GonarthrosisGonarthrosis ( deforming arthrosis of the knee joint) is a degenerative-dystrophic disease in which the hyaline cartilage covering the condyles of the tibia and femur is affected. In the late stages of gonarthrosis, the whole joint is involved in the process;the underlying part of the bone is compacted and expanded. Gonarthrosis is the first in terms of prevalence among all arthroses. The disease usually occurs in patients over the age of 40 and is more common in women. In some cases( after injuries, in athletes), gonarthrosis can develop at a young age. The main manifestation of gonarthrosis are pains worse with movements, restriction of movements and synovitis( accumulation of fluid) in the joint. Gonarthrosis develops gradually, for many years. Treatment of gonarthrosis is conservative. Timely preventive maintenance plays an essential role.
Gonarthrosis or knee arthrosis deformans is a progressive degenerative-dystrophic lesion of intraarticular non-inflammatory cartilage. Gonarthrosis is the most common arthrosis. Usually affects people of middle and old age, women suffer more often. After a trauma or constant intensive loads( for example, in professional sports), gonarthrosis may occur at a younger age. Prevention plays an important role in the prevention of the onset and development of gonarthrosis.
Contrary to popular belief, the cause of the disease is not in the deposition of salts, but in eating disorders and changes in the structure of the intraarticular cartilage. When gonarthrosis in the attachment of tendons and ligamentous apparatus can occur foci of deposition of calcium salts, but they are secondary and do not cause the appearance of painful symptoms.
Classification of gonarthrosis
In view of the pathogenesis in traumatology and orthopedics, two types of gonarthrosis are distinguished: primary( idiopathic) and secondary gonorotrosis. Primary gonarthrosis occurs without previous trauma in elderly patients and is usually bilateral. Secondary gonarthrosis develops on the background of pathological changes( diseases, developmental disorders) or knee joint injuries. Can occur at any age, usually one-sided.
Given the severity of pathological changes, three stages of gonarthrosis are distinguished:
- The first stage is the initial manifestations of gonarthrosis. Periodic blunt pains are typical, usually after considerable stress on the joint. Possible small, self-vanishing edema of the joint. Deformation is absent.
- The second stage is the increase in the symptoms of gonarthrosis. The pains become more prolonged and intense. Often there is a crunch. There is an insignificant or moderate restriction of movements and a slight deformation of the joint.
- The third stage - the clinical manifestations of gonarthrosis reach a maximum. The pain is almost constant, the gait is broken. There is a pronounced restriction of mobility and an appreciable deformation of the joint.
Anatomy and pathological changes in the joint with gonarthrosis
The knee joint is formed by the articular surfaces of two bones: the femur and the tibia. On the front surface of the joint is a patella, which slides along the groove between the condyles of the femur. The fibula in the formation of the knee joint is not involved. Its upper part is located on the side and just below the knee joint and is connected to the tibia by means of an inactive joint.
The articular surfaces of the tibia and femur, as well as the posterior surface of the patella are covered with a smooth, very strong and resilient, dense, hyaline cartilage 5-6 mm in thickness. The cartilage reduces the frictional forces during movements and performs the damping function under impact loads.
In the first stage of gonarthrosis, blood circulation in small intraosseous vessels feeding hyaline cartilage is disturbed. The surface of the cartilage becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of soft, unobstructed sliding, cartilages "cling" to each other. Due to permanent microtraumas, the cartilaginous tissue becomes thinner and loses its damping properties.
In the second stage of gonarthrosis, compensatory changes occur on the part of the bone structures. The articulation pad is flattened, adapting to the increased loads. The subchondral zone is consolidated( part of the bone located immediately below the cartilage).At the edges of the articular surfaces appear bony growths - osteophytes, which in their appearance on the roentgenogram resemble thorns.
Synovial membrane and joint capsule in gonarthrosis also degenerate, become "wrinkled".The character of the articular fluid changes - it thickens, its viscosity increases, which leads to a deterioration of lubricating and feeding properties. Due to a lack of nutrients, cartilage degeneration accelerates. The cartilage is still thinner and disappears completely in some areas. After the disappearance of the cartilage, the friction between the articular surfaces sharply increases, the degenerative changes rapidly progress, the third stage of gonarthrosis begins.
In the third stage of gonarthrosis, the bones are significantly deformed and seem to be pushed into each other, significantly restricting movement in the joint. Cartilaginous tissue is practically absent.
Causes of gonarthrosis
In most cases it is impossible to single out any one cause of gonarthrosis. As a rule, the onset of gonarthrosis is due to a combination of several factors.
Approximately 20-30% of cases of gonarthnosis are associated with previous injuries: shin fractures( especially intraarticular), meniscus lesions, tearing or ligament rupture. Usually, gonarthrosis occurs 3-5 years after a traumatic injury, although it is possible that the disease progresses even earlier, 2-3 months after the injury.
