Symptoms, Diagnosis and Treatment of Knee Osteoarthritis 1,2,3 Degrees
Knee joint gonarthrosis is a fairly common disease, the leader of all arthrosis. His active study of physicians of different countries began over a century ago, which causes significant progress in the fight against the disease. At the household level, this pathology is stubbornly called the deposition of salts, although the process of calcification does not play a primary role. The disease is dangerous in its development and can lead to a restriction of mobility and disability.
Knee joint gonarthrosis requires long-term treatment, which is not always able to help without prompt intervention. In order not to appear on the surgical table, it is very important to detect pathological changes in time and start treatment at an early stage. Like most joint diseases, this type of osteoarthritis is easier to prevent, taking preventive measures, than to treat after debilitating pain.
What happens with this disease?
Gonarthrosis, or osteoarthritis of the knee, is degenerative-dystrophic joint damage caused by degeneration of the cartilage, until its complete destruction, and leading to deformation of the joint;while less pronounced inflammatory reactions are secondary phenomena and are also generated by degeneration processes.
The onset of pathology is usually associated with structural changes in cartilage tissue at the molecular level, including as a result of circulatory disorders in small vessels. Then the hyaline cartilage is involved in the process, which becomes turbid, decreases in thickness, is stratified and covered with multidirectional microscopic cracks. The pathological process is completed by the complete destruction of small and large cartilage, and at the same time bone articulation is exposed.
The body instinctively reacts to the disappearance of cartilage by bone growth in the peripheral zones, which is expressed in the growth of osteophytes. As a result of abnormal changes, the joint is deformed, the lower limb is bent. Such a result ensured the name of destructive pathology - deforming arthrosis.
Disturbances in gonarthrosis
The development of the disease proceeds with the growth of the following pathological disorders in the joint:
- Disturbance of the metabolic process in the cartilaginous tissue: a constant supply of cartilage occurs due to the liberation and absorption of the lubricant when the joint moves, but the disease leads to a change in osmotic pressure and infringement of the makeup;at sites of the raised pressure there is a thinning of a cartilage.
- Structural changes of collagen fibers: the softening of the patellar cartilage begins, the depreciation function of the cartilage and the metabolic capacity of the chondrocytes are broken - the cartilage loses its elasticity and its instability appears.
- Distortion of articular congruence: the synthesis of bone substance, leading to the growth of osteophytes, is activated. As a result, the synovial membrane is irritated, which generates an inflammatory process in it, the loss of joint mobility begins.
- The most active destructive process occurs in the inner region of the joint and in the gap between the knee and the femur.
Classification of pathology
Classification of gonarthrosis is carried out in accordance with the international system of ICD 10 by code 17.0 - 17.9.There are 2 main types of etiology: primary and secondary osteoarthrosis.
The primary( genuine) type is the development of a degenerative process on healthy cartilage that has not previously been subjected to pathological effects. The process is the result of mechanical and physiological overloads. Secondary form of the disease develops on the joint, previously subjected to pathological effects( trauma, disease), and the beginning of the process is due to a decrease in the durability of cartilage tissues to normal loads. The most common form is posttraumatic gonarthrosis.
Given the localization of lesions, one-sided and two-sided gonarthrosis is different. In turn, a one-sided view is characterized by joint damage on only one limb: right-sided and left-sided gonarthrosis. The most difficult and dangerous is the two-sided type, when the knee joints of both legs are subjected to destruction. The main reason for the appearance of this form is the age factor.
Causes and stages of the disease
In order to start a degenerative-dystrophic process of destruction of cartilage tissue, provoking factors are needed.
There are following causes of the disease:
- metabolic disorder, especially hormonal imbalance;
- circulatory disturbance and capillary fragility;
- excessive body weight;
- knee injury( fracture, cracked bone, ruptured ligament or meniscus);
- inflammatory diseases( rheumatism, arthritis);
- frequent and prolonged physical overload( especially among athletes - gymnasts, football players, athletes, tennis players);
- disorders of the endocrine system;
- genetic abnormalities of the structure of tissues;
- hereditary predisposition, violation of body statics;
- age factor.
The severity of gonarthrosis is determined by the type of lesions and complications.
It is subdivided into 3 stages and, accordingly, 4 stages of development:
- 1 stage( 1 degree): the initial phase, characterized by a slight narrowing of the joint gap, visible on the roentgenogram. There is a feeling of discomfort in the joint, fatigue by the evening, a slight limitation of joint mobility.
