Characteristics, features of arthrosis of the knee joint of the third degree
Arthrosis of the knee joint( gonarthrosis) refers to chronic diseases of degenerative-dystrophic type, i.e., which lead to tissue destruction. In this case, the cartilage surfaces of bones are subjected to destruction, the functions of which are to reduce the friction between the bones. Gonarthrosis is one of the most common forms of arthrosis. This is due to the fact that the knee joint is subjected to heavy loads, as it must provide the movement of the foot and maintain the body weight.
About this disease in general, we already spoke on the site:
In this article - a detailed description of the 3rd degree of ailment.
Three degrees of arthrosis of the knee joint. Click on the picture to enlarge
Features of arthrosis of the knee joint of the 3rd stage
In the course of the development of the disease, the hyaline cartilage covering the bones and serving as a shock absorber during movements becomes thinner, cloudy, and then exfoliates and cracks. The stages or degrees of gonarthrosis are only four. For grade 3 gonarthrosis is characterized by an almost complete disappearance of the cartilage, because of which the bone is exposed, the synovial membrane of the joint becomes inflamed. The bone, which has lost protection, experiences excessive friction and is injured.
The body, trying to replace the cartilage, gives the command to thicken the joint capsule and "grows" on the bone surface osteophytes. These spike-like bone formations, which impede movement, contribute to the development of complete immobilization of the joint( contracture).
In the third stage of arthrosis, there is also a significant decrease in the distance between the joint bones - these changes are clearly visible on the X-ray.
In complex cases, when motor activity is reduced to a minimum, there is a risk of complete joint fusion.
A severe disability of the patient often causes his disability.
Grade 3 Arthrosis Knee arthrosis is diagnosed primarily in people over the age of 40, women are sick twice as often as men. The first two stages of the disease are considered reversible and treated( or their development stops).The trouble is that gonarthrosis can last for a long time almost without symptoms, until the moment when the disease can already be called neglected.
Disease can provoke:
- age and hereditary factors;
- diseases of the osteoarticular system( most often arthritis);
- metabolic disorders;
- endocrine pathologies( diabetes, thyroid disease);
- microtrauma and knee injury;
- persistent increased load on the skeleton( including those caused by obesity).
The main reason for the development of gonarthrosis is grade 3 - a disdainful attitude towards the treatment of the disease in its initial stage. Restoring significantly deformed joints is a very difficult task, sometimes requiring surgical intervention.
Also to the development of the third degree of knee arthrosis can lead to attempts to cure the disease at home. The use of folk remedies is acceptable and welcome, but they must complement, not replace, the basic methods of treatment.
Characteristic symptoms of
In gonarthrosis grade 3, all symptoms of early stages( stiffness and pain in the knee area, crunch during movement) are amplified, and new ones are added. The pain becomes very strong, sometimes unbearable, and persists in a state of rest. Patients are often forced to stay in bed, but even then they do not always manage to find a relatively painless leg position.
The next most important symptom of the 3rd degree of arthrosis is a significant limitation of joint mobility, caused by its deformation. The patient with difficulty bends his leg even to a 90 degree angle and can not fully unbend it. This limits the possibility of normal walking. Sometimes blockade of the knee joint develops, when the diseased leg can not be bent or unbent.
In connection with joint deformities with arthrosis, the legs often acquire an X or O-shape, which causes abnormalities of the gait.
Left - X-shaped form of the legs, right -
norm Characteristic features of the third degree of gonarthrosis also include:
- congestion in the joint bag of effusion - synovial fluid( synovitis),
- reduction of interarticular cleft,
- replacement of cartilage cells with connective tissue( sclerosis of the subterranean zone),
- salt deposition on the joint surface.
Treatment of grade 3 gonarthrosis
The methods of therapy of gonarthrosis of the third degree have similarities and differences with the methods of treatment of other degrees of the disease. As in the early stages, apply:
- load reduction,
- taking painkillers and anti-inflammatory drugs,
Effective at 1 and 2 degrees of arthrosis, intra-articular hyaluronic acid injections, chondroprotectors designed to restore cartilage tissues, with 3 degrees of disease bring only temporary relief.
