Gonarthrosisis a deforming osteoarthritis of the knee joint. It is accompanied by damage to the hyaline cartilage of the articular surfaces of the tibia and femur and is chronically progressive. Clinical symptoms include pain that worsens with movement, limitation of movement, and synovitis (fluid buildup) in the joint. In later stages, the support of the leg is impaired and there is a pronounced restriction of movement. The pathology is diagnosed based on the history, complaints, physical examination and x-ray 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 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 osteoarthritis. Middle-aged and older people are mostly affected; women are more commonly affected. Gonarthrosis can occur at a young age after injuries or ongoing intense stress (e. g. in professional sports). 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 lies not in the deposition of salts, but in malnutrition and changes in the structure of intra-articular cartilage. In gonarthrosis, foci of calcium salt deposition may occur at the tendon insertion site and ligament apparatus, but these 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 pathology. As a rule, the occurrence of gonarthrosis is caused by a combination of several factors, including:
- Injuries. Approximately 20-30% of cases of gonarthrosis are associated with previous injuries: tibial fractures (especially intra-articular), meniscus injuries, tears or ruptures of ligaments. Typically, gonarthrosis occurs 3-5 years after a traumatic injury, although earlier development of the disease is possible - 2-3 months after the injury.
- Physical movement. The manifestation of gonarthrosis is often accompanied by excessive stress on the joint. Age after 40 years is a period when many people understand that regular physical activity is necessary to keep the body in good condition. At the beginning of training, they do not take into account age-related changes and place unnecessary stress on the joints, which leads to the rapid development of degenerative changes and the appearance of symptoms of gonarthrosis. Running and intensive, quick squats are particularly dangerous for the knee joints.
- Overweight. With excess body weight, the stress on the joints increases, and both microtraumas and serious damage (meniscus tears or ligament tears) occur more frequently. Gonarthrosis is particularly 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). Risk factors for the development of gonarthrosis include genetic weakness of the ligamentous system, metabolic disorders and innervation disorders in 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 of the joint is the patella, which slides along the depression between the condyles of the femur as it moves. The fibula is not involved in the formation of the knee joint. Its upper part lies to the side and just below the knee joint and is connected to the shinbone via a low movable joint.
The articular surfaces of the tibia and femur, as well as the posterior surface of the patella, are covered with smooth, very strong and elastic, densely elastic hyaline cartilage 5-6 mm thick. Cartilage reduces the frictional forces during movements and assumes a shock-absorbing function when subjected to shock loads.
In the first stage of gonarthrosis, the blood flow to the small intraosseous vessels that supply the hyaline cartilage is disturbed. The cartilage surface becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of sliding smoothly and unhindered, the cartilage "clings" to one another. As a result of constant microtrauma, the cartilage tissue becomes thinner and loses its shock-absorbing properties.
In the second stage of gonarthrosis, compensatory changes in the bone structures occur. The joint platform is flattened and therefore adapts to increased loads. The subchondral zone (the part of the bone that is immediately beneath the cartilage) thickens. On the edges of the articular surfaces, bone growths appear - osteophytes, which resemble spines in their appearance on the X-ray.
In the case of gonarthrosis, there is also degeneration of the joint mucosa and the joint capsule and "wrinkling" occurs. The nature of the synovial fluid changes - it becomes thicker, its viscosity increases, which leads to a deterioration in its lubricating and nutritional properties. Due to theDue to a lack of nutrients, cartilage degradation accelerates. The cartilage becomes even thinner and disappears completely in some places. After the cartilage disappears, the friction between the joint surfaces increases sharply and degenerative changes progress quickly.
In the third stage of gonarthrosis, the bones are significantly deformed and appear to be pressed into each other, which significantly restricts movement in the joint. Cartilage tissue is practically absent.
classification
Taking into account the pathogenesis in traumatology and orthopedics, two types of gonarthrosis are distinguished: primary (idiopathic) and secondary gonarthrosis. Primary gonarthrosis occurs in older patients without previous trauma and is usually bilateral. Secondary gonarthrosis occurs against the background of pathological changes (diseases, developmental disorders) or injuries to the knee joint. Can occur at any age, usually one-sided.
Taking into account the severity of the pathological changes, three stages of gonarthrosis are distinguished:
- First stage– first manifestations of gonarthrosis. Characterized by periodic dull pain, usually after significant stress on the joint. There may be slight swelling of the joint, which will go away on its own. There is no deformation.
