Primary gonarthrosis bilateral

Knee joint gonarthrosis: degrees, types, methods of treatment

What is gonarthrosis?

Gonarthrosis of the knee joint

Gonarthrosis is a degenerative-dystrophic disease of the knee joint. The second name is osteoarthritis of the knee joint. The nature of the disease is not inflammatory, often leads to disability.

According to statistics, he is given one of the leading places among all types of arthrosis. In figures this is more than 20%.Of all the diseases that affect the knee joint, the frequency of manifestations of gonarthrosis is 53%.

Gonarthrosis is well known to doctors for more than 100 years, in everyday life it is called "salt deposition".In fact, with arthrosis, calcification occurs( deposition of calcium salts).However, such calcifications are of limited nature, of clinical importance. The painful process occurs after the pathology of the circulation in small bone vessels, after which changes in the cartilaginous cover of the joint begin.

In the initial stages, changes occur at the molecular level in the cartilaginous tissue, followed by changes in the hyaline cartilage: in some places it becomes cloudy, thinens, stratifies, splits in different directions. This process ends with the complete disappearance of the cartilage, larger and smaller, exposing the underlying bone. In turn, the bone reacts to the death of the cartilage by densification, that is, excessive overgrowth of the bone along the periphery, spines are formed, the foot is deformed and warped. For these reasons, this disease is called "deforming arthrosis".

  • Exchange processes in the cartilage tissue are carried out due to osmotic pressure. When squeezing the lubricant is released, and when unloading it absorbs. So, during the movement, the cartilage is constantly fed. With incomplete recovery, dictated by increased mechanical stress, metabolic processes are violated. In the place of greatest pressure, the cartilage begins to thin out.

  • There is a violation of the structure of collagen fibers, which leads to loss of damping properties, chondromalacia( softening of the patellar cartilage), disruption of the metabolic function of chondrocytes. The cartilage loses stability, elasticity.

  • There is a violation of congruence in the joint. The process is exacerbated by enhanced synthesis of bone substance, which manifests itself in the form of osteophytes( bone growths).The synovial membrane is irritated and inflammation begins. This leads to a restriction of mobility of the joint.

  • Arthrosis of the inner part of the knee joint and between the surface of the femur and the knee is more common. The disease is more susceptible to people of mature and advanced age, athletes.


Causes of gonarthrosis

The main causes of arthrosis of the knee joint include:

  • metabolic disturbance;

  • pathological changes in blood circulation, increased fragility of capillaries;

  • excess body weight, which leads to an increase in the axial load on the joint;

  • traumatization of the knee joints( ruptures of ligaments, menisci, fractures, cracks);

  • transferred inflammatory diseases( rheumatism, arthritis);

  • excessive load on the joint, which is more affected by athletes. Tennis players, football players, athletes, gymnasts are more often ill;

  • hormonal and endocrine disorders;

  • old injuries that are inadequately treated or whose treatment has not been completed;

  • abnormalities of the structure of the joint tissues;

  • hereditary factors.


Symptoms of gonarthrosis

Symptoms of gonarthrosis

The danger of gonarthrosis, like most arthrosis, is untimely diagnosis. At stage 1, the disease almost does not manifest itself at all, except for a slight pulling pain, which the patient writes off for fatigue.

A common symptom of gonarthrosis is a feeling of stiffness in the joint, "pulling" under the knee, pain in the knee after a long walk. Many patients with gonarthrosis( arthrosis of the knee joint) complain of difficulty in walking mostly in the morning, after a dream or after a long sitting. A person needs to "disperse" in order to become easier. With the development of gonarthrosis, pain in the knee, especially on the inner side, becomes more stubborn and permanent. Often, patients with gonarthrosis feel a crunch when moving the knee joint. Further, the limitations of flexion and extension of the leg develop. When the disease progresses, lameness develops. In more neglected cases, a person can not move without the help of outsiders, support or without crutches. Often in the lying position the pain subsides, but it happens that at night a person suffers from pain.

When examining the knee joint in the initial stage of the disease, external changes are usually not detected. With the course of the disease, the deformity of the knee joint, the contours of the bones forming the joint, the coarse, the contracture( incomplete flexion or extension), the curvature of the shin are very noticeable. Putting a palm on the front surface of the knee, you can feel the crunching or extensor movement crunch in the knee joint of varying intensity and duration. A similar sensation can be obtained by shifting the patella outward in the transverse direction( positive patello-cordillary symptom).

When you feel the joint of a patient with gonarthrosis, a painful area is detected, usually on the inside of the joint, at the level of the condyles of the thigh, the large burtz, and the joint slit. Often an effusion accumulates in the cavity of the knee joint, ie, synovitis is attached. Such a state is determined by the smoothness of the contours of the knee joint due to bulging, protrusion of the tissues above the patella and from the side of it and a sense of fluctuation when the protrusion is felt with both hands.

As the disease progresses, the symptoms appear brighter, become more pronounced. Timely correct diagnosis plays an important role in the further fight against gonarthrosis.


Degrees of development of gonarthrosis

1 degree of gonarthrosis

With 1 degree of gonarthrosis fatigue of limb, slight discomfort. During movement, a small crepitation can be traced. Sometimes there is a subtle restriction of movement in the joint.

Knee bones at this stage are not subject to significant changes. On the X-ray, you can see a slight narrowing of the joint space.

2nd degree of gonarthrosis

The second degree is characterized by the onset of pain, especially after you have been standing for long or walk. The characteristic crunch becomes more pronounced. There are problems with extension and full bending of the limb. There is a so-called starting pain.

There may be atrophy of the quadriceps muscle of the thigh. The angle of full flexion and extension of the limb in the knee joint is severely limited. X-ray images clearly show a significant narrowing of the joint gap, the growth of osteophytes. The edges of the bones "flatten".

3 degree of gonarthrosis

At the third stage the character of the pain changes, it intensifies, it can manifest itself in rest. In the joint area, there is often swelling, a local increase in temperature. Due to the possible presence in the joint of the "articular mouse"( fragments of breakaway osteophytes), symptoms of joint blockade may occur. They manifest acute pain, accompanied by a sense of jamming.

The patient in this case may be deprived of the possibility of bringing the joint into motion. There is a deformation of the knee joints with a change in the axis of the limbs, which is clearly seen in the pictures. The instability of the joint may manifest itself.


Types of gonarthrosis

Types of gonarthrosis

Gonarthrosis is divided into species for reasons of occurrence:

  • Primary gonarthrosis of the knee joint proceeds against a background of comparative health. Mostly elderly people, especially women, are ill. In the risk group are people with excessive body weight, that is, obese, they are most often affected by arthrosis of the knee joint.

  • Secondary gonarthrosis of the knee joint develops mainly after a traumatized knee injury or after a previous illness. In the case of timely treatment of all of the above diseases of gonarthrosis can be avoided.

By localization of origin:

  • right-side gonarthrosis - affects the right knee joint. This type of arthrosis is more common for athletes, people whose professional activities are associated with excessive static and dynamic loads on the right leg;

  • left-sided gonarthrosis - affects the left knee joint. Also more characteristic of athletes, middle-aged people with excessive body weight;

  • bilateral gonarthrosis - destroys the joints of both legs. This species is the heaviest, since it significantly increases the risks of disability. Most often it affects older people, since the nature of bilateral gonarthrosis in most cases is idiopathic( age).

All these species do not differ from each other in the nature and origin of the disease. Double-sided gonarthrosis in advanced form can be more pronounced, since both patients suffer simultaneous axial load.


Diagnosis of gonarthrosis

There are many diagnostic methods, but their effectiveness can be greatest only with a comprehensive approach.

Orthopedic examination

Orthopedic examination is the first and very important diagnostic exercise. This includes:

  • palpation of the joint;

  • linear measurements of bones;

  • angular measurement( determination of mobility in the affected joint at various angles).

Clinical Studies

Clinical trials include:

  • study of blood formula, erythrocyte sedimentation rate;

  • levels of fibrinogen, urea and other biochemical indicators of blood and urine;

X-ray studies

The main diagnostic method is the examination of the patient's joint radiographically. In the initial development of gonarthrosis, an x-ray examination can show nothing, and if it does, it will show minor changes. In the late stages of the disease, there is a narrowing of the joint gap, cartilage sclerosis, bone damage, and the deposition of salts.

Ultrasound examination of the

Ultrasound examination of the aching joint gives the best results, however, it can not completely replace the radiographic examination. Therefore, people suffering from joint disease must have an X-ray examination of the affected joint.

MRI - Magnetic Resonance Tomography

The most progressive diagnostic method that allows you to layer-by-layer examine all parts and tissues of the joint, determine the earliest change in the cartilage tissue. The disadvantage of the method lies in the rather high cost of examining each segment. Therefore, it often turns out that gonarthrosis in a patient is far from the only disease of the musculoskeletal system.


How to treat gonarthrosis?

How is gonarthrosis treated?

The procedure for the treatment of arthrosis of the knee differs little from the treatment of arthrosis of other joints.

Step 1 - we remove inflammation

For this traditionally used:

  • NSAIDs are non-steroidal anti-inflammatory drugs that are prescribed intramuscularly or intravenously. In the form of injections or candles, medications give a longer and stronger effect. These include drugs such as diclofenac, olfen, diclac, ibuprofen, indomethacin, ketoprofen.

