Osteoarthritis (gonarthrosis) is a pathological change in the knee joint that has a chronic course and can progress over time. The disease extends to all components of the knee joint: cartilage, subchondral bone, menisci, synovial membranes, ligaments, capsules and periarticular muscles.
The knee joint, which connects the femur and tibia, is subjected to heavy loads throughout life and is regularly injured. Sometimes minor damage immediately goes unnoticed, but makes itself felt in the second half of life. In this regard, joint damage is often detected in older people. But young people also suffer from knee joint pathologies resulting from sports or an active lifestyle.
To maintain maximum mobility and a high standard of living, you should consult a doctor at the first problem with your knee joint. Experienced orthopedic traumatologists will diagnose your condition and prescribe the necessary treatment.
Types of osteoarthritis of the knee joint
Inside the joint, the bones are covered with cartilaginous tissue, which absorbs shock, slides smoothly, and also prevents the bones from rubbing against each other. The cartilaginous tissue is nourished by the synovial fluid located inside the joint and the blood circulating in the vessels.
Cartilage has a spongy structure, so at rest it absorbs fluid and when loaded it moves it. At the same time, during movements, the cartilage constantly experiences microtrauma and recovers at rest.
If the result of mechanical injury exceeds the restoration capacity of the joint, there is insufficient nutrition for the cartilage and, therefore, regeneration does not occur. The damage accumulates and changes the structure of the cartilage tissue. This is how osteoarthritis of the knee joint begins.
Depending on the reasons that caused it, osteoarthritis of the knee joint is usually divided into two types: primary and secondary.
Primary gonarthrosis
Degenerative changes occurring in the joint are associated with age. Some of the reasons that cause this include:
- degeneration or natural degradation due to a slowdown in metabolic processes in the body;
- excess body weight;
- sedentary lifestyle;
- malnutrition;
- genetic predisposition.
As a rule, primary gonarthrosis affects both knees at once and is called bilateral.
Secondary gonarthrosis
Secondary osteoarthritis of the knee joint can occur at any age, as it can be caused by:
- various injuries - bruises, fractures, dislocations, ruptures and sprains of ligaments or menisci;
- joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, gonitis, etc. ;
- regional vascular disorders;
- overload of the knee joints during sports activities or due to the specifics of work;
- endocrine diseases;
- O-shaped and X-shaped leg curvature.
Secondary osteoarthritis of the knee joint most often appears only on one leg and is called unilateral.
In rare cases, idiopathic gonarthrosis is identified, a disease that occurs for no apparent reason.
Stages and symptoms of osteoarthritis of the knee joint
Regardless of the onset of osteoarthritis of the knee joint, experts distinguish three stages of its development, which are determined during an x-ray examination. Each stage is accompanied by characteristic symptoms:
Step 1– mild pain that occurs after prolonged exercise, when climbing stairs, after strenuous exercise and disappears after rest. There are no restrictions on movement, but slight swelling of the joint may sometimes occur. This condition, if left unchecked, can last for years - at this time the cartilage is just beginning to lose its softness due to impaired blood supply. An x-ray will show slight narrowing of the joint space and hardening of the bones.
- 2nd step– the pain becomes intense and lasts quite a long time even with light effort. A cracking sound is heard when flexing and extending the joint. It becomes impossible to completely bend the leg due to severe pain. There is slight deformity, muscle wasting and limited movement. The pain may be relieved with painkillers or go away on its own after rest.
At this stage, the cartilaginous layer is already thinning considerably, in places until it disappears. The synovial fluid becomes thicker and viscous, which alters its nutritional and lubricating properties. Osteophytes appear - bone growths.
- Step 3– the pain increases and worries constantly, even at night. The deformation of the joint becomes noticeable, the gait changes and the lower part of the limb bends. The range of motion of the knee joint is reduced - the leg cannot be completely bent or straightened. When walking, you should use support in the form of a stick or crutch. Painkillers are no longer effective.
The cartilage is almost completely erased, the bones are compacted, the joint space is greatly narrowed or even absent. The presence of numerous osteophytes is noted.
A common symptom of osteoarthritis of the knee joint can be identified: pain of varying intensity, localized along the anterointernal surface of the joint.
Diagnostic
If you observe symptoms similar to the development of gonarthrosis, you should consult a doctor. During the first appointment, the doctor will take the history, check the biomechanical capabilities of the joint and prescribe the necessary examinations. Be sure to inform him about injuries and illnesses suffered, your lifestyle, diet, medications taken and work characteristics.
The most informative and simple way to confirm or refute a diagnosis is an x-ray of the knee joint. It allows you to carry out differential diagnosis, determine the degree of development of osteoarthritis and monitor the treatment process.
However, the radiological signs appear much later than the morphological changes. Therefore, in the early stages, gonarthrosis is difficult to detect even on an x-ray. In such situations, the doctor may prescribe arthroscopy - a very accurate method of diagnosing joint changes using special endoscopic equipment.
Additional research methods are ultrasound and MRI - they are prescribed when x-ray is not sufficiently informative.