- 2nd stage( 2nd degree): on the roentgenogram there is a significant narrowing of the gap and the appearance of osteophytes, bone growths. There is the appearance of pain syndrome with strengthening with prolonged standing or walking, a crunch in the joint, complicated flexion and extension of the leg in the knee, the angle of extension of the leg is limited, the appearance of signs of atrophy of the quadriceps femoris.
- 3rd stage( 3rd degree): joint deformity with foot axis disturbance, articular instability. There is a sharp increase in pain, even at rest, edema, local temperature, impaired mobility of the joint.
- Stage 3 at 4 degrees of severity: severe joint deformity, complete disappearance of cartilage, impaired mobility of the limb, pain is permanent.
At the initial stage, the symptoms of gonarthrosis are manifested by a feeling of tightening the muscle under the knee and a slight pain after a long hike. In the mornings or after a long sitting, it takes time to "puff up" the joint and eliminate discomfort in the knee. The development of pathology leads to the appearance of a pain syndrome under the knee. When walking, there is a crunch in the joint. Further progression of the disease limits the mobility of the joint, there are problems with squatting and extension of the legs, lame appears. Pain is getting stronger and longer.
Visual inspection of the joint in the initial stages does not reveal any changes. Gradually, the joint deformity becomes noticeable, and then the curvature of the shin. If you put your hand to the knee, then when you bend your legs you can distinguish a distinct crunch. Palpation indicates the presence of a painful patch on the inside of the knee joint.
Signs of gonarthrosis are greatly enhanced if the disease is complicated by synovitis( inflammation of the inner shell).In this case, already at the first stage swelling of the joint is noticeable due to liquid. At further stages, it fills even the popliteal fossa in the posterior articular region( Baker's cyst).Pain syndrome is greatly enhanced.
The primary diagnosis is established by examination, palpation of the joint, changing the direction of the bones, the angulation of the mobility of the joint. Laboratory tests are conducted on general blood and urine tests: determination of ESR, fibrinogen, urea and other biochemical parameters. The ultrasound of the knee joint is performed. The most informative are X-ray studies and magnetic resonance imaging. Only after that the doctor treats the disease.
Tactics and methods of therapy
The question how to treat gonarthrosis of the knee joint, the doctor decides, taking into account the stage and severity of the disease.
In general, treatment is carried out in a complex manner, but usually includes the following steps:
- Elimination of the inflammatory reaction: Non-steroidal anti-inflammatory drugs are prescribed: Diclofenac, Olfen, Diclac, Ibuprofen, Indomethacin, Ketaprofen, Meloxicam, Nimesulide;at a complicated stage, injections with the introduction of hormones - drugs "Hydrocortisone", "Kenalog", "Diprospan";To stop degenerative processes, antifoam agents are prescribed - Counterline, Ovomin, Gordoks.
- Anabolic and anti-catabolic effects, restoration of cartilaginous tissue: chondroprotectors - Structum, DONA, Rumalon, Alflutol, Mukosat.
- Normalization of blood circulation, warming and soothing effect: ointments, gels, creams - "Finalgon", "Fastum gel", "Nikofleks", "Apizarthron", "Feloran".
- Improvement of blood circulation, strengthening of vascular tissues: vasodilating drugs - Cavinton, Trental, Actovegin, Uppsit, Ascorutin.
- Reduction of muscle tension: antispasmodics - "No-shpa", "Midokalm", "Tizalud".
- Restoration of synovial fluid: substitutes - "Otrovisk", "Hyalual", "Fermatron".
Complicated forms of the disease are treated with additional methods, such as: oxygen therapy( introduction of oxygen);introduction of stem cells;laser therapy;the introduction of the protein preparation "Ortokin" on the basis of blood serum.
In the last stages of gonarthrosis, the only effective method is surgical treatment. A surgical operation for prosthetics of the affected tissues is performed. Depending on the severity of the disease, the following operations are performed:
- arthrodesis( removal of the destroyed cartilage along with the joint);
- arthroscopic debridement( removal of deformed cartilage with an arthroscope);
- osteotomy( fixation of bones in a different position);
Treatment of gonarthrosis of the knee joint, especially at the initial stage, is carried out in ways that do not involve medical therapy. The therapeutic sports complex allows to improve blood circulation, strengthen the musculoskeletal system, raise muscle tone, maintain joint mobility. LFK is developed by the treating orthopedist under the individual scheme.