  • NSAIDs COX-2, are the most effective and sparing compared to the COX-1 NVPD.They can be used for a long time, for several months. These are meloxicam, celecoxib, nimesulide.

  • Preparations of hormones. This group is used for intraarticular injections in the presence of synovitis. The purpose of the application is the removal of inflammation and pain syndrome as soon as possible. Minus of application is a damaging effect on cartilage tissue, a large number of contraindications and side effects. The most commonly used for gonarthrosis are representatives of this group: hydrocortisone, kenalog, diprospan.

  • Antiferment preparations. They neutralize the synthesis of certain enzymes and prevent further degeneration of the joints. The most famous drugs: counter-kal, ovomin, gordoks. When gonarthrosis they are administered intra-articularly.

Step 2. We have anabolic and anti-catabolic effect of

This group replaces the substances necessary for the synthesis of cartilage, has a narrowly specific effect on cartilaginous tissue. They are also called chondroprotectors. They contain substances that are part of the matrix of cartilage. These medicines are natural and well perceived by the body. Stimulate the synthesis of collagen.

To justified use of drugs include: structum, DONA, alflutop, rumalon, mucosate. All of them are slow-acting drugs that use long courses. Some of them are used as injections. This form of application is the most effective.

Step 3. Mage, heat, rub

We use various kinds of gels, ointments, creams. In their majority they are warming and anti-inflammatory. The purpose of their application is to activate local blood circulation, remove inflammation. The most famous of them: apizartron, finalgon, doloben, feloran, fastum gel, nicofleks.

Step 4. Improve blood circulation

Vasodilator drugs are used to reduce the tone of intravascular muscles. Allow to improve the internal blood flow, improve trophic tissue located near the joint. When gonarthrosis is recommended: Cavinton, Trental, Actovegin. To strengthen the vascular walls: upsavit, ascorutin.

Step 5. Remove excess tone

Such antispasmodics as: midolkalm, sirdalud, no-shpa, tyzalud, can remove unnecessary muscular tension in the damaged segment. Often it arises as a compensatory reaction of the body.

Step 6. Introduce synovial fluid prosthesis

The most progressive treatment in recent years has been the inclusion of hyaluronic acid-based drugs in the treatment protocol. It is a natural component of articular cartilage and synovial fluid. Therefore, its administration does not cause inflammation, rejection and other negative reactions.

At the same time, the use of such drugs as: otrovisk, sinocorm, hyalual, allow to soften movements in the joint and relieve the pain caused by friction of the joint surfaces. In gonarthrosis, the most recommended drug of this group is the fermatron.

The treatment sequence is determined by the attending physician, and leads him, according to the current protocols. At the same time, anti-inflammatory therapy can be conducted, a course of chondroprotectors, and a course of physiotherapy. Preparations of hyaluronic acid are allowed to enter the joint only when the inflammation is completely removed. Otherwise, instead of a curative effect, the course of the disease can be aggravated.


Author's and innovative methods of treatment of gonarthrosis

Author's methods include:

  • methodology Evdokimova

  • method Bubnovsky

  • method Geeta

All of them have different principles of influence, but have proven themselves as effective means of supporting joints affected by gonarthrosis. Unfortunately, there is no question of recovery.

Oxygenotherapy is a method of filling the joint cavity with medical oxygen. It helps to eliminate puffiness, reduce pain syndrome. Can be used as an alternative to hormone therapy.

Treatment with stem cells .The essence of the method is the transplantation of the patient's stem cells into the joint. The method is developed in Germany and allows to postpone conservative treatment for many years. It is used only in large medical centers in Germany.

Method of intra-articular laser therapy. Performed with a low-intensity helium-neon laser, which penetrates into the joint with the help of a waveguide introduced into the needle. It allows to reduce painful sensations, to increase the amplitude of motion in the joints. The method was developed in Russia, clinically investigated, but not widely used.

Ortokin is a biological technique for the treatment of gonarthrosis, which has been used in Europe since 2003.Autologous serum obtained by selecting specific proteins from the patient's own blood. These proteins have an anti-inflammatory effect. After the selection of blood and production of serum, the drug is again administered to a person intra-articularly, under the supervision of ultrasound or computed tomography.

The drug allows:

  • to slow down the process of destruction of cartilaginous tissue;

  • reduce pain syndrome;

  • to stop inflammation;

  • to increase mobility in the joint.

One or two injections are sufficient for treatment. About 70% of patients experience pain after the first injection.


Surgical treatment

Operative treatment

At different stages of gonarthrosis, conservative therapy may not give positive dynamics. In such cases, they begin to consider the need for surgical intervention.

There are several types of operations for gonarthrosis:

  • Arthrodesis. With this technique, remove the deformed cartilage tissue with the joint. The method does not allow preserving the physiological mobility of the limb. They resort to it quite rarely.

  • Arthroscopic debridement. The technique is to release the joint from the deformed cartilage tissue with the help of an arthroscope. It is used in the early stages of the disease. Thanks to arthroscopy, pain is eliminated. The operation is simple. The effect of the procedure is temporary, 2-3 years.

  • Periarticular osteotomy. This is a technically complex and rare type of surgical intervention. It lies in the preliminary filing and fixing the bones of the joint from a different angle. This is done to redistribute the load. Rehabilitation is long enough, the effect is from 3 to 5 years. It is used rarely in the early and middle stages of gonarthrosis.

Endoprosthetics

Nowadays it is the most common and effective type of surgical intervention. It allows you to keep the mobility of the limb, which provides the patient the opportunity to lead a full life. Prosthetics in gonarthrosis is a complex operation. It lasts about an hour, but after it it is necessary to undergo a course of rehabilitation and joint development. This is one of the main features of knee arthroplasty. The effect is retained for up to 20 years, depending on the modification of the material. After this, the joint will have to be changed again, since the prosthesis is blown under the influence of axial and mechanical loads.

Do not forget about possible complications such as:

  • marginal necrosis of the skin

  • paresis of the peroneal nerve;

  • thrombosis of the subcutaneous femoral vein;

  • risk of rejection.

Similar troubles occur extremely rarely and account for about 1% of the total number of transactions. Therefore, it must be taken into account that the effect of endoprosthetics, sometimes, is the only way to improve the quality of life.


Physical training in gonarthrosis - curative and not only

The goal of physical exercises with gonarthrosis is several factors:

  • preservation and increase of joint mobility;

  • formation of compensation by strengthening the musculoskeletal system;

  • increased blood circulation and improved trophism of adjacent tissues and the joint itself;

  • preservation of the physiological tone of the muscles.

Exercises and the method of their execution are selected depending on the surviving active movements.

Contraindicated include:

  • exercises with violent interventions, accompanied by pain;

  • performing exercises with the maximum load;

  • sharp and high-amplitude execution of exercises with great speed;

  • exercises with full axial load on the affected joint.

Complex of exercises for gonarthrosis

  1. Shaking. Standing, try to relax completely, hands down. Perform shaking movements with your whole body. Make sure that your knees are shaken with a small amplitude.

  2. While holding the support, bend the leg in the knee, point the heel to the buttock, then straighten the leg forward, put it on the heel in front of you. Execute 15-20 times. Then make the other leg.

  3. Put your palms on your knees. Perform small circular movements in the knee joint in one and the other side. Amplitude adjust for sensations. Do at least 20 times.

  4. Exercise on the folded blanket. The surface should not be too hard. Stand on your knees and perform shaking as in 1 exercise.

  5. From the position, as in the previous exercise, go on your knees, following several steps in different directions.

  6. Stand at point-blank position, lying on your lap( the floor should touch the palms and knees).Drop your chest on the floor, stretching your arms forward, then move the hips and buttocks to the heels, making the heel on the heels, without lifting the chest from the floor. Again, go straight up and repeat the exercise several times.

  7. Lie down on the left side, take the right leg up, bend the leg in the knee, straighten and stretch the heel to the wall as much as possible. Perform up to 12 times and change your foot.

  8. Sit down, put your bent legs in front of you. Stretch the knee of the right leg to the left, then straighten it, unbending the knee up, bend and return to the starting position. After 12 repetitions, change your leg.

  9. From the same initial position, straighten the legs alternately without lifting the heels off the floor, then simultaneously bend again, also without tearing off the floor. Repeat 12-14 times.

  10. Lie on your back, pull your bent leg to your chest, grip your toe of the foot and smoothly move your legs as straight as possible. Try to do it without jerks.

  11. Also, lying on your back, tie a rubber shock absorber to the ankles, and fix the other end to the battery. Smoothly bend and unbend your legs, pulling your knees to your chest.

Stand on the knees. One end of the rubber damper is tied to the ankle foot, the other is fixed to the battery. Slowly( smoothly) bend and unbend the leg at least 10-15 times. The shock absorber should not be too rigid.


Physiotherapy for gonarthrosis

Physiotherapy with gonarthrosis

All types of physiotherapy can be prescribed in the phase of remission or a slight exacerbation, but not in the most acute phase, with inflammation.

The most effective are:

  • electrophoresis with such drugs as bischofite, caripain. Deeper penetration of the drug in such cases is provided with the help of dimexide;

  • magnetotherapy;

  • ultrasound;

  • microwave therapy;

  • paraffin treatment;

  • application of radon and hydrogen sulfide baths;

  • mud treatment.

To maintain and prolong the phase of remission, it is necessary to undergo a course of physiotherapy 2-4 times a year. Depending on the degree of the disease.

