Gonarthrosisdeforming arthrosis of the knee joint. It is accompanied by damage to the hyaline cartilage of the articular surface of the tibia and femur and has a chronically progressive course. Clinical symptoms include pain that worsens with movement, limited range of motion, and synovitis (accumulation of fluid) in the joint. In the later stages, the posture of the leg deteriorates and a pronounced limitation of movements is observed. The pathology is diagnosed based on the history, complaints, physical examination and radiography of the joint. The treatment is conservative: drug therapy, physiotherapy, exercise therapy. If significant destruction of the joint occurs, endoprosthesis is recommended.
general information
Gonarthrosis (from the Latin genus articulatio - knee joint) or deforming arthrosis of the knee joint is a progressive, degenerative-dystrophic change of the intra-articular cartilage, of a non-inflammatory nature. Gonarthrosis is the most common form of arthritis. It usually affects middle-aged and elderly people, and affects women more often. 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 belief, the cause of the disease is not the deposition of salts, but malnutrition and changes in the structure of the intra-articular cartilage. In the case of gonarthrosis, foci of calcium salt deposition may occur at the point of tendon attachment and in the ligamentous apparatus, but these are secondary and do not cause painful symptoms.
Causes of gonarthrosis
In most cases, it is impossible to identify a single cause of the pathology. The occurrence of gonarthrosis is usually caused by a combination of several factors, including:
- Injuries. Approximately 20-30% of cases of gonarthrosis are related to previous injuries: tibial fracture (especially intra-articular), meniscus injury, ligament tear or ligament tear. Gonarthrosis usually occurs 3-5 years after the traumatic injury, although earlier development of the disease is possible - 2-3 months after the injury.
- Physical exercise. Manifestation of gonarthrosis is often associated with excessive load on the joint. The age after 40 years is the period when many people understand that regular physical activity is necessary to maintain the good condition of the body. When starting exercise, age-related changes are not taken into account and the joints are unnecessarily loaded, 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 excessive body weight, the load on the joints increases, microtrauma and serious damage (meniscus or ligament tears) occur more often. Gonarthrosis is especially difficult 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 development of gonarthrosis include genetically determined weakness of the ligament system, metabolic disorders and impaired innervation due to certain neurological diseases, traumatic brain injuries and spinal 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 slides along the depression between the condyles of the femur during movement. The fibula is not involved 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 by a low-moving joint.
The joint surface of the tibia and femur, as well as the back surface of the patella, is covered by smooth, very strong and flexible, densely elastic, 5-6 mm thick hyaline cartilage. 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 interrupted. The surface of the cartilage dries out and gradually loses its smoothness. Cracks appear on its surface. Instead of smooth, unhindered sliding, the cartilages "stick" to each other. Due to constant microtraumas, the cartilage tissue becomes thinner and loses its shock-absorbing properties.
In the second stage of gonarthrosis, compensatory changes occur in the bone structures. The articulated platform is flattened, adapting to increased loads. The subchondral zone (the part of the bone directly below the cartilage) thickens. On 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 degenerate and become "wrinkled". The character of the synovial fluid changes - it thickens, its viscosity increases, which leads to a deterioration in its lubricating and nutritional properties. Cartilage degeneration is accelerated due to the lack of nutrients. The cartilage becomes even thinner. after the disappearance of the cartilages, 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 press into each other, significantly limiting the movement of the joint. Cartilaginous tissue is practically absent.
Classification
Considering traumatology and orthopedic pathogenesis, two types of gonarthrosis are distinguished: primary (idiopathic) and secondary gonarthrosis. Primary gonarthrosis occurs in elderly patients without previous trauma and is usually bilateral. Secondary gonarthrosis develops against the background of pathological changes (diseases, developmental disorders) or injuries of the knee joint. It can occur at any age and is usually unilateral.
Considering the severity of the pathological changes, we distinguish three stages of gonarthrosis:
- First phase– initial manifestations of gonarthrosis. It is characterized by periodic dull pain, usually after a significant load on the joint. Slight swelling of the joint may occur, which will disappear on its own. No deformation.
- Second stage- increase in the symptoms of gonarthrosis. The pain becomes longer and more intense. A crackling sound is often heard. There is mild or moderate limitation of movement and mild deformation of the joint.
- Third stage– the clinical manifestations of gonarthrosis reach their maximum. The pain is almost constant, and walking 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 minor pain when moving, especially going up or down stairs. There may be stiffness in the joint and a feeling of "tension" in the popliteal area. A characteristic symptom of gonarthrosis is "starting pain" - painful sensations that appear during the first steps of rising from a sitting position. When a patient suffering from gonarthrosis "diverges", the pain decreases or disappears, and reappears after significant stress.