Often the manifestation of gonarthrosis is associated with excessive stress on the joint. Age after 40 years is a period when many people understand that regular physical activities are necessary to keep the body in good condition. Starting to engage, they do not take into account age changes and overload the joints, which leads to a rapid development of degenerative-dystrophic changes and the appearance of symptoms of gonarthrosis. Especially dangerous for the knee joints is running and intense quick squats.
Another predisposing factor in the development of gonarthrosis is excess weight. With excessive body weight, the load on the joints increases, both microtrauma and serious damage( meniscus tears or ligament tears) occur more often. Especially hard is gonarthrosis in complete patients with pronounced varicose veins.
The risk of gonarthrosis also increases after the arthritis( psoriatic arthritis, reactive arthritis, rheumatoid arthritis, arthritis with gout or Bekhterev's disease).In addition, among the risk factors for gonarthrosis is the genetically determined weakness of the ligamentous apparatus, metabolic disorders and innervation disorders in certain neurological diseases, craniocerebral trauma and spinal trauma.
Symptoms of gonarthrosis
The disease begins gradually, gradually. Patients are concerned at minor gonarthrosis with minor pain during movement, especially during climbing or descending the stairs. Perhaps a feeling of stiffness in the joint and "tightening" in the popliteal region. A characteristic symptom of gonarthrosis is "starting pain" - painful sensations that arise during the first steps after lifting from the sitting position. When a patient with gonarthrosis "diverges", the pain decreases or disappears, and after a significant load appears again.
Externally the knee is not changed. Sometimes patients with gonarthrosis note a small swelling of the affected area. In some cases, in the first stage of gonarthrosis fluid accumulates in the joint - a synovitis develops, which is characterized by an increase in the volume of the joint( it becomes inflated, spherical), a sense of heaviness and restriction of movements.
In the second stage of gonarthrosis, the pains become more intense, occur even under small loads and are intensified with intense or prolonged walking. As a rule, the pain is localized on the anterior-internal surface of the joint. After a long rest, soreness usually disappears, and when they move, they reappear.
As the progression of gonarthrosis, the volume of movements in the joint gradually decreases, when you try to bend your leg as much as possible, there is a sharp pain. A rough crunch is possible when moving. The configuration of the joint changes, it seems to expand. Synovitis appears more often than in the first stage of gonarthrosis, characterized by more persistent flow and accumulation of more fluid.
In the third stage of gonarthrosis, the pains become almost constant, patients worry not only during walking, but also at rest. In the evenings, patients try to find a comfortable position for a long time to fall asleep. Often the pains appear even at night.
Flexion in the joint is significantly limited. In some cases, not only flexion, but also extension is limited, because of which the patient with gonarthrosis can not completely straighten the leg. The joint is enlarged in volume, deformed. Some patients experience valgus or varus deformity - the legs become X-shaped or O-shaped. Because of the restriction of movement and deformation of the legs, the gait becomes unstable, overbalanced. In severe cases, patients with gonarthrosis can move only with support on a cane or crutches.
When examining a patient with the first stage of gonarthrosis, external changes can not usually be detected. In the second and third stages of gonarthrosis, coarsening of bone contours, deformation of the joint, restriction of movements and curvature of the limb axis are found. When you move the patella in the transverse direction, a crunch is heard. With palpation, a painful patch is revealed from the inside of the patella, at the level of the joint gap, and above and below it.
When synovitis the joint increases in volume, its contours become smoothed. There is a bulging in the anterolateral surfaces of the joint and above the patella. When palpation is determined by fluctuation.
Diagnosis of gonarthrosis
The diagnosis of gonarthrosis is made on the basis of patient complaints, objective examination data and X-ray examination.
Roentgenography of the knee joint is a classical technique that allows you to clarify the diagnosis, establish the severity of pathological changes in gonarthrosis and observe the dynamics of the process, making repeated pictures after a while. Because of its affordability and low cost, it remains the main method to diagnose gonarthrosis to this day. In addition, this method of research makes it possible to exclude other pathological processes( for example, tumors) in the tibial and femur.
At the initial stage of gonarthrosis, changes in radiographs may be absent. In the future, narrowing of the joint gap and compaction of the subchondral zone is determined. The articular ends of the femoral and especially the tibia broaden, the edges of the condyles become pointed.
When studying the radiograph, it should be borne in mind that more or less pronounced changes characteristic of gonarthrosis are observed in most elderly people and are not always accompanied by pathological symptoms. The diagnosis of gonarthrosis is only exhibited when a combination of x-ray and clinical signs of the disease.
Currently, along with traditional radiography for diagnosis of gonarthrosis, modern techniques are used such as computed tomography, which allows detailed study of pathological changes in bone structures and magnetic resonance imaging, used to detect changes in soft tissues.