Electrophoresis with karipainom allows you to remove excess tone, promotes resorption of contractures and adhesions. It is necessary to perform at least 20 procedures, since the drug is cumulative. It works only when the body receives the maximum concentration. A course of 10 procedures does not justify the costs spent.

The course of mud therapy for gonarthrosis should be performed 2 times a year, for 10-15 procedures. You can carry it at home using the dirt bought in the chemist's system. Before use, it must be heated to 38-40 degrees.


Massage, manual therapy for gonarthrosis

These kinds of effects on the knee joint are aimed at stretching, warming and improving blood circulation in the joint area. Massage is performed in the region of the knee, along the lymph flow from the periphery to the center, but without affecting the popliteal fossa. Manual therapy is performed after the massage, an experienced specialist. Its main thrust is the traction and stabilization of the joint. The following exercise can be performed independently.

Stand up with a healthy side to the support. Take your foot off the aching joint forward, then back, then with a sharp movement, "throw it" out of the way.


Prevention of deforming gonarthrosis

Gonarthrosis belongs to a group of diseases that are better and easier to prevent than expensive and long to treat.

To the list of preventive measures it is possible to attribute:

  • doing dances, sports, try to beware of serious injuries( ruptures of ligaments, fractures, severe knee injuries);

  • moderately engage in sports, since movement is the mechanical basis of cartilage nutrition;

  • correctly make up the diet;

  • watch the body weight;

  • When getting injured, or showing discomfort in the knee area, immediately seek qualified medical attention;

  • since 35 years, pass preventive courses of treatment with chondroprotectors;

  • daily, drink plenty of water.


Useful advices for

Helpful Tips
  • Begin the treatment of gonarthrosis with accurate diagnosis. It is better to get advice from several leading experts.

  • Do not self-medicate. All drugs, their dosage and duration of use should be prescribed and monitored by a physician.

  • Begin and end your day with gymnastics.

  • If you want to do sports, consult a doctor about the type recommended for you. Even some yoga asanas can be disastrous.

  • Eliminate from your diet salty, sharp, fatty dishes. Give preference to natural home products. Lactic acid products should have an average fat content, otherwise calcium will be poorly absorbed. Include in the diet low-fat jelly( cooked on turkey meat), natural jelly. Do not forget about the need to eat sea fish, seafood.

  • If a week of use of the anti-inflammatory drug does not bring relief, consult a doctor to review the treatment protocol.

  • If there is a remission and the disease does not bother, do not exceed the permissible loads. The absence of pain does not mean that you are completely healed.

  • Try not to overcool the joints. Although, gonarthrosis and non-inflammatory disease, the joint can react to hypothermia with a new relapse.

The main thing, remember! You will not be able to help even the best doctor, if you do not want to make an effort and help yourself. In case of need of an operative intervention, it is better to delay this moment to more mature or advanced age. It is important that by the time of the surgery you were in good physical condition, so that postoperative rehabilitation was easier. And it depends only on you.

Author of the article: Candidate of Medical Sciences Volkov Dmitry Sergeevich, surgeon

ayzdorov.ru

Knee joint gonarthrosis

Gonarthrosis is a deforming arthrosis of the knee joint, a degenerative-dystrophic disease in which the hyaline cartilage covering the articular surfaces of the tibial andof the femur. In the late stages of the pathology, when the cartilage tissue is completely destroyed, the bone tissue begins to suffer, the disease acquires the character of osteoarthritis. The bone becomes denser, cystic cavities are formed, osteophytes grow at the edges of the joint, which causes the loss of joint function and disability.

Gonarthrosis is in the first place in terms of prevalence among all arthroses. Mostly middle-aged and elderly people, mostly women, are ill. But gonarthrosis of the knee joint can also occur in young people. In such cases, it is often a secondary process and develops after the trauma of the knee joint( posttraumatic gonarthrosis).

Gonarthrosis develops gradually over many years. The main signs of the disease: pain in the knees, the integration of their mobility and the periodic development of synovitis( accumulation of fluid inside the articulation).At first, the symptoms of arthrosis are almost invisible, but as the joint deteriorates, it becomes more intense and negatively affects the quality of human life.

Osteoarthritis of the knee joint
This is how the knee joint affected by arthrosis

Reasons and types of knee joint gonarthrosis

As a rule, it is impossible to single out one cause that led to the development of gonarthrosis. In most cases, there are 2-3 or more risk factors for the development of the disease.

The main groups of reasons are:

  1. Increased load on the components of the joint. This situation is observed in athletes, in people engaged in heavy physical labor, as well as in patients suffering from obesity.
  2. Knee injury, congenital or acquired deformities of the musculoskeletal system. In such situations, the load on the joint is distributed unevenly and some areas of the cartilage are under increased pressure, which causes their destruction. An example of such deformations may be flatfoot, kyphosis, scoliosis, incorrect fusion of bones after fractures, etc.
  3. Disturbance of the metabolism of cartilaginous tissue and its ability to self renewal. This situation leads to a shortage of substances in the body, necessary for the regeneration of hyaline cartilage, metabolic and endocrine disorders, a decrease in microcirculation in the tissues of the articulation.
  4. Disturbance of secretion of synovial fluid in the knee joint. As you know, the synovial fluid, which is produced by the synovial membrane of the joint, provides smooth movements, reduces the frictional force, and also nourishes the cartilage, which does not have its own vessels. If, for some reason, the synovia becomes smaller, degenerative changes develop in the cartilage, it cracks and collapses.

There are many more risk factors for gonarthrosis. Their definition is very important not only for treatment, but also for prevention. Having got rid of such negative influence, it is possible to completely stop the development of arthrosis and preserve the full function of the lower limb.

Depending on the causes of the onset, two types of gonarthrosis are distinguished:

  • Primary - diagnose when the true cause remains unknown. At risk are women, elderly people, patients with obesity, with metabolic and endocrine diseases.
  • Secondary - is established when there is a clear connection between arthrosis and its causative factor. For example, after a joint injury or surgery.

As a rule, the primary gonarthrosis is always bilateral, and the secondary one affects only one knee.

According to ICD-10( International Classification of Diseases 10 revision), gonarthrosis has an M17 cipher.

Professional athletes
Strengthened loads of knee joints can cause the development of gonarthrosis

Degenerative gonarthrosis levels

Gonarthrosis is a chronic and slowly progressive disease. Symptoms, prognosis and tactics of treatment depend on the degree of pathological changes in the joint. There are three clinical stages of the disease:

  • Arthrosis of the 1st degree is characterized by the appearance of pain or discomfort after an increased stress on the joints, at the end of the working day. After rest, all signs disappear on their own. The amplitude of the movements is not disturbed, there is no deformation of the joint.
  • Gonarthrosis of the 2nd degree. At this stage, pathology is diagnosed in most people, because it constantly makes itself felt. Patients complain of pain in the joint even after minor loads. Rest does not give the desired relief, and you have to take various painkillers. There is a limitation of the amplitude of movements in the knee, begins muscle atrophy, you can see the initial stage of limb deformation.
  • Osteoarthritis of the knee of the 3rd stage. The pain bothers the person round the clock, for its occurrence it is not necessary even to load a joint. Anesthetics do not help anymore. The mobility of the knee is partially or completely lost, its deformations develop, which is often the cause of disability. Treatment in this case is only surgical.

4 degrees of arthrosis does not happen, but there is a fourth X-ray degree of pathological changes in the joint, which coincides with the third, clinical stage.

Symptoms of the disease

It is difficult to diagnose the initial stage of the disease, as patients do not take the symptoms seriously and perceive them as ordinary fatigue. Most people can not even say that they are concerned about pain, most likely, unpleasant sensations in the knees after work or excessive load of joints, which completely and quickly disappear after rest.

A characteristic sign is pain during descent or ascent on stairs, as well as starting pain( occurs at the first steps after rest, then disappears).Outwardly, there are no changes. From time to time, patients may note some swelling( reactive synovitis).Also, most people complain of crepitation in the knee( crackling sounds with active and passive movements).

Pain in the knee joint
Pain in the knee joint is the first and the main sign of arthrosis

As arthrosis progresses, the pain becomes more intense, appears more often after minor loads. Independently does not pass, which often prevents a person from falling asleep. We have to take analgesics. Synovitis appears more often, have a more persistent current. Also a rough crunch develops during movements. The amplitude of movement decreases. It becomes difficult for a patient to perform familiar things, for example, to get off his knees. The knee joint begins to deform, it becomes wider, the shin bends( the beginning of the formation of O- or X-shaped deformation of the legs).

At the last stage the pain is intense and constant, it is not removed even by medications. Significantly difficult movements in the knee, especially flexion. The leg is in a forced position. The knee is enlarged in volume. There may be varus or valgus deformities of the legs.

Because of the described changes, gait and limb support function are disrupted. This leads to the fact that a person moves only with the help of an additional support( crutches, walking stick) or is not able to walk at all.

Diagnosis

At the 2 nd and 3 rd stage, it is not difficult to establish a diagnosis. You can do this at the first, but only if you suspect a disease. Diagnostic program includes:

  • examination by a doctor orthopedist or rheumatologist;
  • clarifying complaints and identifying risk factors;
  • objective examination of knee joints, determination of the amplitude of their movements;
  • X-ray examination;
  • joint ultrasound;
  • in severe cases for diagnosis use MRI or CT;
  • standard laboratory tests for blood and urine.
Radiography of knee joints
Radiography is a valuable and informative method for diagnosing gonarthrosis

Conservative treatment of

Knee arthrosis therapy consists of several methods, individually they are ineffective, but if you use the whole treatment complex, very soon you will start moving without pain.

