ligament tears or tears. Usually, gonarthrosis appears 3-5 years after a traumatic injury, but earlier development of the disease is possible - 2-3 months after the injury.
- Physical exercises. Often the manifestation of gonarthrosis is associated with excessive load on the joint. The age after 40 is a period when many people understand that regular physical activity is necessary to keep the body in good condition. When they start training, they do not take into account age 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.
- Overweight. With excess body weight, the load on the joints increases, both microtraumas and serious injuries (torn meniscus or torn ligaments) occur more often. Gonarthrosis is particularly difficult in obese patients with severe varicose veins.
The risk of gonarthrosis also increases after a history of 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 impaired innervation in certain neurological diseases, craniocerebral trauma and spinal cord 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 is the patella, which during movement 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 laterally and just below the knee joint and is connected to the tibia by a low movable joint.
The articular surfaces of the tibia and femur, as well as the back surface of the patella, are covered with a smooth, very strong and elastic densely elastic hyaline cartilage with a thickness of 5-6 mm. Cartilage reduces frictional forces during movements and performs a shock-absorbing function during shock loads.
In the first stage of gonarthrosis, the blood circulation in the small intraosseous vessels feeding the hyaline cartilage is disturbed. The surface of the cartilage becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of smooth, unimpeded sliding, the cartilages "stick" to each other. Due to constant microtraumas, the cartilage tissue thins and loses its shock-absorbing properties.
In the second stage of gonarthrosis, compensatory changes occur in the bone structures. The joint platform is flattened, adapted to increased loads. The subchondral zone (the part of the bone immediately below the cartilage) thickens. On the edges of the joint surfaces, bone growths appear - osteophytes, which in their appearance on the X-ray image resemble spikes.
During gonarthrosis, the synovial membrane and the joint capsule also degenerate and "wrinkle". The character of the joint fluid changes - it thickens, its viscosity increases, which leads to a deterioration of its lubricating and nutritional properties. Due to a lack of nutrients, the degeneration of the cartilage 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 the degenerative changes rapidly progress.
In the third stage of gonarthrosis, the bones are significantly deformed and appear 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 previous trauma in elderly patients and is usually bilateral. Secondary gonarthrosis develops against the background of pathological changes (diseases, developmental disorders) or injuries to the knee joint. It can appear at any age, usually unilateral.
Considering the severity of pathological changes, three stages of gonarthrosis are distinguished:
- First stage– initial manifestations of gonarthrosis. It is characterized by intermittent dull pain, usually after a significant load on the joint. There may be slight swelling of the joint, which goes away on its own. There is no deformation.
- Second stage- intensification of the symptoms of gonarthrosis. The pain becomes longer and more intense. A crunch often occurs. There is mild or moderate limitation of movement and slight deformity of the joint.
- Third stage– the clinical manifestations of gonarthrosis reach their maximum. The pain is almost constant, the gait is impaired. There is a pronounced limitation of mobility and noticeable deformation of the joint.
Symptoms of gonarthrosis
The disease begins gradually, gradually. In the first stage of gonarthrosis, patients experience slight 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 "starting pain" - painful sensations that appear during the first steps after rising from a sitting position. When the patient with gonarthrosis "gets along", the pain decreases or disappears, and after significant stress it reappears.
Externally, the knee is not changed. Sometimes patients with gonarthrosis note 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 movements.
In the second stage of gonarthrosis, the pain becomes more intense, occurs even with light loads and increases with intensive or prolonged walking. As a rule, the pain is localized on the front inner surface of the joint. After a long rest, the painful sensations usually disappear and reappear with movement.
With the progression of gonarthrosis, the range of motion in the joint gradually decreases, and when trying to maximally bend the leg, sharp pain appears. There may be a harsh grinding sound when moving. The configuration of the joint changes as if it were 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, bothering patients not only when 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 are limited, due to which the patient with gonarthrosis cannot fully straighten the leg. The joint is enlarged and deformed. Some patients develop a hallux valgus or varus deformity – the feet become X- or O-shaped. Due to limited movements and deformation of the legs, the gait becomes unstable and wobbles. In severe cases, patients with gonarthrosis can move only with the help of a cane or crutches.
Diagnosis
The diagnosis of gonarthrosis is made on the basis of the patient's complaints, data from an objective examination and X-ray examination. When examining a patient with the first stage of gonarthrosis, external changes usually cannot be detected. In the second and third stages of gonarthrosis, roughening of the contours of the bones, deformation of the joint, limitation of movements and distortion of the axis of the limb are found. When moving the patella in a transverse direction, a crunch is heard. During palpation, a painful area is found inward from the patella, at the level of the joint gap, as well as above and below it.
With synovitis, the joint increases in volume, its contours are smoothed. A bulge is found on the anterolateral surfaces of the joint and over the patella. A fluctuation is determined by palpation.
X-ray of the knee joint is a classic technique that allows you to clarify the diagnosis, establish the severity of pathological changes in gonarthrosis and monitor the dynamics of the process by taking repeated photographs 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, radiographic changes may be absent. Subsequently, narrowing of the joint space and densification of the subchondral zone is determined. The articular ends of the femur and especially the tibia expand, the edges of the condyles become pointed.
When examining radiography, it should be borne in mind that more or less pronounced 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 with a combination of radiological and clinical signs of the disease.
Currently, along with traditional radiography, modern techniques such as computed tomography of the knee joint, which allows detailed examination of pathological changes in bone structures, and MRI of the knee joint, used to identify changes in soft tissues, are used to diagnose gonarthrosis. .
Treatment of gonarthrosis
Conservation activities
Treatment is carried out by traumatologists and orthopedists. Therapy for gonarthrosis should begin as early as possible. In the period of exacerbation of the patient with gonarthrosis, rest is recommended for maximum unloading 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 treatment.
Drug therapy for gonarthrosis includes chondroprotectors (drugs that improve metabolic processes in the joint) and drugs that replace synovial fluid. In some cases, intra-articular administration of steroid hormones is indicated for gonatrosis. Subsequently, the patient can be referred for sanatorium treatment.
A patient with gonarthrosis may be advised to walk with a cane to relieve stress on 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 load on the joint, choose comfortable shoes, monitor your weight, properly organize your daily routine (alternate exercise and rest, perform specialexercises).
surgery
With pronounced destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. With severe pain, joint dysfunction and limited working capacity, especially if a young or middle-aged patient suffers from gonarthrosis, surgery (knee joint replacement) is resorted to. After that, rehabilitation measures are carried out. The period of complete recovery after joint replacement surgery for gonarthrosis takes from 3 months to six months.