Treatment of gonarthrosis
Orthopedics treat gonarthrosis. Therapy of gonarthrosis should be started as soon as possible. During a period of exacerbation, a patient with gonarthrosis is recommended to rest for maximum unloading of the joint. The patient is prescribed therapeutic gymnastics, massage, physiotherapy( UHF, electrophoresis with novocaine, phonophoresis with hydrocortisone, diadynamic currents, magneto- and laser therapy) and mud therapy.
Drug therapy for gonarthrosis includes chondroprotectors( drugs that improve metabolic processes in the joint) and drugs that replace synovial fluid. In some cases, gonatrosis shows intra-articular injection of steroid hormones. Later the patient may be referred to a sanatorium-and-spa treatment.
Patients with gonarthrosis may recommend walking with a cane to unload the joint. Sometimes use special orthoses or individual insoles.
To slow the degenerative processes in the joint with gonarthrosis, it is very important to observe certain rules: exercise, avoiding excessive stress on the joint, choose comfortable shoes, monitor weight, organize the day regimen correctly( alternating load and rest, performing special exercises).
With pronounced destructive changes( at the third stage of gonarthrosis) conservative treatment is ineffective. With severe pain syndrome, joint disruption and disability, especially if gonarthrosis affects a young or middle-aged patient, they resort to a surgical operation to replace the joint( endoprosthetics).In the future, rehabilitation activities are carried out. The period of complete recovery after the operation to replace the joint with gonarthrosis takes from 3 months to 6 months.
Knee joint gonarthrosis of the 2nd degree: characteristic signs of the disease
Under gonarthrosis, also called arthrosis of the knee joint, it means the destruction of cartilage and bony growths appearing along the edge of the joint, as well as xytotic irritation of the joint tissue.
Knee joint gonarthrosis is one of the degenerative-dystrophic joint diseases. This disease has 3 degrees of severity, the most common is gonarthrosis of the knee joint of the 2nd degree, because only at this stage people begin to pay attention to this disease and practice treatment, practically ignoring the first degree.
It should be noted that arthrosis in general is a scourge of modern society, this disease was formerly characteristic only of middle-aged and elderly people. Now, arthrosis is not just young, they just do not have age limits, appearing even among young people as a result of injuries.
The risk group of this disease consists of overweight people, professional athletes and people with varicose veins of the legs experiencing serious physical exertion.
Causes of development of
The main cause of disease occurrence is mechanical factor. There is microtraumatization of articular cartilage, as a result of which begins its degeneration. As a consequence, the load on some parts of the joint surface increases, and further - its destruction. It was also found that with this disease there are changes in metabolism in cartilage tissue. The essence of these changes is a decrease in the saturation of chondroitin sulfate, which is a specific component of cartilage and nowhere else in the body is found.
In general, you can identify such causes of the disease:
- intra-systemic fractures of the bones that form the knee joint;
- arthrosis, which was caused by Paget's disease;
- malignant and benign bone tumors;
- rheumatoid arthritis and ankylosing spondylitis.
Degrees of severity of the disease
When developing gonarthrosis passes several stages of the disease( degrees of severity):
Gonarthrosis 1 degree is the initial stage of the disease, which is often ignored by patients. She periodically has pain( usually after exercise), sometimes the knee swells up, the deformity of the joint is insignificant and invisible.
Gonarthrosis of the knee joint of the second degree is a logical continuation and development of the disease. At this stage, the symptoms intensify, the intensity and duration of pain in the joint increases, and a crunch in the joint and bending difficulties may also appear. Deformation takes a pronounced character.
Gonarthrosis of the third degree is the most severe stage of the disease. It is characterized by pains that occur not only during movement, but also in those moments when the joint is in a state of rest, there is a reaction to changing weather conditions. The gait is greatly disturbed, the mobility of the joint is limited.
Also distinguish primary gonarthrosis( arising initially) and secondary gonarthrosis( occurs against the background of other diseases of the knee joint).
Characteristic signs of gonarthrosis
It is very important to notice the onset of the disease in time. As we have already said, people usually skip the signs of the disease and notice it only when it says "pripeklo."Treatment in this case will be more prolonged and difficult.
In general, the main symptoms of the disease are pain and limitation of mobility in the joint, as well as gait disturbance. Gonarthrosis develops gradually and time passes between the first and second severity severely.
A very characteristic sign of gonarthrosis, which distinguishes this disease from other diseases of the knee joint, is that the pain appears after a state of rest, and then gradually subsides( when a person "diverges").But by the end of the day the pain returns - this is due to the increased load on the affected joint.
Another characteristic feature of this disease is the appearance of osteophytes( marginal bone growths).Soft cartilage tissues constantly rub against osteophytes, which leads to inflammation of the joint membrane - synovitis, which manifests itself with redness, swelling and an increase in local temperature. Also, when you move or feel the joint, you can feel a crunch.