In the third stage of gonarthrosis, when the articular cartilage is almost destroyed, and the bones underwent significant changes, conservative treatment is not enough - in this case, they resort to surgical intervention. Operative treatment of gonarthrosis includes several technologies, the most common of them are two:
The operation to remove osteophytes and deformed bone elements. Such operations are low-traumatic and are performed with the help of an arthroscope - a tool that can be manipulated through several holes.
Endoprosthetics - replacing the destroyed knee joint with an implant.
Operations of arthrodesis( joint fixation with bony bone surfaces) and arthrolysis( removal of bone adhesions and thickened synovial membranes with a view to increasing the volume of movements in the joint) are much less often performed.
Light pain that occurs in the knee during exercise is often considered unworthy of attention, taking it only for temporary and minor discomfort. This error can be expensive. When you turn to the doctor on time and follow all his recommendations, you will save yourself from developing a severe form of arthrosis of the knee joint - gonarthrosis of the third degree. Take good care of your health and be healthy!
Treatment of gonarthrosis( arthrosis of the knee joint) 1, 2, 3 degreesWhat is gonarthrosis? Knee joints can rightly be called the most loaded in the human body. The process of walking, as is known, is a fall, which prevents the second leg from setting. Thus, the knee joint( more precisely, the tibia) at every step experiences a load in the form of the weight of the complete human body( except the tibia of the standing leg).
Given the prevalence of obesity, which greatly increases the load on the articular cartilage, the lifting of various weights, which also contribute to the gradual destruction of the knee joints, one can understand why the degenerative degenerative lesion of the knee joints, called deforming gonarthrosis, occurs frequently, especially in adulthood and old age. Disability is often the outcome of gonarthrosis.
Stages of gonarthrosis
Treatment of gonarthrosis should be differentiated, depending on the stage of the disease:
- in the first stage of deformation of cartilage and articular bag does not happen, there is only swelling of soft tissues;
- the second stage develops, usually after a few months. It manifests itself in the intensification of pain after minor loads and movements. It can be said that any movement hurts. To the pain has passed, you need a long rest. Osteoarthritis of the knee joint of the 2nd degree is still reversible with proper and timely treatment.
- Gonarthrosis of the third degree, in addition to functional disorders, is manifested by progressive destruction of the cartilaginous tissue. The pain arises even at rest. It is at this stage that the classic aching in the knees "on the weather" begins, there is a significant restriction of movement in the knees. This disease brings considerable suffering, and leads to disability.
How to treat arthrosis of the knee joint
Treatment of all diseases, and gonarthrosis in particular, is only three types:
- etiotropic, that is, aimed at eliminating the cause of the disease;
- pathogenetic, directed to one of the links in the development of the disease;
- is symptomatic, aimed at relieving suffering.
Only all these measures in the complex can give a lasting positive result. Applicable to gonarthrosis, medical treatment measures should be directed to:
- pain relief( improvement of quality of life) - NSAID group;
- improvement of trophism and restoration of the surface of articular cartilages - reparants( chondroprotectors);
- reduction of blood stagnation( ischemia) and improvement of blood circulation in the microcirculatory bed of the periarticular tissues and the joint bag - vitamins, massage, physiotherapy, local treatment;
- improvement in trophic muscles of the thigh and lower leg - exercise therapy.
In addition, with various arthrosis, treatment with folk remedies is quite effective: phytotherapy, deep warming.
The main groups of drugs used in the treatment of knee arthrosis
- NSAIDs are nonsteroidal anti-inflammatory drugs. Are non-hormonal. They are used to relieve acute pain. Therefore, they are used in the first place, since only after the withdrawal of the expressed pain syndrome other methods of treatment are possible. However, their administration should not be long, as it is possible to develop side effects, for example, such as NSAID-induced gastropathy.