Read more: Osteoarthritis of the knee joint How to cure arthrosis of the knee joint?

The main tasks of treatment of gonarthrosis:

  • relieve a person from pain;
  • to adjust the supply of cartilaginous tissue and accelerate its recovery;
  • to improve microcirculation;
  • reduce the load and pressure on diseased hyaline joint cartilage;
  • to develop a good muscular knee joint corset for protection and support;
  • to increase the mobility of the joint;
  • prevent deformation and ankylosis.

This can be done using the methods described below.

Medication treatment

Not essential, but allows you to quickly eliminate pain and signs of inflammation. Most often prescribe drugs from the group of NSAIDs( diclofenac, meloxicam, ibuprofen, ketoprofen, celecoxib, aceclofenac, etc.).These drugs are used for both systemic therapy( tablets, injections), and for topical treatment( ointments, gels, creams, patches).They quickly and effectively relieve the pain, but they are forbidden to take long courses, as severe adverse reactions may occur.

Chondroprotectors are on the second place. These medicines in their composition have chondroitin and glucosamine( the main structural elements of the cartilage).Thus, it is believed that chondroprotectors with long-term admission can stop the progression of the disease and contribute to the restoration of already destroyed cartilage. Among the most popular drugs worth noting: Arthra, Dona, Structum, Teraflex, Hondrolon, Alflutop. Treatment should start with a monthly course of intramuscular or intra-articular injections, and then switch to 3-4 months of maintenance therapy with tablets. Only in this case it is possible to achieve a positive result.

Don
Dona is a modern and effective chondroprotector

A popular method of treating gonarthrosis are intraarticular injections. Inside the knee can introduce chondroprotectors, as well as glucocorticoid anti-inflammatory drugs of long-term action( Diprospan, Kenalog).The pain passes even after 1 injection, the effect can last for several months.

Also today, the introduction of so-called liquid transplants of synovial fluid( Fermatron, Hyastat, Synvisc, Ostenil) is popular. These drugs are based on hyaluronic acid, which compensate for the synovial deficiency in the joint and promote the resumption of cartilage.

LFK

Therapeutic exercises are the most important element of arthrosis therapy. Without regular special physical exercises, it is almost impossible to achieve improvement. Complex exercise therapy is selected individually, depending on the stage of arthrosis, the age of a person, his physical fitness, the presence of concomitant diseases.

A simple and effective complex of exercise therapy for arthrosis of knee joints:

Other methods of

Other methods of conservative therapy are:

  1. Massage and physiotherapy. They are used during remission, when acute pain is absent. Allow to improve blood circulation in the tissues of articulation, which contributes to the regeneration of damaged structures.
  2. Orthopedic aids. To protect the joint and prevent the progression of arthrosis, you can use special knee pads for physical work or sports. They perfectly support the articulation and protect it from damage. At the last stage of gonarthrosis, a cane can be used to facilitate movement and reduce pain.
  3. Treatment with folk remedies. Folk methods of therapy are very popular among the population. There are not one dozen recipes that can help reduce pain, improve the mobility of knee joints. But we must not forget that such treatment should be used only as an additional one, and not replace all other methods. Also, before using any prescription, you need to consult a doctor about possible contraindications.

Surgical treatment

Operation with gonarthrosis is prescribed in the following cases:

  • inefficiency of conservative therapy;
  • constant pain, which can not be eliminated in other ways;
  • deformity or ankylosis of the joint;
  • loss of leg function;
  • patient desire.
Endoprosthetics of the knee joint
Before and after knee replacement

There are 2 groups of operations that are performed with gonarthrosis:

  • organ-preserving,
  • knee arthroplasty.

All modern organ-preserving surgeries are performed by arthroscopy. There are several options for surgery: arthrodesis, arthroscopic debridement, periarticular osteotomy. The surgeon chooses the necessary procedure depending on the individual characteristics of the patient.

Endoprosthetics is the most effective and widespread type of operation for gonarthrosis. Replacement of the destroyed joint with an artificial prosthesis( in some cases, and bilateral prosthesis) allows you to save the mobility feet and live a full life without pain. It is also important to know that success depends not only on the operation, but also on the correctness of the rehabilitation period. Sometimes only such cardinal measures can help a person to move again without pain.

MoyaSpina.ru

Knee joint gonarthrosis: symptoms and medical gymnastics

All information on this site is for informational purposes only and should not be accepted by you as an instruction for self-diagnosis or self-treatment. Remember that you have one health, therefore, only qualified specialists - doctors should take care of it!

This disease most often causes discomfort in the knee joint of people who have crossed the 40-year threshold. And although many suggest that the cause of pain in the legs when walking is the deposition of salts, in fact, it can be deforming arthrosis. With this disease, thinning of the cartilaginous tissue of the knee joint occurs at the expense of deterioration of its blood supply, which leads to complete destruction of cartilage and denudation of bones. As a result of rubbing the bare bones against each other, during the movement of the legs, a person suffering from gonarthrosis experiences terrible pain. Over time, if the disease is not treated, it leads to deformation of the knee joint and curvature of the entire limb.

Factors causing the development of the disease

Physicians call several reasons, which mainly cause the onset of gonarthrosis of the knee:

  • the presence of excess weight in humans;
  • is a sedentary lifestyle;
  • various injuries of the knee joint, transferred earlier( as a result of this, post-traumatic gonarthrosis of the knee joint may develop);
  • is the age of a person who has exchanged the fifth decade in his life;
  • engaging in activities that involve a long standing on their feet;
  • excessive load on the legs, for example, when playing sports;
  • presence in a person of a certain type of diseases, for example, diabetes, gout and others.

In this case, the primary and secondary types of the disease are distinguished. So, a secondary disease is considered to have developed as a result of injuries of the knee joint or due to some disease. However, only the primary gonarthrosis of the knee joint can be bilateral.

Symptoms of the disease

Symptoms of this disease may differ from each other, depending on the stage of development of gonarthrosis of the knee joint.

1 degree:

  • the affected joint makes itself felt by the feeling of tightness in the knee region;
  • a person begins to experience difficulties during walking after waking up or a long walk, as well as after physical work and so on;
  • pain fades if you walk a little, and also at rest;
  • no noticeable violations in the joint work is not seen.

2 degree:

  • the pains become intense and last a long time;
  • when you move in the joint, you hear a crunchy sound;
  • weak mobility of the knee, especially in the morning;
  • the knee starts to bend badly - to unbend( it may stop bending at all);
  • appears swelling of the knee;
  • shows the first visible deformities of the foot;
  • there are painful sensations in the calf muscles in the evening and at night.

3 degree:

  • constant pain sensations whether you are on the move or at rest;
  • the knee starts to hurt simultaneously with deterioration of weather conditions;
  • limb deformities continue so intensively that they become visible to the eye;
  • amplitude of mobility of the knee joint is sharply reduced;
  • appearance of lameness during walking.

4 degree: in principle - very neglected state of the third degree of the disease, characterized by a strong deformation of the surfaces of the joint bones, as a result of which the gap between them is almost absent. This causes the patient to continuously intense pain.

If you show, at least some, signs of the disease you need to see a doctor who will diagnose and tell you how to treat it.

Diagnosis and treatment

The specialist will listen to your complaints, examine the knee and send it to:

NashyNogi.ru

Gonarthrosis: signs, forms, diagnosis, what is it

  • Prevention of gonarthrosis

A disease affecting every seventh inhabitant of the planet is a gonarthrosis. It is a non-inflammatory, degenerative-degenerative process. It flows in a cartilaginous tissue covering the head of the bones that form the knee joint. Develop the disease can be unnoticed for several decades, and can arise in just a few months. Sometimes the ailment leads to disability.

Gonarthrosis often occurs in parallel with other diseases of the knee joint. Because of the imposition of signs of one ailment on another, it can be extremely difficult for doctors to clearly distinguish the symptoms of gonarthrosis.

Signs and stages of gonarthrosis

A typical symptom of gonarthrosis is a feeling of constriction and stiffness in the knee joint. The onset of pain after prolonged walking, prolonged sitting, standing or lying. To become lighter, you usually have to "poke" your leg. With the development of the disease, discomfort becomes more stubborn and permanent. Limited mobility of the joint develops.

Often, patients who are diagnosed with granitis, feel a crunch at the time of motion by the knee. When the disease progresses, lameness develops.

In the most difficult clinical cases, the patient becomes unable to move without the assistance of unauthorized persons, some supports or crutches. Often when lying down, discomfort disappears, but there are times when pain reappears at night.

It's good to understand what it is - gonarthrosis is possible if you consider the stages of the disease:

  • gonarthrosis 1 degree: no external deformation of the knee, slight swelling of the joint, periodically manifested severe pain;
  • gonarthrosis of the 2nd degree: intense unpleasant sensations even after minimal load, pronounced "joint crunch", problems with full knee flexion;
  • gonarthrosis of 3rd degree: discomfort is experienced constantly, because of this - sleep disturbance, the body's response to weather change;the mobility of the joint is severely limited or absent completely, the gait changes, deformity of the legs is observed - they can have an X or O-shape.