Diagnosis of the disease consists in interviewing the patient's complaints, checking the volume of movement in the joint and examining the joint itself. Naturally, according to such information, only preliminary conclusions are made, and the main ones are instrumental methods of diagnostics. In the case of gonarthrosis, this is primarily the radiography of the joints. Depending on the overall picture of the disease, the stage of the disease is determined. Also recently, in the diagnosis of gonarthrosis, arthroscopy and ultrasound are often used.
Is it possible to treat gonarthrosis at home?
Now complex treatment of arthrosis is applied, in other words - treatment is not limited to only one method. In this case, the treatment of gonarthrosis does not differ from the treatment of other osteoarthrosis of other location. With this disease, it is recommended to limit the load on the joint. But we must not forget that the practice of physiotherapy in this disease is mandatory, since movements in the joint make it possible to preserve its mobility, to provide an improvement in the nutrition of the joint elements. The complex of exercises is formed by the physician of exercise therapy or a methodologist in therapeutic physical culture. The main condition for choosing exercises is the fact, you can not load the knee, but you need to ensure its maximum mobility. That's why most exercises are done sitting or lying down. Also swimming and swimming in the pool will be very useful - water allows you to remove the load from the joint.
Almost always doctors recommend performing self-massage of the leg and thigh muscles, as well as the area of the knee joint. This improves the blood supply of the joint, allows you to maintain your leg muscles in good condition.
In addition, anti-inflammatory drugs and analgesics are prescribed to relieve the pain syndrome. You can also use various analgesic and irritating ointments. Venotonics, vasos-regulating drugs will also be useful - they will improve the blood supply of the joint. And since the main problem is the state of cartilage, chondroprotectors are appointed for a long time, which are intended to improve his condition.
It often happens that people try to use folk remedies for gonarthrosis of the knee joint of the 2nd degree. Such treatment, in principle, is permissible, but only with the permission and approval of the attending physician, since much of what is printed in newspapers under the guise of "folk remedies" is in fact just a profanation.
Often, conservative methods of therapy are useless or simply do not bring the desired result with a neglected form of the disease.
In such cases, a small surgical intervention( with relative preservation of the motor function of the joint) is possible-arthroscopy. In this case, the joint is washed, the damaged parts of the menisci and cartilage are removed, osteophytes are removed. This operation at low traumatism makes it possible to restore or improve the function of the joint for 2-3 years.
In more serious conditions, more serious operations can be assigned. In the overwhelming majority of cases, they give very good results and make it possible to keep the mobility of the joint for a fairly long time.
But the most common and effective method of a neglected form of gonarthrosis, which allows a person to fully return to active life, is knee arthroplasty.
Knee joint gonarthrosis treatment, symptoms, causes
For the first time this disease appears after forty years and most often it is diagnosed in women who complain of pain in the knee.
Knee joint gonarthrosis
No one pays special attention to this and everything is written off to the deposition of salts.
But in fact the cause of pain is gonarthrosis of the knee joint. The essence of the development of this disease lies in the dystrophic changes of the hyaline cartilage, which are covered with the tibial condyles, as well as the femur. In the future, gradual destruction of the cartilage takes place and as a result the subchondral surface of the bones forming the knee joint is exposed.
Causes of the appearance of the disease
The causes of this disease are different, it all depends on whether primary or secondary gonarthrosis is diagnosed.
This type of disease appears most often in the elderly, and against a background of complete health. It is suggested that the cause of the disease is a disturbed metabolism, because gonarthrosis is more often diagnosed in patients with obesity and overweight.
There are suggestions that the cause of the disease is a hereditary factor, and this can be influenced by the long reception of hormonal drugs and much more. In this case, do not forget that the presence of anomalies in the structure of the joint tissues, not only cartilaginous, but also bone may be the cause of gonarthrosis. Also, the appearance of the disease can significantly affect the various pathologies of the ligament apparatus.
In this version of the disease, the causes are more obvious:
- injuries of the knee joint - bruises, dislocations and the like;
- surgical operations, which a person suffered after a knee injury, removal of the meniks;
- joint disease - arthritis or swelling and other inflammatory diseases in the joints;
- untimely application for medical aid after the received knee injuries, which leads to the development of gonarthrosis;
- hormonal imbalance. This can be a slow metabolism or a malfunction of metabolic processes in the body;
- excessive intensity of physical exertion on the joint. As a rule, it manifests itself in people engaged in professional sports;
- diseases that adversely affect muscle tone, muscle spasms and clamps, stiffness of muscles.
Symptoms and stages of the disease
Symptoms of gonarthrosis of the knee depends on its stage. There are three main stages of the disease.
Each stage characterizes a certain period of the course of the disease - from the moment of small changes, to serious lesions of cartilaginous tissue and its complete disappearance.
Gonarthrosis 1 degree
In the initial stage, the disease manifests itself stiffness in the knee joint in the morning hours after sleep and a little pain.