In addition, taking pain, taking these medications does not prevent further destruction of the joints, but only improves the quality of life. Representatives of this extensive group of drugs are such as nimesil, tselebrex, movalis, orthophene, voltaren and many others.
Modern NSAIDs( eg, meloxicam) cause few side effects, and are selective, that is, they exhibit selective, more precise action.
- Preparations protecting cartilage surfaces from destruction and helping to restore it - chondroprotectors. Their main active substances are chondroitin sulfate, glucosamine and hyaluronic acid( synviscus, fermatron).Simply put, these drugs contribute to the timely "lubrication" of the joint, the preservation of its biomechanical function, reducing friction and pain syndrome.
These drugs significantly help in the very beginning of the disease, as well as in the 2nd stage. If the cartilage does not already exist, then the best lubricant will be unable to restore the function. In addition, it has been shown to be effective only in intraarticular administration of the drug, only directly into the joint cavity( Don, Hondrolon, Elbon).
All tablets( Artra, Teraflex, etc.), which are so expensive, are in fact not more effective than a cold containing approximately the same compounds. The course of treatment with chondroprotective agents is quite long.
- Local treatment in the form of ointments, creams and applications on the surface of the knees. This is an extremely widespread method of treatment at all stages of the disease. They do not so much heal as they ease the condition and refer to the means of symptomatic therapy. Most often used ointments with a warming effect, able to improve blood circulation in the joint area. There are a lot of them: Nikoflex, Dolgit, Fastum-gel, Kapsikam, Finalgon and many others.
In the event that a synovitis has joined, that is, there is inflammation and effusion, it is impossible to warm. This can increase swelling of the inflammatory fluid in the joint cavity. In the event that there is effusion, it is possible to use intraarticular injections of hormonal preparations of long-term action( Kenalog, Diprospan) and their analogues.
Dimexid, penetrating through the skin, and bischofite have a good therapeutic( analgesic and anti-inflammatory) effect. Bishofit is an "oil brine" that accompanies the emergence of oil while drilling wells. It warms well and anesthetizes, if applied in applications and compresses.
- Of great importance are non-medicinal methods: therapeutic gymnastics, physiotherapy, massage. Special exercises, especially in the pool, with reduced load, have a beneficial effect on the restoration of articular cartilage. Using the cane also reduces the load on the affected joint.
- Also an important component of complex therapy for gonarthrosis is a diet. Food should not be monotonous, it is necessary to exclude refined meat byproducts that can cause urine acid diathesis and the attachment of microcrystalline arthritis, which worsen the course of gonarthrosis.
Genuine scourge of the twenty-first century is gonarthrosis of the knee joint. If several years ago only elderly people were at risk, now the disease does not spare the youth.
In most cases, gonarthrosis develops against the background of injuries sustained by athletes in training and competition.
The destruction of the knee joint is gradual: first, against a background of mechanical damage, microtraumatic cartilage arises, and then the process of its degeneration occurs.
This disease is characterized by a change in the tissue of the cartilage of metabolism, the essence of which is that the saturation of the cartilage with chondroitin sulfate is markedly reduced.
The causes of progression of gonarthrosis are:
- arthrosis, formed against the background of Paget's disease;
- bone tumors of benign or malignant nature;
- fractures of the bones of the knee joint;
- ankylosing spondylitis( arthritis affecting the joints of the sacrum and spine);
- rheumatoid arthritis.
Modern physicians distinguish 3 degrees( or stages) of gonarthrosis.
Unfortunately, this stage of gonarthrosis is often ignored by most people. Pain syndrome occurs only after a load, and the deformation of the knee joint to notice with the naked eye is almost impossible.
Symptoms of the disease become more specific. Thus, the duration and intensity of painful sensations localized in the joint increases, and often a characteristic crunch is formed during flexion.
Gonarthrosis of the third degree
Gonarthrosis, developed to 3 degrees, is characterized by quite strong painful sensations, arising both during movement and when a person is standing or sitting. In addition, the affected joint "reacts" to the weather change. The mobility of the knee joint is limited, there are changes in the gait( lameness).