Kinds of gonarthrosis on the side of localization

Given that the knee of which leg( right, left or both) will be diagnosed with an ailment, in medicine, a right-sided, left-sided and bilateral gonarthrosis is distinguished. Regardless of the location of the site: in one or both laps, the severity of the symptoms will depend on the severity of the course of the disease. The intensity of therapy will also be determined by the degree of neglect.

Two-way gonarthrosis

In medical practice, situations are very common where patients are diagnosed with one of the complex forms of arthrosis of the knee joint - gonarthrosis bilateral. Moreover, the cases of the development of the disease at once on two legs are much greater than the cases of the appearance of the disease on the one hand. In either case, gonarthrosis is primary - there is no apparent cause, and secondary - a provoked injury or disease.

Primary gonarthrosis

Usually, the primary form begins to form in childhood or young age. To serve as an excuse may be the formation of articular surfaces or ligamentous apparatus.

Due to the fact that the joint during walking constantly endures disproportionate to its capacity, it begins to deform. In adults, the disease can occur in the ordinary life cycle.

Usually primary bilateral bilateral gonarthrosis diagnoses to the elderly. Great risk of gonarthrosis in those who have an increased body weight. In this case, the malaise, small bone vessels are first affected by pathological changes. Because of this, the supply of essential nutrients to the synovial fluid feeding the knee cartilage is disrupted. Therefore, he begins to "feel hungry."

Then the turbidity begins to form in the joint, thinning and stratification of the tissue takes place. In some areas, the cartilage can disappear completely, exposing the surface of the bones. In response to such changes, the bones are flattened and expand into sides. Deformations are exposed to other elements of the knee - muscles, ligaments, capsule. Gradually the joint loses the ability to perform its functions and "fades."

Secondary gonarthrosis

The development of secondary gonarthrosis by the trigger mechanism in most cases becomes systematic traumatization of the cartilage.

Secondary posttraumatic gonarthrosis occurs against the background of such injuries as ligament ruptures, fractures, dislocations, severe knee injuries. This form of the disease develops in the same way as the primary gonarthrosis. Therefore, it needs timely treatment to the doctor and adequate treatment.

The development of the secondary form of gonarthrosis can result in:

  • operations to remove the meniscus - they disrupt the integrity of the knee structure and lead to its rapid wear;
  • disproportionately high burden on the legs, injuries;
  • large body weight - exerts excessive pressure on joints and cartilage of the knee;
  • arthritis - inflammation of the joints: a prolonged course of the disease leads to the formation of fluid in the joint cavity, which in time can be complicated by arthrosis;
  • surgery on the knee;
  • radical metabolic disorders, due to which the deposition of salts in the cavities of joint tissues occurs;
  • other factors and diseases, which for a long time were accompanied by spasm of the muscles of the legs or blood vessels.

Bilateral deforming gonarthrosis

One of the diseases, whose tactics of treatment at the modern level of orthopedics development is far from unambiguous, is the deforming gonarthrosis. According to the generally accepted opinion in medicine, there is only one factor in the progression of degenerative changes. It is represented by a violation of the limb axis, which subsequently leads to a significant overload of the knee joint articular tissue.

The treatment of deforming gonarthrosis should be considered separately, since it does not fit into the usual treatment regimen. This is due to the need for preventive surgical interventions. Their goal is to normalize biochemical relationships in the knee joint, which is necessary both to prevent the development of the disease and for treatment. This correction gives good results.

With the advent of arthroscopy, surgeons quickly realized the value of this method of treatment with deforming gonarthrosis: minimally invasive and low-traumatic. Already at the beginning of the operation, you can determine the further treatment tactics. If there is no cartilage in the inner and outer parts of the joint, total endoprosthetics is used. In the presence of one of the cartilage departments, corrective osteotomy may be indicated.

Right-sided gonarthrosis: symptoms and treatment

The main symptom of the disease is pain in the right knee. At the onset of gonarthrosis, a feeling of stiffness in the joint disturbs only in the morning. In the future, unpleasant feelings can manifest themselves after a long walk or stay on their feet. If you do not start treatment on time, in the late period of gonarthrosis the pain will be constantly disturbed. A person can not lead a habitual way of life for him.

There will be a characteristic crunch in the knee joint, the severity of which will depend on the progression of the disease. Obvious will be the deformation of the right knee joint, because of what the movements in the joint will gradually be limited. This is the most unfavorable manifestation of such a disease as a right-sided gonarthrosis.

For successful treatment, it is necessary to relieve the load from the knee with the help of such measures:

  • getting rid of excess weight;
  • performing special exercises to strengthen the muscles of the right leg;
  • limits the time spent on legs and walking.

Left-sided gonarthrosis: symptoms and treatment

The leading sign of the lesion of the left knee is pain. When gonarthrosis, they are initially palpable in the morning and go through a certain time.

In the late stages of the progression of the disease, the pain of the left knee becomes noticeable after a long hike or standing on the legs. The insidious symptom of gonarthrosis is the restriction of joint mobility and deformity of the knee.

At first the patient notices that he can not completely bend his left leg in the knee. With the passage of a long time, when the left-sided gonarthrosis progresses, the volume of movements in the knee decreases. The patient becomes increasingly difficult to walk, he can even become disabled. With severe left-sided gonarthrosis, unpleasant sensations in the knee are permanent. The crunch becomes audible.

Like the right-sided, the development of left-sided gonarthrosis is inherent in the "morning stiffness" of the joint - the knee obstruction that occurs in the morning. Half an hour later, the volume of movements usually returns to normal.

Prevention of gonarthrosis

Medication therapy for gonarthrosis, despite its popularity and effectiveness, has a modest role. To solve a problem with an ailment prevention first of all helps. To prevent deforming gonarthrosis, a reasonable combination of exercise and rest, exercise in physical education, and timely access to a doctor will help. The active maintenance of the vascular and muscular system in tone will also help.

There are important rules for prevention. They allow, without waiting for the moment when signs of gonarthrosis begin to manifest clearly, improve the condition of knee ligaments:

  • constantly wear comfortable shoes;
  • adhere to the right and balanced diet;
  • exercise regularly;
  • avoid excessive loads on the knee joint;
  • take( preferably prescribed by a doctor) vitamin complexes.

To people who have only developed gonarthrosis, careful treatment of the health of knee joints is recommended. To prevent the progression of the disease, you need to avoid hypothermia of the legs. It will be necessary to perform every day for a few minutes all the "bicycle" exercise known since childhood. A complex of simple methods of prevention will help to reliably protect the body from the appearance of gonarthrosis.

mirsustava.ru

Gonarthrosis - arthrosis of the knee joint |Dr. Yolkin

Osteoarthritis of the knee joint

Gonarthrosis, aka arthrosis of the knee joint, is considered to date one of the most common types of this disease. According to statistics, almost 20% of the world's population suffers from it, that is, almost every fifth inhabitant of the Earth.

Most often, gonarthrosis is detected in people after 40 years. The disease is susceptible to both men and women, but among women, arthrosis of the knee joint is twice as common.

The knee joint is one of the largest joints in our body and is characterized by a very high level of mobility - it not only provides leg movement, but also helps to keep the weight of our body. The knee joint connects the femoral, tibia and tibia and is supported by various groups of ligaments and tendons.

The knee-forming bones are "joined" by special cartilaginous pads( menisci), which play an important role - they absorb static and dynamic loads and stabilize the knee joint, preventing excessive movements.

The articular surfaces of the bones are covered with hyaline cartilage, the function of which is to reduce the friction that occurs during any motor activity. The healthy cartilage is very tight and smooth, which allows the ends of the bones to slide easily and noiselessly relative to each other.

With gonarthrosis, blood circulation is disturbed in small bony vessels and a degenerative-dystrophic process begins in the cartilage covering of the joint and surrounding tissues. Under the influence of age factors or other negative causes, the cartilage loses its density and elasticity, is covered with various defects - depressions, cracks, and patterns.

First deforming arthrosis of the knee joint develops only at the molecular level. Only then noticeable changes appear in the hyaline cartilage: it becomes turbid, stratifies and splits. The consequence of this pathological process is the complete or partial disappearance of the cartilage and exposure of the underlying bone. Motor activity becomes difficult, since any load on the knee joint causes painful sensations.

With further development of the disease, the inflammation of the synovial membrane of the knee joint begins, the functionality of the synovial fluid decreases, and the joint capsule thickens. Osteophytes( bone spines) begin to appear on the surfaces deprived of cartilaginous bones, which, clinging to each other, further complicate the process of movement.

Damage to the joint is not limited to bone and cartilage components - the capsular-ligamentous apparatus also begins the pathological process. The further the disease develops, the more the muscle around the joint becomes atrophied. All this leads to the appearance of contracture of the knee joint, in which motor activity becomes almost impossible. In complex cases of arthrosis, due to such immobility, there is a risk of complete fusion of bones.

ReasonsSymptoms StagesDiagnosticsLeaching Prevention

Reasons for

One of the main causes of the development of the disease is the natural aging process of the body, therefore the main group of people suffering from this disease are the elderly.

But in addition, there are additional negative factors affecting the development of arthrosis of the knee joint. First of all, these are diseases that have caused cartilage destruction( chondromatosis, arthritis) and traumas of any origin( meniscus damage, ligament rupture, fracture of the thigh or tibia), which cause posttraumatic arthrosis of the knee joint.

The disease can also be caused by a genetic predisposition, increased body weight or a prolonged intake of a certain group of drugs.