Grade 1Gonearthrosis A person notices that pain and stiffness are aggravated by long walking or prolonged stays in a sitting position. However, with the first degree of gonarthrosis, there is no deformation of the cartilage in communication, with which the pain syndrome is not strongly manifested, and the mobility of the joints remains the same. It is for this reason that in many cases the disease remains unnoticed;
Gonarthrosis of 2nd degree
Gradually the pains become stronger and more persistent. They appear not only after sleep, but also with a prolonged load on the knee - for example, if you stand on your feet or climb the stairs for a long time.
Gonarthrosis of 2nd degree
In the recumbent position the pain decreases. The knee deforms and increases in volume, the patient feels a characteristic crunch when flexing the leg. Bony outgrowths - osteophytes - grow on the surface of the joint. Also, there is no full possibility of bending the leg, which leads to a curvature of the vertebra.
Gonarthrosis of 3rd degree
Symptoms are all the same, but they are more pronounced. The pain in the knee is permanent, it tortures a person both during walking and at night, preventing them from falling asleep normally.
Gonarthrosis of 3rd degree
Sharply disrupted joint function - the patient can not bend the leg in the knee even at ninety degrees.
There is lameness, a person falls on an affected leg or is unable to move without help at all.
Deformation of the joint can be seen immediately, a change in its structure is diagnosed on the X-ray. The bone surfaces are so deformed that there is practically no gap between them, which is necessary for movements and the person has to experience continuous cutting pain.
Treatment with medical and folk remedies
Knee joint gonarthrosis is treated for a long time, and treatment requires doctors to be highly professional, and the patient must be patient. But you can not get rid of the disease forever, but it is quite possible to slow its development.
Medication therapy involves the administration of the following drugs:
- for pain relief. To do this, anti-inflammatory non-steroid drugs are prescribed: diclofenac, indomethacin, paracetamol and others. But they are taken according to the doctor's prescription, a long reception of these medicines can cause an exacerbation of gastritis or stomach ulcers. It should be noted that the action of these drugs is aimed at reducing inflammation and the manifestation of a feeling of pain. Therefore, they only hide the unpleasant symptomatology and do not relieve the disease;
- chondroprotectors. These drugs contain chondrocytes, which will restore the structure of the cartilage. The drugs help to increase the mobility of the affected joint and stop the development of the disease. However, chondroprotectors have a positive effect on the initial stages of the development of pathological changes in the knee joint. They are absolutely useless in the complete destruction of cartilage. These medications are very slow acting and need to be systematically used in certain doses for several courses over a period of one to one and a half years;
- anti-inflammatory drugs. These are corticosteroids, which are hormonal drugs with a strong effect. When the cartilage tissue is destroyed, an inflammatory process occurs and a fluid forms in the joint, and corticosteroids are injected into the joint itself. This hydrocortisone, Kenalog and much more. Assign and hormonal gels with ointments - Diclofenac, butadione and others;
- preparations of hyaluronic acid. A film is formed on the damaged joint, which prevents further destruction of the cartilage by reducing the friction between the articular cavities. As a result, the cartilaginous tissue becomes much more elastic and elastic, including its depreciation abilities. The treatment of gonarthrosis with hyaluronic acid preparations is carried out by courses.
Methods of treatment without the use of medications
This is a physiotherapy that can reduce pain in the affected joint and relieve inflammation. In most cases, electrophoresis is used, because with its help, external drugs penetrate much deeper than the usual application to the skin. Also, to improve nutrition and microcirculation of tissues in medicine, magnetic devices, ultrasound, laser radiation are used.
Medical gymnastics together with manual therapy will relieve the overstrain from muscles and joints, improve the condition and mood of the patient. Wellness gymnastics is an indispensable component of successful treatment of gonarthrosis. Exercise helps to strengthen the muscular system of the lower leg and thigh, thereby increasing mobility of the limb and improving the condition of the ligaments.
In some cases, surgical treatment is prescribed. As a rule, it is necessary in cases when pronounced deformity of the knee joint is observed and its complete immobilization arises and at the same time conservative methods of treatment are not effective. This is endoprosthetics and arthroscopic debridement. In the first case, the patient is placed with a ceramic, metal or plastic prosthesis. In the second case, with the help of an arthroscope, the painful, broken parts of the cartilage are removed.
Folk recipes do not lose their relevance. The joint use of "grandmother's recipes" and medications will have a good therapeutic effect.
It is recommended to rub the joint joint with camphor oil, apply a mixture of apple cider vinegar and honey, or apply a compress from the burdock leaves to the affected knee.
Also, the section of traditional medicine advises you to tie a heated shredded horseradish root at night to your knee, and with pain, drink three times a day a glass of broth from onions, which is prepared by calculating two onions per 1 liter of boiling water. In addition, it is useful to take a bath twice a week with a decoction of grass hay and malt. If there is a pronounced inflammatory process, wipe the knee joint with a lemon wedge.