Medicine is known for two types of disease: primary( idiopathic) and secondary.
The disease occurs and develops due to intensive loads of the knee joint. The risk group includes middle-aged and elderly women, as well as athletes and people suffering from obesity.
The pathological process extends both to one joint and to both. When there is a simultaneous destruction of both joints, doctors diagnose bilateral gonarthrosis.
The provoking factors of gonarthrosis secondary are:
Knee joint gonarthrosis of 1, 2 and 3 degrees: treatment, causes, symptomsWhat is it - gonarthrosis is a non-inflammatory disease of the knee that disrupts the blood supply of cartilage, covering the articular surfaces of the femoral and / or tibia. As a result, the cartilage is destroyed, the parts of the bones begin to rub against each other, as a result of which they become denser and expand. This is often accompanied by inflammatory phenomena. Symptoms of the disease are due only to the above processes;calcium salts, if they are deposited in the joints, the cause of the pathology is not. Pathology most often develops in individuals 40 years and older, mainly women and people who are engaged in professional sports or having knee injuries. Articular cartilage does not regenerate, so the disease must be detected and treated early in the early stages.
Causes of gonarthrosisThe disease develops with a combination of several causes:
- fractures of the bones of the lower leg involving the knee joint;
- trauma of cartilage interlayers of the joint - meniscus;
- tears of knee joints;
- increased load on the joint - running, squatting, lifting weights from the vertical position of the body - after 40 years of age, especially if a person does not exercise regularly;Excess weight
- joint inflammation( arthritis), which has a different - psoriatic, gouty, rheumatoid or reactive - etiology;
- genetically determined weakness of the ligamentous-capsular apparatus of the joint, because of which its looseness occurs;
- pathology of joint innervation, characteristic of craniocerebral and spinal cord injuries;
- metabolic disease.
- 1) Primary. It occurs against the background of full joint health( without pre-injury or inflammation).It is based on metabolic diseases, long reception of hormonal means, genetic predisposition of articular cartilage. The process is usually two-sided( although it can begin as one-sided).It develops more often in the elderly.
- 2) Secondary. Develops due to injuries, inflammations, tumors transferred to the joint operations. Can develop at any age. The process is usually one-sided.
Symptoms of knee joint graft diseaseHow the disease manifests itself will depend on how far the degenerative process has progressed. Depending on this, three stages of the disease are distinguished, each of which has its own symptomatology. As a rule, the first degree of gonarthrosis of the knee joint is manifested by certain symptoms, which should be noted:
- a feeling of contraction under the knee;
- stiffness in the knee, which manifests itself after sleep, prolonged sitting or prolonged immobility of the joint;
- joint pain:
- arising from prolonged walking, squats, walking on stairs;
- aggravated after standing or physical exertion
- swelling of the joint can occur for a short time, passes by itself.
- joint pain becomes more intense, lasts longer. It disappears after rest.
- pain is felt inside the joint or on the inside of the knee.
- there is a crunch in the knee when walking.
- in the morning it is impossible to unbend the knee.
- closer to night and at night there are pains in calves.
- the leg is not fully straightened.
- joint swells, acquires signs of initial deformation.
- 1) Joint pain is a constant concern, regardless of the physical activity of a person.
- 2) Pain syndrome increases with changing weather.
- 3) The mobility of the joint is limited, due to which the person limps.
- 4) The knee is enlarged in size and deformed. When the process progresses, the joint becomes an X-shaped or O-shaped.
Diagnosis of gonarthrosisIt is possible to suspect the presence of gonarthrosis of the knee in the patient already on the basis of his complaints and objective examination data. The diagnosis is confirmed with the help of such instrumental studies:
- 1) Radiography. This method may be uninformative at the first stage of the disease, but subsequently it visualizes the narrowing of the joint gap, the compaction of the bone zone below the articular cartilage, and the sharpening of the edges of the condyles.
- 2) Computed tomography of the joint. This is more expensive, but more informative( even at stage I) method based on x-ray radiation. Visualizes the joint itself and surrounding tissues in more detail and layer by layer.