Symptoms of

Knee joint gonarthrosis has the following symptoms: feeling stiff and tight in the joint, knee pain after a long walk. With the development of the disease, the pains are becoming stronger, the movements of the knee joint are accompanied by a crunch.

Without timely and adequate treatment, the curvature of the legs( O-shaped or X-shaped) is gradually formed. This is due to the fact that the condyles are being destroyed( bone protrusions serving to attach muscles) and the joints begin to sag.

A consequence of this is a change in the axis of the shin, which leads to lameness. The motor function of the joint is seriously limited and there is an atrophy of the muscular apparatus. With gonarthrosis in an advanced stage of development, it becomes difficult to move independently. Deformation and contracture of the knee joint develops - impossibility of its bending and extension.

At the first symptoms of deforming arthrosis, the patient should immediately contact the hospital. If the doctor does find out for him an arthrosis of the knee joint, the treatment should begin immediately. At the initial stages, the development of the disease is always easier to suspend.

Stages of gonarthrosis

The development of gonarthrosis is characterized by three stages of development.

Osteoarthritis of the knee joint 1 degree

This is the initial stage of the disease, in which, as a rule, there are primary symptoms - discomfort, small pain that appears after prolonged being on the legs or physical exertion. In some cases, a small swelling in the region of the knee joints, which disappears after rest, can be seen.

Osteoarthritis of the knee joint of the 2nd degree

The painful manifestations at this stage become brighter and more prolonged, in the joint when you move, you can hear "crunching", "creaking".As a rule, in the second stage of the disease there is a "starting pain", which appears after a long stay at rest and disappears after a while. Also there is a slight restriction in movement - stiffness in the knee joint.

In addition, the joint itself begins to increase in volume. If you do not start the immediate treatment of gonarthrosis at this stage, the deformity of the joint will progress. The gait will change, you need additional support - crutches or walking stick.

Osteoarthritis of the knee joint of the third degree

In the third stage of the disease development, painful sensations are present not only during movement, but also in resting. The contracture of the knee joint is pronounced, the gait is broken, X-shaped or O-shaped curvature of the legs arises, the joint acquires a deformed shape.

Primary and secondary gonarthrosis

Primary gonarthrosis can occur in quite healthy people. At risk, usually elderly people( especially women), as well as those who are obese, because in this case there is a serious strain on the knee joints. Also, primary gonarthrosis occurs with a genetic predisposition( to metabolic disorders or circulatory disorders) and due to inadequate physical exertion.

Secondary gonarthrosis of the knee joint may occur as a result of a traumatic injury or knee disease( arthritis, chondromatosis).In the presence of any of the diseases that can affect the destruction of cartilage, it is necessary to deal with its treatment, as it will prevent the emergence and development of gonarthrosis.

Most pathology develops after 40 years, but young people are also immune from it. It is not uncommon for bilateral gonarthrosis, when both knees are immediately affected. In the case of timely treatment, there is always the possibility to suspend both primary and secondary and posttraumatic arthrosis of the knee joint.

Diagnosis

Before starting treatment for deforming arthrosis, doctors determine the degree of its development.

Diagnostic examinations, in addition to visual examination and collection of anamnesis, include mandatory radiography or magnetic resonance imaging. This will clearly see the narrowing of the joint gap, changes in the shin of the axis, the presence of bone growths( osteophytes).

For the exclusion of other diseases, differential diagnosis is carried out and additional clinical studies are carried out - blood analysis and analysis for rheumatoid factor.

How to treat arthrosis of the knee joint?

Conservative treatment of

In the early stages of a disease such as knee arthrosis deformans, treatment is begun with conservative methods.

Conservative treatment of deforming arthrosis of the knee joint primarily involves taking medications of various groups - painkillers and anti-inflammatory( non-hormonal) drugs, as well as drugs aimed at improving cartilage tissue nutrition and strengthening bone tissue.

In addition, a large role in the treatment play a variety of physiotherapy procedures - electrophoresis, phonophoresis with hydrocortisone, ultraviolet irradiation, laser and magnetic therapy.

Application of a full complex of these procedures will allow to normalize the metabolic processes in the joint and improve the nutrition of the cartilage, which will help reduce pain, improve the motor function of the joint, prevent the development of contracture of the knee joint and slow the further development of the disease.

An important part of conservative therapy is the implementation of a massage course and exercise therapy, which are designed to strengthen the knee muscles and restore normal blood circulation in the joint region.

Unfortunately, conservative treatment of knee joint gonarthrosis can be effective only at the earliest stages of the development of the disease and to a greater extent plays the role of preventive treatment.

Surgical treatment of

If there is a neglected gonarthrosis of the knee joint, the treatment is already performed surgically.

The basic operations carried out to get rid of the problem of arthrosis are arthrodesis, corrective osteotomy and arthroplasty.

An arthrodesis is indicated for patients who are contraindicated in carrying out other types of surgical intervention and its main purpose is to restore the limb's limb and reduce painful manifestations. During the operation, bones are fixed by means of special devices( screws, plates, transplants).After such fastening, the bones coalesce, the leg sustainability is restored and this, despite the fact that the motor limitations remain, allows to solve the pain problem with deforming arthrosis of the knee joint.

Osteotomy is an effective method of treating gonarthrosis, which allows not only to regain the lost motor functions, but also to slow the pathological process developing in the joint. The essence of the operation is to cut bone( or artificial fracture) and then fix it in a functionally correct position. This surgical intervention aims at a uniform and more accurate distribution of the load on the joint and, as a consequence, the normalization of intraosseous pressure, which will lead to a decrease, and in some cases, a complete disappearance of the painful sensations.

Supportive conservative therapy, conducted after the operation, will speed up the fusion of bones, restore the work of the musculoskeletal system and finally get rid of the problem of arthrosis.

Osteotomy is divided into closed and open. As a rule, closed osteotomy is more correct, which is carried out through small incisions - this reduces the traumatic nature of the operation and allows you to recover faster. In addition, after such intervention there are no ugly scars left.

In the early stages of arthrosis, when the joint is not yet completely destroyed, the effect of the performed osteotomy may persist for a long time.

Arthroplasty can completely solve the problem of lost or limited motor functions of the knee joint. During the operation, new joint surfaces are modeled and a special spacer is placed between them, which will replace the affected joint. This gasket can be made from artificial materials or from the patient's own tissues.

If you have a knee arthrosis deforming in an advanced stage of development, only total arthroplasty or endoprosthetics can help.

Endoprosthetics today is the most effective method of surgical treatment of arthrosis, because during the operation a complete replacement of the affected joint with an artificial joint occurs. In some cases, this is the only way to save a person from pain and give him the opportunity to walk.

Special endoprostheses used to replace the affected joint are made of durable and advanced materials that can serve for decades. In addition, there are special designs and special types of endoprostheses, which are established, for example, with dysplastic coxarthrosis of the hip joint. And special implants with short legs can reduce the risk of a second operation.

The operation itself is performed using special techniques, in which muscles and tissues are not cut, but are "pushed".If the patient's condition requires more serious intervention, the muscles cut off during the operation are attached to their original position with high accuracy. This approach not only reduces the operational trauma, but also allows you to recover after surgical treatment for a short time. Gentle machines do not injure the muscles - the muscle-ligament apparatus subsequently works in full.

The timing of recovery depends both on the size of the operation, and on the patient's age and other factors. But, as a rule, a week later a person can walk and even independently climb the stairs( of course, using crutches).After the endoprosthesis of the knee joint, there will be no pain associated with gonarthrosis.

Important point - after total arthroplasty, you must undergo a full rehabilitation course, which is aimed at restoring the muscles. One of the world recognized methods of rehabilitation after such surgical interventions is myostimulation of muscles, which will return the normal biomechanics of gait and motor functions in full.

It happens that in addition to arthrosis, the patient is diagnosed with other knee joint lesions( for example, meniscopathy).In such cases, to remove all causes of pain and movement restrictions, surgery for the underlying disease is combined with other surgical interventions.

Prevention

To prevent the development of arthrosis, it is important to adhere to simple rules, compliance with which will not allow the disease to worsen the quality of your life.

Regular and moderate physical activity is very important - they strengthen muscles and joints, allow to maintain normal blood circulation and maintain the function of the joint in good condition. And, of course, it is necessary to treat any diseases and injuries in a timely manner.

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AliveJoint.ru

Knee joint gonarthrosis: treatment of all kinds of the disease

Medical methods

In most cases, gonarthrosis is manifested by pain in the knee region, which is why non-steroidal anti-inflammatory drugs( NSAIDs) are included in the treatment of this pathology. As a rule, they are prescribed short courses, the dosage is selected individually, depending on the severity of the pain syndrome.

Also, when selecting a preparation, it matters which process: primary or secondary, bilateral or unilateral. The advantage is given to selective inhibitors of cyclooxygenase-2( meloxicam, nimesulide, celecocosib).

In diseases of the knee joint they are used twice a day, more frequent administration is not recommended because of the possibility of side effects. In this case, a diet that reduces the irritant effect of medications on the gastrointestinal tract can be recommended. Of nonselective non-steroidal anti-inflammatory drugs, diclofenac, ibuprofen, has been used.

Traumatologists do not recommend indomethacin for gonarthrosis, as it increases the degeneration of cartilaginous tissue. The second group of medications, which are included in the treatment of degenerative joint damage, are chondroprotectors.