Prevention of gonarthrosis
The most important thing in the prevention of this complex disease is muscle training and constant support of them in tone. Very often, having heard advice from a doctor to do gymnastics, a person neglects this and very much in vain. Exercises will help to adapt the body to constant loads, because when they are performed, the muscles of the legs are strengthened.
Prevention of gonarthrosis
Excess weight is also a risk factor for the onset of gonarthrosis. This same gymnastics will help him to fight, because the fat people are constantly stressed by joints due to weight.
One of the causes of the disease is trauma. Therefore, while skating, skiing should be cautious and if you do not imagine your life without it, then take care of good protective equipment and use quality knee pads.
Vitamins are especially useful for prevention. This vitamin E, D and C, so you need to periodically use vitamin complexes.
Calcium fortress will take care of calcium fortress, a high amount of calcium is found in eggs, sesame and celery.
The right diet will help the joints. The food should be balanced and correct, for the prevention of gonarthrosis you need to consume a lot of fresh vegetables, cakes and sweets replace with fruits. In winter it is useful to eat cranberries with honey. Homemade cottage cheese, milk and cheese will also help to strengthen joints with bones.
Osteoarthrosis - Wikipedia
The term "osteoarthritis" combines a group of diseases of different etiology, but with similar biological, morphological and clinical outcomes, in which not only the articular cartilage but the entire joint is involved in the pathological process, including the subchondral bone, ligaments, capsule, synovial membrane and periarticular muscles.
The main clinical symptoms of osteoarthritis are joint pain and deformation, leading to functional insufficiency.
At the heart of degenerative dystrophic changes in arthrosis is primary damage to the cartilage followed by an inflammatory reaction, so often arthrosis is called arthrosis-arthritis .Osteoarthritis is always associated with deformation of the bone tissue, in connection with which it is also called osteoarthritis or deforming arthrosis .
Terminological definitions - osteoarthritis, arthrosis, osteoarthritis, deforming arthrosis - are currently listed in the X International Classification of Diseases as synonyms.
Most often, the term "osteoarthritis" is used to refer to a chronic progressive disease of synovial joints.
Isolate localized( with lesion of one joint) and generalized forms of osteoarthritis( polyostearosis ).Some common types of osteoarthritis have been given separate names. In particular, the term "gonarthrosis"( from other Greek - γόνυ - the knee) is used to refer to arthrosis of the knee joint, "coxarthrosis"( from the Latin coxa - thigh) - to denote arthrosis of the hip joint.Years of life adjusted for the incapacity for work for osteoarthritis per 100 000 population in 2004.no data ≤ 200 200-220 220-240 240-260 260-280 280-300 300-320 320-340 340-360 360-380 380-400 ≥ 400 Frequency and severity of joint disease in osteoarthritis
Osteoarthritis is the most common form of lesionjoints and one of the main causes of disability, causing a deterioration in quality of life and significant financial costs, especially in the elderly.
There is osteoarthritis everywhere. In the US, he suffers from 21 million people( about 7% of the population).A large-scale study in 7 cities of the former USSR revealed a manifest( accompanied by clinical symptoms) osteoarthritis in 6.43% of the examined( 41,348 people over 15 years old).
In general, the prevalence and incidence of osteoarthritis varies widely in different countries of the world. For example, the prevalence of osteoarthritis in Ukraine is 2515.7 per 100 thousand population, the incidence is 497.0 per 100 thousand population. As established by population studies, these rates are slightly lower than in the US, and significantly higher than in the UK.
The incidence of osteoarthritis sharply increases with age, reaching a third of the population in the elderly and senile ages. Among patients with osteoarthritis at a young age, men predominate, and in the elderly, women. In the US, osteoarthritis occurs in 2% of the population under the age of 45, 30% at the age of 45-64 years and 63-85% older than 65 years.
At the same time in Sweden, the manifest osteoarthritis of peripheral joints was found only in 5.8% of the population aged 50-70 years.
Most often, osteoarthritis affects the joints of the hand, the first metatarsophalangeal joint of the foot, the joints of the cervical and lumbar spine, knee and hip joints. However, the severity of the disability of the musculoskeletal system is dominated by the hip, knee and ankle joints, as well as the shoulder joint.
ThiologyBasic etiological factors of osteoarthrosis
Osteoarthritis is a consequence of mechanical and biological causes that disrupt the formation of cells of articular cartilage and subchondral bone. It can be initiated by many causes, including hereditary, evolutionary, metabolic and traumatic.
Osteoarthritis affects all joint tissues. The disease is manifested by morphological, biochemical, molecular and biomechanical changes in cells and matrix that lead to softening, deflation, ulceration and decrease in the thickness of articular cartilage, as well as to osteosclerosis with sharp thickening and densification of the cortical layer of the subchondral bone, osteophyte formation and development of subchondral cysts.