- 3) Magnetic Resonance Tomography - a method based on a non-radiological, considered harmless radiation, which can be used for contraindications to CT.Also layer-by-layer displays the picture in the joint, but is more informative regarding the surrounding soft tissues.
- 4) Arthroscopy is an invasive technique for joint research when a fiber optic device is inserted into the hole made under local anesthesia, allowing the specialist to examine the joint from the inside.
- 5) The knee ultrasound is informative for the diagnosis of such complication of gonarthrosis as synovitis.
Treatment of gonarthrosis of the kneeThe doctor involved in the treatment of this disease is an orthopedist. Drug therapy of the disease includes the following groups of drugs:
- 1) Non-steroidal anti-inflammatory and pain medications: Voltaren, Celebrex, Rofika, Nimesil, Movalis.
- 2) Chondroprotectors: "Artra", "Arthron", "Dona", "Teraflex", "Chondroitin complex".These drugs are taken for at least six months in the dosage prescribed by the doctor.
- 3) Inside the joint with pronounced inflammatory phenomena, enter "Hydrocortisone" or "Kenalog" no more than 3 times.
- 4) The preparations of hyaluronic acid are shown, which must be inserted into the joint when the inflammatory phenomena in it subsided: "Hyalurum", "Ostenil", "Sinocrom".These medications show a very good effect, they are administered only a few times, while having a fairly high cost.
- 5) Heating compresses with "Dimexid", "Bischofite", medical bile to improve the blood supply of the joint, increase the production of "lubricating" liquid in it.
- 6) Soya and avocado extract - "Piascladin" - has also proved to be an effective tool in the treatment of gonarthrosis of the knee joint. At the same time, the treatment course is not less than six months.
Physiotherapy for gonarthrosisIn an acute period a person needs to provide complete rest for the diseased knee. Then proceed to the gradual introduction into his regime of the day of physical exertion. Exercises are carried out in the position of the patient lying on his back, they consist mainly in lifting the straightened legs, keeping them in the raised position. It is important to perform exercises smoothly, carefully, so that they do not cause pain. Begin with 10 minutes, gradually, 2 minutes a day, increasing the duration of classes. Increase and the amplitude of movements, which should be selected by specialists individually for each.
Consequences of gonarthrosis
If the disease is triggered, everything can result in the disappearance of cartilage, outcropping of bone, deformation of the joint. This leads to immobilization of the knee and subsequent prosthetics. The end result of gonarthrosis can be a complete loss of joint function and disability. The adverse effects of gonarthrosis can be attributed to inattentive and disparaging treatment of their knee. This disease is quite easily diagnosed and cured at the first stages.
If you do not pay attention to morning stiffness, swelling, a slight aching pain, then as a result you can get lameness, crooked legs, stalling gait. Therefore, you need to find time for yourself, on your knee and visit the doctor at the first signals of the body. Moreover, today there is a large arsenal of means and methods of treating this disease. The earlier a patient turns to a doctor, the greater the chance of a full recovery.
Consequences of gonarthrosis
Treatment of gonarthrosis
Treatment of gonarthrosis at an early stage is not a problem, it is often possible to do just prevention. But in the 3 stages it is already very problematic. Deforming severely deformed joints is very difficult. All forces are aimed at eliminating pain, preventing inflammation, returning mobility of the joint. If the outcome is unsuccessful, surgical intervention is prescribed.
Treatment begins with the elimination of edema with anti-inflammatory drugs. This reduces pain and makes the patient's condition easier. After removal of the pain syndrome, you can go to physiotherapy, gymnastics, massage. Anti-inflammatory drugs are taken no more than 3 months.
Chondroprotectors are introduced to restore cartilaginous tissue. They affect the cause of the disease. Improves the development of joint fluid. True, with stage 3 gonarthrosis, they may not be useful.