Treatment of osteoarthritis of the knee joint
After diagnosis, the doctor selects the optimal treatment depending on the stage of the disease and individual characteristics. This solves three problems:
- pain relief;
- stop the progression of pathology;
- restoration of joint functionality.
The specialist selects a comprehensive solution, which can be adjusted during the treatment process.
In modern medicine, there are many ways to treat joint diseases. All of them can be divided into three types: conservative, minimally invasive, surgical.
Conservative method of treatment of knee osteoarthritis
Usually used in stages 1-2 of osteoarthritis of the knee joint. Treatment begins with reducing the load on the joint - the patient should avoid excessive vertical load on the joint: jumping, running, etc. If necessary, it is recommended to lose excess weight. The doctor will recommend a diet and select a set of gentle exercises that will reduce axial impacts and improve the nutrition of cartilage tissue.
To improve blood circulation in the joint area, increase the range of movements, and also enhance the effect of medications, physiotherapy is prescribed:
- shock wave therapy – short-term impact on bones and connective tissue with acoustic pulses of significant amplitude and low frequency;
- electrotherapy – exposure of the affected area to electric current, magnetic or electromagnetic fields;
- laser therapy - exposure to optical radiation generated by a laser;
- phonophoresis - exposure of the affected area with ultrasound and drugs applied to the skin;
- electrophoresis - exposure of the affected area to electricity.
Massages, compresses, wearing orthotics and kinesiotaping have also proven effective in the treatment of osteoarthritis.
In addition, well-chosen drug treatment helps relieve pain, stop inflammation and slow down the process of destruction of cartilage tissue. For this purpose, anti-inflammatory, hormonal, antispasmodic and chondroprotective drugs are prescribed. They can be in tablet form, injectable or topical, depending on the situation.
Minimally invasive method of treating knee osteoarthritis
If the above procedures have no effect, the doctor may prescribe intra-articular injections:
- hyaluronic acid – as a replacement for synovial fluid to improve friction, reduce pain and improve knee joint function. The average duration of action of the drug is 3 to 6 months;
- own plasma enriched with platelets - for nutrition and restoration of cartilage tissue;
- corticosteroids – to reduce inflammation.
Surgical method for treating knee osteoarthritis
If conservative treatment turns out to be ineffective or you first turn to a specialist with the third stage of osteoarthritis of the knee joint, then the doctor may resort to surgical intervention:
- arthrodesis - artificial immobilization of the affected joint in a physiological position to eliminate pain;
- arthroscopic debridement - joint sanitation using an arthroscope;
- corrective osteotomy – elimination of bone deformities by artificial fracture;
- endoprostheses - replacement of a worn joint with an implant created artificially from biocompatible materials.
The type of operation is chosen by the doctor based on the characteristics of osteoarthritis of the knee joint. But stents are considered the gold standard because they allow you to completely return to your normal lifestyle. At the same time, a good implant does not require replacement for 15-30 years. To fully recover after surgery, it is necessary to undergo a rehabilitation course that lasts 3-4 months.
Complications
Gonarthrosis develops quite slowly, but it can be detected in time and the necessary treatment can begin. Ignoring the disease and its symptoms can lead to serious consequences:
- constant pain that is not relieved by medication;
- complete immobility of the diseased joint;
- inability to lean on the injured limb;
- severe deformation of the joints and curvature of the legs;
- damage to other parts of the musculoskeletal system;
- shortening of the leg.
In particularly difficult situations and in the absence of rapid treatment, osteoarthritis can lead to disability and deterioration of motor activity, or even immobility.
It is important to remember that osteoarthritis cannot be completely cured. But it is entirely possible to stop the progression of the disease and improve quality of life.
Prevention
There is no preventive treatment for knee osteoarthritis. But people at risk are advised to respect certain rules:
- make sure that your weight does not exceed the age norm;
- do not play sports that put great pressure on the knee joint;
- if possible, completely cure infectious diseases without causing complications;
- don't be too cold or too tired;
- avoid injuries and overload of the joint;
- avoid stressful situations;
- don't forget about rest;
- engaging in exercise therapy;
- wear orthopedic shoes.
Risk groups include the elderly, athletes and dancers. You can also add here those who lead a sedentary lifestyle, stand a lot at work or lift weights and are overweight.
Any change in the axis of the lower limb or the normal biomechanics of the joint, dysplasia, decreased volume and strength of the leg muscles, or trauma can also lead to osteoarthritis.
Get checked regularly and take preventive measures.
Question Answer
- What is the difference between knee arthritis and osteoarthritis of the knee?
Arthritis is the collective name for inflammation of the joint, and osteoarthritis is a degenerative-dystrophic process.
- Which doctor treats osteoarthritis?
Traumatologist-orthopedist or rheumatologist.
- Is it possible to play sports with knee osteoarthritis?
Prolonged and heavy loads on the joint, as well as axial impacts, should be avoided. But you should not completely exclude sport from your life: when you move, your joints are better "nourished" and restored. It is important to observe the measure and adhere to the recommendations of the doctor, who will select the type and mode of exercise.