Clinically, osteoarthritis is manifested by arthralgia, pain and movement limitation, recurrent synovitis, local inflammation in various joint tissues.
Primary and secondary osteoarthrosis
Osteoarthritis is primary and secondary.
If the cause of the development of the disease is not established, then such an arthrosis is usually called primary, or idiopathic( from the Greek, ἴδιος - a peculiar, special, unusual and πάθος - disease).
The main causes of
Osteoarthritis is a multifactorial polytological disease. The three main causes of the degenerative-dystrophic process in the joint: trauma, dysplasia and inflammation.
Joint trauma is the most common cause of arthrosis. In the second place is dysplasia of the joint - congenital features that are accompanied by poor biomechanics of the joint.
Inflammation also often causes damage to joint tissues and the development of secondary arthrosis. Most often this is the result of autoimmune diseases( for example, rheumatoid arthritis), less often - the infectious process( for example, acute purulent inflammation of the joint caused by staphylococcus or another specific infection( in gonorrhea, syphilis, tick-borne encephalitis)).it is also a very common complication in chronic hemarthrosis( Hemophilia).
Risk factors for
Risk factors for primary osteoarthritis are: hereditary predisposition, overweight, elderly age, specific occupations. In addition, the incidence of osteoarthritis depends on sex and race / ethnicity.
Genetic factors include: hereditary disorders and mutations of collagen type II, other hereditary diseases of bones and joints, congenital disorders of joint development( dysplasia).
Non-genetic( non-hereditary) multiple factors, such as:
- age, osteoporosis, affect the development and progression of osteoarthritis;
- metabolic disorders in the body;
- deficiency in the body of microelements;
- developmental disorders( dysplasia) and acquired diseases of bones and joints;
- neurodystrophic manifestation of the pathological process in the lumbosacral( lumbosacral muscle syndrome), or in the cervical spine( shoulder-scapular periarthritis);
The following risk factors for osteoarthritis are environmental factors:
- action of chemical toxins;
- joint injury, repeated microtrauma;
- operations on joints( eg, meniscectomy);
- occupation and physical activity at work.
Stages of the diseaseStages of arthrosis
Regardless of the cause, there are 3 stages of arthrosis. At the first or the initial stage of arthrosis there are no pronounced morphological disturbances of the joint tissues. The changes refer only to the function of the synovial membrane, to the biochemical composition of the synovial fluid, which, through diffusion, nourishes the cartilage and menisci of the joint. The joint loses its ability to withstand the usual load for it, and the joint overload is accompanied by inflammation and pain syndrome.
In the second stage of the disease, we see the beginning destruction of articular cartilage and meniscus. Bone reacts to the load of the articular area with edge growths - osteophytes.
The second stage inevitably goes to the third stage of severe arthrosis. Its signs are pronounced bone deformation of the joint support site, which changes the axis of the limb. Insolvency, shortening of ligaments of the joint leads to pathological mobility of the joint or in combination with the stiffness of the joint bag - to a sharp restriction of natural movements - contractures. Chronic inflammation and chronic pain syndrome usually accompany 2 and 3 stage.
In the initial stage of the disease, the muscles that perform movements in the joint are weakened, but, in general, are not changed. In the second stage there is a violation of muscle function due to violation of reflex neuro-trophic regulation. In the third stage of the disease, joint loading and motor activity are severely disrupted, due to contractures and limb axis violation, the amplitude of muscle contraction changes, normal attachment points of the muscular-tendon complex change.then it is accompanied by a shortening or stretching of the muscle, a decrease in the ability to fully reduce. Trophic disorders in the joint disease affect not only the muscles, but all limb tissues.
The pathogenesis of this disease is caused by a disruption of the function and structure of the cartilage of the joint. Articular cartilage is a highly specialized tissue consisting of a matrix and chondrocytes immersed in it. Matrix contains two main macromolecules, glycosamines( proteoglycans) and collagen. The high concentration of proteoglycans in the cartilage keeps the collagen network energized, thereby promoting a uniform distribution of the load that affects the cartilage, and ensuring the restoration of the shape after the termination of the load. With the loss of even a small amount of glycosamin, the resistance of the cartilage matrix to physical stress is reduced, and the surface of the cartilage becomes sensitive to damage. In the earliest stages of arthrosis, the cartilage becomes thicker than normal, but with progression it becomes thinner. The cartilage becomes soft and friable, on it there are deep ulcers, usually only in the most loaded part of the joint.
Normally, with periodic loads, for example walking, the cartilage plate deforms and returns to its original form, performing the function of a peculiar pump that provides for the expulsion of the decomposition products and the "absorption" of nutrients and building material. Compression and restoration of the form under loading is the main condition for the regeneration of damaged cartilaginous tissue. However, excessive or prolonged loading of the joint adversely affects the function of the articular cartilage and increases the flow of arthrosis.