X-ray of the joint
Intraarticular injections of hyaluronic acid are very effective at 1 and 2 degrees of disease, and at 3 only bring relief and then for a short while. A greater result in severe form of gonarthrosis can be achieved by stretching in combination with physiotherapy. Bones are bred by stretching, which increases the distance between them, relieves the load from the joint. Physiotherapeutic treatment improves blood circulation in the joint, the condition of the tissues. Painful muscle spasm is removed.
To assist in the treatment of gonarthrosis, it is worthwhile to resort to the use of a cane. When walking with support on it, the cane takes about 40 percent of the load intended for the joint. A cane should be chosen according to growth. Its length should be equal to the distance from your wrist to the floor in the upright standing position with the arms extended downwards. A cane with a rubber nozzle at the lower end does not absorb or slip.
Surgical treatment for gonarthrosis
When gonarthrosis takes severe forms and conservative treatment does not lead to positive results, the patient is offered surgery. In different forms and for different purposes, various surgical procedures are performed:
Operation against gonarthrosis
- puncture - excess fluid is removed with subsequent administration of hormonal drugs;
- overblack osteotomy of the tibia - correction of the axis deflection during deformation of the joint;
- arthrodesis - joint resection with bone fusion is performed. Such an operation is extremely rare;
- arthrolysis - removes altered and thickened synovial membranes, adhesions to provide more volume for joint motion;
- arthroplasty - the remains of articular cartilages are reduced with the formation of simplified articular surfaces. This type of surgery is rarely performed due to the development of joint instability;
- endoprosthetics - replacement of a damaged joint with an implant.
Rehabilitation is an important part of the rehabilitation process. Under the supervision of a doctor, the patient after the operation from the first days begins gradual movement in the joint to be restored. If the general well-being of the patient is satisfactory, he is allowed to get up on the second day. Exercises that strengthen the muscles of the hip are performed, gait is developed, sparing the operated joint. The rehabilitation period can last about six months.
First the movement is carried out with the help of crutches, then they are replaced by a cane. It is important to perform the prescribed exercises. It is useful to walk, the more, the better, but not exhausting yourself. Walking does not replace exercise. On the stairs, you should move very carefully.
Any redness of the wound, discomfort should be reported immediately to the doctor. Sudden numbness or weakness in the leg may indicate damage to the blood vessel or nerve. Whatever modern implants are not doing a knee replacement, they wear out sooner or later. However, the more modern and expensive the prosthesis, the longer it will last.
Traditional medicine for gonarthrosis
Gonarthrosis at an early stage is completely treated with conservative methods. In the course you can start treatment with folk remedies with recipes that are very effective for arthrosis of the knee joint. That only there is a red or blue clay! True, it can not be collected with a metal spatula, so as not to damage the healing properties. It is better to do this with a wooden spoon.
Clay, diluted with water to a consistency of sour cream, spread on a rag with a layer of 2 cm and apply as a compress for 2 hours, wrapped in a woolen scarf. The second clay used is not used. This lotion for 5 days well removes the edema. It is possible to take clay water during this period.
Folk recipes against gonarthrosis
It is recommended to use the following recipe from compresses: 3 tbsp.apple cider vinegar mixed with 1 tbsp.honey. This mixture is smeared knee joint. From above it is necessary to impose a fresh leaf of burdock or cabbage, and it is better to have aloe. All this is wrapped in polyethylene and a woolen cloth for the night. If there is patience, you can so walk for several days, until the leaves dry.
Of anti-inflammatory tinctures, improving and blood circulation, it is necessary to adopt this option: through a meat grinder to skip 3 lemons, 120 g of garlic, 250 g of celery root or nettle. All this pour boiling water in a three-liter jar. Wait for a night, cover with a pillow or a warm blanket. Drink half a glass for half an hour before eating. One bank is enough for a month, and for the course you have to drink three.
It is good to apply the therapeutic massage with honey from the painful sensations. To begin with, within 10 minutes, you need to warm up the knee joint, for example, a warmer. Then the sore spot is smeared with honey and massaged for 15 minutes. Do it better before going to bed, covering the knee with the velvet side of the burdock. Within 10 days the pain goes away.