Externally, the knee does not change. Sometimes patients with gonarthrosis notice a slight swelling of the affected area. In some cases, during 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), heaviness and limited movement.
In the second stage of gonarthrosis, the pain becomes more intense, occurs even with a light load, and increases with intense or long walking. The pain is usually localized along the anterior inner surface of the joint. After a long rest, the painful sensations usually disappear and reappear with movement.
As gonarthrosis progresses, the range of motion of the joint gradually decreases, and when you try to bend your leg as much as possible, sharp pain appears. A harsh creaking sound is heard during movement. The configuration of the joint changes as if it were expanding. Synovitis appears more often than in the first stage of gonarthrosis and is characterized by a more persistent course and more fluid accumulation.
In the third stage of gonarthrosis, the pain becomes almost constant and bothers patients not only while walking, but also at rest. In the evening, patients spend a long time trying to find a comfortable position for sleeping. Often the pain appears even at night.
Joint flexion is significantly limited. In some cases, not only bending, but also extension is limited, so the patient with gonarthrosis cannot fully straighten his leg. The joint is enlarged and deformed. Some patients experience a hallux valgus or varus deformity – the feet become X or O shaped. Due to the limited movements and deformation of the legs, the gait becomes unstable and ducks. In severe cases, patients with gonarthrosis can only move with a stick or crutches.
Diagnostics
The diagnosis of gonarthrosis is based on the patient's complaints, objective examination data and X-ray examination. When examining a patient suffering from the first stage of gonarthrosis, external changes are usually not noticeable. In the second and third stages of gonarthrosis, roughening of the contours of the bones, deformation of the joint, limitation of movements and curvature of the axis of the limb are observed. When the patella moves transversely, a grinding sound is heard. By palpation, a painful area can be seen from the patella inward, at the level of the joint gap, as well as above and below it.
In case of synovitis, the volume of the joint increases and its contours are smoothed. We notice a bulge along the anterolateral surfaces of the joint and above the patella. Fluctuation is determined by touch.
X-ray imaging of the knee joint is a classic technique that allows clarifying the diagnosis, establishing the severity of pathological changes in gonarthrosis and monitoring the dynamics of the process by taking repeated images after a certain period of time. Due to its availability and low cost, this is still the main method for diagnosing gonarthrosis. In addition, this research method makes it possible to exclude other pathological processes (for example, tumors) in the tibia and femur.
In the initial stage of gonarthrosis, changes in radiographs may be absent. After that, the narrowing of the joint space and the compaction of the subchondral zone are determined. The articular ends of the femur and especially the tibia expand, the edges of the condyles become pointed.
When studying the X-ray, it should be taken into account that the more or less pronounced changes characteristic of gonarthrosis can be observed in most elderly people and are not always associated with pathological symptoms. The diagnosis of gonarthrosis is made only by a combination of radiological and clinical symptoms of the disease.
Currently, together with conventional radiography, modern techniques are used to diagnose gonarthrosis, such as computerized tomography of the knee joint, which allows for a detailed study of pathological changes in bone structures, and MRI of the knee joint, which is used to identify changes in the soft tissues. .
Treatment of gonarthrosis
Conservative activity
The treatment is carried out by traumatologists and orthopedists. Treatment of gonarthrosis should be started as early as possible. During the period of exacerbation, the patient suffering from gonarthrosis is recommended to rest in order to relieve the joint as much as possible. The patient is prescribed therapeutic exercises, massage, physiotherapy (UHF, electrophoresis with novocaine, phonophoresis with hydrocortisone, diadynamic currents, magnetic and laser therapy) and mud therapy.
Drug therapy for gonarthrosis includes chondroprotectors (drugs that improve joint metabolism) and drugs that replace synovial fluid. In some cases, intra-articular administration of steroid hormones is recommended for gonatrosis. 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 a special orthosis or custom insole is used. In order to slow down the joint degenerative processes associated with gonarthrosis, it is very important to follow certain rules: exercise, avoiding unnecessary stress on the joint, choosing comfortable shoes, monitoring your weight, organizing your daily routine properly (alternating exercise and rest, special performance exercises).
Surgery
With pronounced destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. In case of severe pain, joint dysfunction and limited work capacity, especially if a young or middle-aged patient suffers from gonarthrosis, they resort to surgery (knee replacement). After that, rehabilitation measures are implemented. The complete recovery period after gonarthrosis joint replacement lasts from 3 to six months.