Glucosamine and chondroitin-sulfate are used. When gonarthrosis must comply with the following conditions: take these drugs need a long time, at least 2-3 months, and repeat such courses throughout the year several times with a break of 1 month.

In severe cases, with gonarthrosis with severe pain syndrome and ineffectiveness of NSAIDs, intraarticular injections are made to the knee joint area with the introduction of glucocorticoid hormones( Kenalog, diprospan).

The orthopedic physician is being manipulated, taking into account the presence of concomitant somatic diseases in the patient, since glucocorticoids can cause serious side effects. After the administration of prolonged corticosteroid hormones, the pain syndrome rapidly decreases, the edema is eliminated and the volume of movements of the knee joint is increased. Do such injections no more often than once in 2 weeks. The effect of the drug is maintained for up to 3-4 weeks.

If after such treatment fails to achieve positive dynamics, it is recommended to replace the drug with another, similar. For the treatment of articular pathology quite often use various ointments containing analgesics and chondroprotectors. In the pharmacy they are represented a great many, the correct choice of a drug will help the attending physician-traumatologist. Some ointments are used when a therapeutic massage is performed.

Non-pharmacological methods

One of the main conditions for the correct treatment of gonarthrosis is a change in the whole way of life, as this disease is very often caused by immobility and the presence of excess weight in the patient. Therefore, it is very important to ensure a balanced and nutritious diet.

Compliance with the diet is a prerequisite for the treatment of knee joint gonarthrosis.

It is compulsory to follow a diet, especially in patients with excess weight. Nutrition for gonarthrosis should be low-calorie and, at the same time, include a sufficient amount of protein and microelements necessary for the synthesis of cartilage elements.

The diet of a patient with a left-sided or right-sided gonarthrosis, provides low-fat varieties of meat, vegetables, sour-milk products. In this case, the food should be fractional, small portions. Exclude the following foods: flour and sweet dishes containing a large number of calories. Also, the diet prohibits alcoholic, carbonated drinks, canned food, smoked products.

What Traditional Medicine offers

Medicine has long been treating folk remedies for patients with various joint diseases, including those with bilateral gonarthrosis. You can use them both independently and in combination with traditional therapy.

One of the effective ways of treating folk remedies for knee joint diseases is the mummy, especially it is effective in case of pain syndrome. Before use, the mummy is mixed with honey( 3 g of substance and 150-200 g of honey).The mixture is applied to the joint area and light massage is done, then left overnight. From above the joint can be covered with a warm kerchief or a terry towel.

Left-sided or right-sided gonarthrosis is also treated with a burdock compress. To do this, take the leaves of a medium-sized plant( 4-5 pieces).On the leaves put a saucepan with boiling water and leave for 2-3 hours. Leaves are applied to the affected joint( you can both), top covered with a plastic wrap and then with a towel. Leave such a two-sided compress at night.

For treatment, alcoholic tincture of ficus can also be used;it is used when the massage of a diseased joint and adjacent tissues is done. For preparation take 2-3 small leaves of ficus, crush them with a blender or in a meat grinder. The resulting gruel is filled with 100 ml of alcohol or vodka. Insist 2-3 weeks.

The use of exercise therapy

Mandatory in diseases of the knee joint is treatment with the use of special physical education, since immobility refers to one of the etiological factors of the disease. Walking during the day is highly recommended. Also, a patient with right-sided or left-sided gonarthrosis is prescribed special exercises aimed at strengthening the ligament apparatus and muscle tissue.

Gymnastics must be gentle and not cause pain. It is recommended to perform exercises lying on the back, it is better to do it on the floor.

In this position, the load on the knee joints is reduced. Duration of exercise therapy at the initial stage should be 10-15 minutes, in the future you can increase the time of classes and introduce additional new exercises. Also, when performing exercise therapy, sharp and jerky movements should be avoided, they should be smooth;after classes you can have a massage.

Often recommend swimming lessons in the pool. Exercises performed in the water, contribute to an increase in the volume of movements of the knee joint and, at the same time, do not load the muscles and ligament apparatus.

Massage and manual therapy

A noticeable effect in the treatment of gonarthrosis is obtained when combined massage, manual therapy and gymnastics. The first two techniques allow to strengthen the muscles located periarticularly, and promote better fixation of the joint.

For grade 3 gonarthrosis and severe restriction of motion,

endoprosthetics are shown. Manual therapy also helps increase the volume of movements in the joint. Massage improves blood circulation in periarticular tissues and reduces their edema. It is best if this procedure is performed by a massage therapist. In his absence, you can perform massage yourself or ask someone to make a relative. Manual therapy should always be done by a certified specialist. Otherwise, there is a risk of serious complications.

Physiotherapy methods use magnetotherapy, thermal procedures, laser therapy. Obligatory condition: this treatment is used only not at exacerbation. Otherwise, physiotherapy can cause increased pain in the affected joint.

Surgical method

Surgical intervention is recommended for patients with grade 3 gonarthrosis and with severe movement limitations. The operation consists in replacing the joint with an artificial implant. The service life of such an artificial joint is 15-20 years.

At present, low-traumatic arthroscopic techniques for the installation of the knee implant in gonarthrosis have been developed, and its physico-mechanical characteristics have been improved. Therefore, the rehabilitation period after surgery is minimal and allows the patient to quickly return to normal motor activity. During the rehabilitation period, you can also apply therapeutic exercises, massage, physiotherapy.

vashekoleno.ru

Knee joint gonarthrosis - basic concepts

Knee joint gonarthrosis

Knee joint gonarthrosis is a very common disease, especially for professional athletes and weightlifters. In its essence, it represents a gradual drying out of the cartilaginous tissue, which entails deformation of the entire joint and subsequent loss of its functions. Also, this ailment is often known as osteoarthritis and deforming gonarthrosis.

Most often, gonarthrosis is at risk for people of age, people who get intense and frequent physical activity. People who are overweight also overload their joints unnecessarily, and most often gonarthrosis is found in women.

Source kiberlekar.ru

Bilateral

1 degree

1 degree of arthrosis of the knee joint is the easiest and most favorable for patients. It is characterized by the appearance of minor changes in the tissue of the articular cartilage. Symptoms of this disease, as a rule, do not bring any serious restrictions to the patients' life. In addition, in most cases at this stage of gonarthrosis progression of the disease stops.

Symptoms of

Osteoarthritis of the knee joint of the 1st degree develops long and gradually. Therefore, patients almost never can tell the exact time of onset of the disease.

Long before the onset of patients' pains, the feeling of discomfort in the joint may be troubling. Usually people do not attach importance to this, writing off all not ordinary fatigue, hypothermia or recent trauma.

However, this symptom may already be the first sign of arthrosis of the knee joint, as the initial changes in the structure of the joint have already begun to occur, which is manifested clinically.

After a while, patients begin to experience pain in the knee. They may be weak enough that the patient does not pay due attention to them and does not consider themselves sick.

As a rule, pain manifests itself in the morning, after sleep. After awakening and walking, the joint is developed and the pain passes. Often, pain occurs during the day, after a long sitting or lying.

Such pains are called "starting", because they occur at the beginning of movement after a long rest, and after the joint work passes.

During the day, the pain may appear again. Especially often this happens when climbing or descending the stairs. The pains are caused by the fact that the weight of the whole body rests on the knee bent in the knee. Because of this, the articular cartilage contracts and abuts against each other.

Sometimes the initial sign of the disease may be a crunch in the joint. It arises from the fact that the deformed articular surfaces, as it were, cling to each other while moving.

Also a fairly infrequent manifestation of the first degree of arthrosis of the knee joint may be weakness of the muscles on the affected leg. Diagnosis

For an experienced physician to suspect that the patient has arthrosis of the knee joint of the first degree is not a big problem. More often for this purpose it is enough to correctly estimate the symptoms of the disease and the peculiarities of their occurrence.

To confirm the diagnosis, an x-ray of the knee joints should be performed. When using this method, a narrowing of the joint gap is usually found.

Source sustavartroz.ru

Treatment with ointments synovitis knee joint treatment is described by reference.

Treatment of knee arthritis pricks http: //sustavprof.ru/lk/ lechenie-artrita-kolennogo-sustava.html.

2nd degree

Gonarthrosis of the second stage is characterized by an increase in the symptoms that appeared in the first stage. The pain syndrome becomes more prolonged and intense. Patients mark the appearance of a crunch in the joint with motion of the knee. Many complain of stiffness in the joints in the mornings, which passes after a short walk. At this stage, patients periodically use analgesics. There is an insignificant limitation of flexion and extension in the knee joint. The joint is enlarged in volume.

Source vrach-travmatolog.ru

3rd degree

The third degree of arthrosis of the knee joint is considered to be the heaviest. The disease significantly complicates the life of patients, severely restricts their ability to work and often becomes the cause of disability.

At the third degree of gonarthrosis the structure of the knee joint undergoes very serious changes. Articular cartilage is practically absent. This leads to the fact that the articular surfaces of the bones are sharply compressed, which is clearly visible on the X-ray.

Osteophytes( bone growths) on them becomes much larger. Also, with this degree of gonarthrosis, a pronounced narrowing of the joint gap is observed.

Symptoms of

Among the symptoms, an important place is occupied by pain in the affected joint. They worry patients constantly and almost never pass. Even in bed, patients are constantly trying to find a "painless" position for the affected leg.