The supply of cartilage and meniscus joint is carried out only at the expense of synovial fluid. The "health" of the sliding and damping structures of the joint depends on the quantity and quality of the fluid secreted by the synovial membrane.
Synovial membrane performs an important function of filtering the building material of cartilage - hyaluronic acid, it protects the elution of the latter from the joint cavity. Violation of the biochemical composition of synovial fluid in case of trauma or inflammation of the joint actually leads to the development of a disease called osteoarthritis.
The efficiency of the circulation and diffusion of the synovial fluid is directly related to movement in the joint and joint loading. Movement in the joint is necessary for the metabolism in the cartilage. In itself, prolonged restriction of movements in the joint leads to a deterioration in the supply of cartilage.
With arthrosis, the equilibrium between the formation of a new building material for the restoration of cartilage and its destruction is disturbed. The cartilage of a firm, elastic structure turns into a dry, thin with a rough surface. The underlying bone becomes thicker and grows apart from the cartilage, which limits movement and causes deformity of the joints. The joint capsule thickens - is fibrotic, and also inflames. The joint is filled with an inflammatory fluid that stretches the capsule and ligaments of the joint. Pain, and later deformation of articular surfaces with arthrosis leads to joint stiffness and joint contractures. Morning and starting pain, as well as stiffness in the joint in patients with deforming arthrosis itself is due to the low elasticity of the cartilage and the need for starting movements to restore sufficient elasticity of the cartilage.it creates a feeling of pain and stiffness.
In inflammation, the joint assumes a resting position or a physiological position. In this position, the maximal spreading of the ligaments and the capsule of the joint is ensured. In this position, the pain in the joint is minimal. A major influence on the course of the pathological process is the condition of the so-called muscle corset of the joint, that is, a system of muscles that not only moves in the joint but also stabilizes the joint, absorbing powerful inertial impulses during movement. Thus, the internal broad muscle in the quadriceps femur protects the knee from lateral instability at the moment of landing on the heel while walking, and the middle gluteal muscle on the side of the support leg limits the pelvic inclination at the time of transfer, which protects the hip joint from overload.
Outcome of the diseaseOutcome of arthrosis of the knee and hip joint
The outcome of arthrosis is the complete destruction of the joint with the formation of ankylosis - complete immobility of the joint or neoarthrosis with unnatural mobility.then it is accompanied by a severe disability of the limb. Recently, without waiting for the outcome of the disease, more and more often special operations are used to replace the joint with a prosthesis - joint replacement. The figure depicts the varus deformity of the knee typical for the terminal stage of knee arthrosis in combination with lateral pathological instability of the knee joint. Osteoarthritis of the block-shaped or globular joint, such as the hip joint, ends with ankylosing. In this case, the closure of the joint usually occurs in the nonphysiological( vicious) position of the limb. In this case, we see the hip in the position of flexion and reduction, in which the leg is shortened, and the limb axis and biomechanics of the locomotor system are significantly impaired.
Clinical course and diagnosis
If at the onset of the disease pain occurs only periodically, after considerable physical exertion, and quickly passes at rest, then as the disease progresses, the intensity of pain increases, it does not disappear after rest and appears at night.
In the context of evidence-based medicine, a number of standard tests have been developed to evaluate osteoarthritis. To assess joint pain and morning stiffness, a ten-point visual analogue scale is used. To characterize gonarthrosis and coxarthrosis, the Leken index is widely used.
Knee joint gonarthrosis 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 the cartilage covering the joint surfaces of the femoral and / or tibialbones. 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 reasons:
- fractures of the bones of the lower leg with involvement of the knee in them;
- trauma of cartilage interlayers of the joint - meniscus;
- tears of knee joints;
- increasing the 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;
- joint inflammation( arthritis), which has a different - psoriatic, gouty, rheumatoid or reactive - etiology;
- genetically determined weakness of the ligamentous-capsular apparatus of the joint, due to 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 gonarthrosis of the knee jointHow 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 are worth paying attention to: the
- feeling of constriction 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
- joint swelling may occur for a short time, passes by itself.
- the pain in the joint becomes more intense, lasting longer. It disappears after rest.
- pain is felt inside the joint or on the inside of the knee.
- feels crunching 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.
- does not fully extend the leg.
- joint swells, acquires signs of initial deformation.
- 1) Pain in the joint worries constantly, regardless of the physical activity of the 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 an optical fiber device is inserted into the hole made under local anesthesia, allowing the specialist to examine the joint from the inside.
- 5) Knee ultrasound is informative for the diagnosis of such complication of gonarthrosis as synovitis.
Treatment of knee joint gonarthrosisA doctor who is treating 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) In 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 "Dimexide", "Bischofite", medical bile to improve the blood supply of the joint, increase the production of "lubricating" liquid in it.
- 6) The preparation on the basis of drawing from soya and avocado plants - "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.