- Second floor– Increase in symptoms of gonarthrosis. The pain becomes longer and more intense. A crunching noise can often be heard. There is a slight to moderate restriction of movement and slight deformation of the joint.
- Third section– The clinical manifestations of gonarthrosis reach their maximum. The pain is almost constant and gait is impaired. There is a significant limitation in mobility and a 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 climbing stairs. There may be a feeling of stiffness of the joint and a "tension" in the popliteal area. A characteristic symptom of gonarthrosis is the "initial pain" - painful sensations that occur during the first steps after getting up from a sitting position. When a patient with gonarthrosis "deviates, " the pain decreases or disappears, and after significant stress, it recurs.
The knee is not changed externally. Sometimes patients with gonarthrosis notice 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 severe, occurs even with light exertion and increases with intensive or long walking. As a rule, pain is localized along the anterior inner surface of the joint. After a long period of rest, the painful sensations usually disappear and reappear with movement.
As gonarthrosis progresses, the mobility of the joint gradually decreases and stabbing pain occurs when trying to bend the leg as much as possible. A harsh crunching sound may occur 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 course and the accumulation of more fluid.
In the third stage of gonarthrosis, pain becomes almost constant and bothers patients not only when walking, but also at rest. In the evening, patients spend a long time trying to find a comfortable sleeping position. Pain often occurs at night.
The flexion of the joint is significantly restricted. 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 experience a hallux valgus or varus deformity - the legs become X or O shaped. Due to restricted movements and deformation of the legs, the gait becomes unstable and waddles. In severe cases, patients with gonarthrosis can only move with the help of a cane or crutches.
diagnosis
The diagnosis of gonarthrosis is made based on the patient's complaints, objective examination data and an X-ray examination. When examining a patient in the first stage of gonarthrosis, external changes are usually not noticeable. In the second and third stages of gonarthrosis, coarsening of the bone contours, deformation of the joint, restriction of movement and curvature of the axis of the limb are noted. When the patella moves transversely, a crunching sound is heard. Palpation reveals a painful area within the patella, at the level of the joint space and above and below it.
With synovitis, the joint volume increases, its contours are smoothed. A bulge is noted along the anterolateral surfaces of the joint and above the patella. The fluctuation is detected when scanning.
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 by repeatedly taking images after a while. Due to its availability and low cost, it remains the main method for diagnosing gonarthrosis today. In addition, this research method allows us to exclude other pathological processes (e. g. tumors) in the tibia and femur.
In the early stages of gonarthrosis, changes may be absent on x-rays. Subsequently, a narrowing of the joint space and a compaction of the subchondral zone are noted. The articular ends of the femur and especially the tibia expand, the edges of the condyles become pointed.
When examining an X-ray image, it should be borne in mind 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 made only when there is a combination of radiological and clinical signs of the disease.
Currently, to diagnose gonarthrosis, in addition to traditional radiography, modern techniques are used, such as computed tomography of the knee joint, which allows a detailed study of pathological changes in bone structures, and MRI of the knee joint, which is used to identify changes in soft tissue.
Treatment of gonarthrosis
Conservative activities
Treatment is carried out by traumatologists and orthopedists. Therapy for gonarthrosis should begin as early as possible. During the exacerbation phase, the patient with gonarthrosis is recommended to rest in order to maximally relieve the load on 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.
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 gonarthrosis. The patient can then be referred for sanatorium treatment.
A patient with gonarthrosis may be recommended to walk with a cane to relieve pressure on the joint. Sometimes special orthoses or custom-made insoles are used. In order to slow down the degenerative processes in the joint in gonarthrosis, it is very important to follow certain rules: play sports, avoid unnecessary stress on the joint, choose comfortable shoes, watch your weight, properly organize your daily routine (alternate load and rest, performancebring). special exercises).
surgery
With pronounced destructive changes (in the third stage of gonarthrosis), conservative treatment is ineffective. If there is severe pain, joint dysfunction and limited ability to work, especially if a young or middle-aged patient suffers from gonarthrosis, an operation (knee joint replacement) is resorted to. Remedial measures will then be carried out. The period of complete recovery after joint replacement surgery for gonarthrosis is 3 to 6 months.