Another important symptom of the 3rd degree of gonarthrosis is joint deformation and a sharp restriction of movements in it. It is extremely difficult for the patient to bend the leg in the knee even at a right angle. Many patients also can not fully unbend the aching leg.

Osteoarthritis of the knee joint of the third degree often leads to X or O-shaped deformation of the joint, which, in turn, is the cause of various abnormalities of the gait.

Sometimes, with this disease, the so-called blockade of the knee joint can develop: a condition in which a person can neither bend his leg nor unbend it.

Treatment of

With this disease, both therapeutic treatment and surgical treatment can be used. The therapeutic does not differ much from the treatment of other degrees of gonarthrosis: decreased exercise, pain relief, chondroprotectors, physiotherapy, massage, diet, etc.

Patients with grade 3 gonarthrosis, whose treatment is not effective with conservative methods, can be used for surgical intervention.

Operative treatment of arthrosis of the knee joint includes two large technologies:

Joint operations aimed at removing outgrowths and deformed elements that "prevent" the joint from working normally. The operations are carried out with the help of an arthroscope - a special device that allows you to carry out all these manipulations without opening the joint completely, but by making several holes. Prosthetic joints - an operation aimed at replacing the "native" joint elements with their artificial counterparts.

Source sustavartroz.ru

Reasons for

For reasons of occurrence, the disease is divided into two large groups: primary and secondary arthrosis of the knee joint.

With the primary form of the disease, the exact cause that caused this disease is unknown.

The secondary form is spoken of when there is already a problem in the joint( for example, a previous inflammation, trauma, etc.), and osteoarthritis, as it were, is layered again on the already changed joint.

The exact cause of gonarthrosis is unknown to date. But the risk factors leading to the appearance of this disease are well studied.

There are three large groups of causes, or risk factors for knee arthrosis.

The first group of reasons: hereditary and age factors.

The second group of causes: congenital and acquired diseases of the musculoskeletal system.

Source artrozamnet.ru

Signs

Pain sensations in gonarthrosis do not appear immediately. For a long time, many months or even years, there are minor pains that occur solely with prolonged walking, exercise, walking on a ladder or getting up from a chair.

If the pain in the knee has arisen sharply, and before there were no pains, it usually indicates some other disease or damage - for example, pinching of the meniscus or getting a piece of cartilaginous tissue between the knee cartilage. There are three stages of arthrosis of the knee:

I stage of gonarthrosis is characterized by fatigue of the limb, moderate restriction of movements in the joint, a slight crunch is possible. Usually, pain occurs at the beginning of the walk( "starting pain") or after a long load. At rest and with a small load, pain is absent. In the first stage, the bones of the knee retain their original shape and are almost not deformed. An x-ray reveals some narrowing of the joint gap.

At the II stage of arthrosis of the knee joint, there are restrictions of movements. Pain at this stage accompanies almost any movement in the affected knee. But especially the knee hurts after a long walk, wearing even small weights. The pain syndrome decreases only after a long rest. There is a noticeable crunch in the knee joint during movements, deformation of the joint, muscle hypotrophy, lameness. X-ray reveals narrowing of the joint gap 2-3 times in comparison with the norm, osteophytes appear( marginal growth of the bone).Synovitis( congestion in the joint of the pathological fluid) at this stage of gonarthrosis happens much more often and is much more pronounced than at the beginning of the disease, at its first stage.

In the third stage of gonarthrosis, pain in the knee is further intensified. The mobility of the knee joint is reduced to a minimum. Pain in the third stage of arthrosis of the knee joint is preserved and at rest, do not pass after rest. There is a noticeable deformation of the bones of the knee joint. It is difficult for a patient to find a comfortable position in bed, arrange an affected knee so that it does not hurt. If the destruction of the joint is combined with a violation of blood circulation, the joints begin to "twist" and in the middle of the night, usually when the weather changes - "to rain."X-ray joint joint is almost completely absent. The articular surface is deformed, the marginal growths are expressed.

Source of nanoplast-forte.ru

Symptoms of

A common symptom of gonarthrosis is a feeling of stiffness in the joint, "pulling" under the knee, pain in the knee after a long walk. Many patients with gonarthrosis( arthrosis of the knee joint) complain of difficulty in walking mostly in the morning, after a dream or after a long sitting. A person needs to "disperse" in order to become easier. With the development of gonarthrosis, pain in the knee, especially on the inner side, becomes more stubborn and permanent. Often, patients with gonarthrosis feel a crunch when moving the knee joint. Further, the limitations of flexion and extension of the leg develop. When the disease progresses, lameness develops. In more neglected cases, a person can not move without the help of outsiders, support or without crutches. Often in the lying position the pain subsides, but it happens that at night a person suffers from pain.

When examining the knee joint in the initial stage of the disease, external changes are usually not detected. With the course of the disease, the deformity of the knee joint, the contours of the bones forming the joint, the coarse, the contracture( incomplete flexion or extension), the curvature of the shin are very noticeable. Putting a palm on the front surface of the knee, you can feel the crunching or extensor movement crunch in the knee joint of varying intensity and duration. A similar sensation can be obtained by shifting the patella outward in the transverse direction( positive patello-cordillary symptom).

When you feel the joint of a patient with gonarthrosis, a painful area is detected, usually on the inside of the joint, at the level of the condyles of the hip, the large burtz, and the joint slit. Often an effusion accumulates in the cavity of the knee joint, ie, synovitis is attached. Such a state is determined by the smoothness of the contours of the knee joint due to bulging, protrusion of the tissues above the patella and from the side of it and a sense of fluctuation when the protrusion is felt with both hands.

Source ayzdorov.ru

Deforming

Deforming gonarthrosis is one of the problems, the solution of which at the present stage of development of orthopedics is far from ambiguous. However, the generally accepted factor in the progression of degenerative changes is the violation of the limb axis, which leads to a significant overload of articular surfaces of the knee joint. A number of scientific papers devoted to biomechanical correction of the knee joint showed quite good results of treatment.

Current trends in the treatment of this pathology can be reduced to the following. In the first stage, it is advisable to use chondroprotectors, hyaluronic acid preparations, non-steroidal anti-inflammatory drugs of the COX-2 inhibitor group( of which nemesulide is available), glucocorticoids for the management of inflammatory phenomena in the synovial membrane, physiotherapy and sanatorium treatment. In the second stage, surgical methods are added to the above methods of drug therapy - in the form of extraarticular osteotomies. As has been proved by many years of experience, classical arthroplasty operations with joint surface remodeling do not always give a therapeutic effect. At the onset of the third stage, patients are shown endoprosthetics or as an extreme case of arthrodesis.

Dysplastic gonarthrosis should be considered separately, since it does not fit into this scheme due to the need to perform preventive surgical interventions aimed at normalizing biomechanical interrelations in the knee joint both for preventing development and for treating arthrosis.

With the advent of arthroscopy and the accumulation of experience of these operations on the knee joint, we came to the formation of a technique for its use in arthrosis of the knee joint. The value of these operations in minimally invasive and low traumatism.

Source golovakha.dp.ua

Post-traumatic

Posttraumatic gonarthrosis can be a consequence of both chronic trauma of the knee joint and acute acute mechanical damage.

The appearance and speed of progression of degenerative-dystrophic process always directly depends on the degree of severity and extent of injury of the knee joint, as well as on the methods of treatment used for its correction. In most cases, gonarthrosis occurs three to five years after injury. Sometimes the characteristic changes occur much earlier - two or three months after the fracture or dislocation of the knee.

The development of gonarthrosis is facilitated by pinching, tearing and tearing of the meniscus, accompanied by wedging of the knee joint, especially when it was not quickly and timely eliminated. For possible causes of arthrosis can be attributed to cartilage and ligament injuries.

minor, mild injuries sometimes become a source of serious problems, turning into a kind of trigger mechanism for the development of aseptic( avascular) necrosis of the condyle of the hip and tibia. This subsequently threatens to pass into post-traumatic gonarthrosis with all the manifestations typical for this pathology.

To date, the instability of the knee, which is often a consequence of its significant damage, is considered one of the most common causes of secondary gonarthrosis in young and middle-aged people. In addition, almost universally performed stabilization of the joint by reconstructing its ligamentous apparatus does not prevent the development of deforming arthrosis, but, on the contrary, it leads to the resumption of unrestrained physical injuries and overloads interrupted by the trauma.

The optimal approach to the correction of instability should provide for not only its leveling, but also be designed to further prevent the progression of deforming arthrosis. An important role in this is given to restoring the balance balance of the knee by performing a valgus osteotomy of the tibia.

On average, in 20-30% of cases, the cause of gonarthrosis are various injuries of the knee joint. They suffer mainly the able-bodied category of citizens, to prevent and timely diagnosis of this pathology should be approached extremely scrupulously. This will help in the future to avoid early disability and social disadaptation of such persons. Particular attention should be paid to patients who underwent partial or complete removal of the meniscus during the treatment of injuries. As this leads to increased pressure on the articular cartilage.

Source rusmedserv.com

Two-way

Primary bilateral gonatrosis - ICD 10

Quite often diagnosed complicated version of arthrosis of the knee joint - gonarthrosis bilateral. In this case we are talking about the fact that two legs are struck at once. This kind of gonarthrosis is more common than unilateral arthrosis, and at the same time requires more scrupulous examination and treatment.

Source sustavartroz.ru

sustavprof.ru

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