Physiotherapy for osteoarthritis involves the use of the following methods: electrophoresis with bischofite, caripain and reinforcement with dimexide;magnetic therapy;ultrasound;microwave exposure;paraffin application;reception of radon and hydrogen sulphide baths;mud baths. Its effectiveness was proved by therapeutic massage and manual therapy, if conducted by a specialist.
Prophylaxis of the disease necessarily provides proper nutrition.
The diet for gonarthrosis excludes the use of pickles, spicy and fatty dishes. The menu recommends the inclusion of increased consumption of low-fat chill( for example, in poultry meat), jelly from natural fruits. It is useful to eat sea fish and seafood.
Loss of ability to work and a group of disabilities are not threatened if the prevention is carried out by people's means. Effective use of infusion based on garlic and lemon with the addition of celery. Recommended tea from the grass of black beans. Especially useful is the grass of moccas, which should be added to various salads. And of course, the welding of beef knees and hoofs, it is better to eat hot, not hardened fat.
Gonarthrosis 1 degree: treatment and causes
Treatment of medicines is carried out as follows:
- Non-steroidal anti-inflammatory and analgesic drugs include Voltaren, Nrimsil, Movalis and others;
- The chondroprotectors include Artru, Arthron, Don, Teraflex. The listed medicines must be taken at least six months in a dosage that the doctor will prescribe;
- To remove inflammation in the joint, hydrocortisone or Kenalog is administered no more than three times;
- After the inflammation subsides, ostenil, sinocra and other similar drugs are injected into the joint. Such treatment is expensive, but it is quite effective;
- To improve the blood supply in the joint and increase the production of lubricant in it, the doctor appoints to make warming compresses with Dimexid and Bishofit;
- Treatment of gonarthrosis is carried out and drawing from soybean and avocado plants. It should be treated for at least six months.
Treat a disease with exercise therapy
If a patient has an acute form of the disease, he needs to ensure peace. A little later the joints begin to gradually load with physical exertion.
Sick on the back. Raise his straightened legs and hold him in the raised position. Exercise should be done in a smooth and careful movements, so as not to cause pain.
You need to start from ten minutes. After a while, the duration of physical education should be increased by two minutes every day. Exercises for physiotherapy exercises for each patient are selected by the attending physician on an individual basis.
Strictly contraindicated to squat, bend and unbend knees, walk for a long time, as well as perform movements that bring pain in the knee joint.to table of contents ↑
To reduce inflammation in the joint, accelerate the regeneration of the articular cartilage, and also to stop the pain syndrome treatment is carried out with the help of physiotherapy. Bilateral gonarthrosis is treated with electrophoresis with novocaine, diadynamic currents, magnetotherapy, UHF, phonophoresis with hydrocortisone, laser therapy, paraffin or ozocerite applications, mud therapy.
After discharge, the patient is sent to a resort sanatorium.to contents ↑
When the acute period falls, the patient can move with a cane. On the knees special orthoses are worn or orthopedic insoles are used.to the table of contents ↑
In case of impaired joint function, and also with a significant disability, the doctor performs an arthroplasty operation with prostheses made of biologically intact materials.
Operation can not be done with concomitant osteoporosis. After the operation, for three to six months, physiotherapy, exercise therapy, sanatorium treatment are carried out as rehabilitation.to the table of contents ↑
Diet in case of
disease If the weight is too high, the patient should try to lose excess weight. For this purpose, foods rich in animal and vegetable proteins are included in its diet. It is recommended to eat low-fat varieties of meat and fish, boiled, stewed and steamed dishes. Useful cheese, cottage cheese, bean products. It is useful to eat cold, to strengthen the cartilage and ligaments in the joints.
Entering the body fat should be plant. It is also useful to eat butter. The menu must contain products enriched with B vitamins.
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 orself-medication. 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
Doctors refer to several causes that 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, posttraumatic gonarthrosis of the knee joint may develop);
- the age of a person who has exchanged the fifth decade in his life;
- engaging in activities that involve a long standing on the legs;
- 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.
- 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;
- the pain fades, if you walk a little, and also at rest;
- no appreciable disturbances in joint work are not noticed.
- 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 begins to bend badly - to unbend( it may even cease to unbend);
- appears swelling of the knee;
- the first visible deformities of the foot appear;
- there are painful sensations in the calf muscles in the evening and at night.
- persistent pain, regardless of whether you are on the move or at rest;
- the knee starts to hurt simultaneously with worsening of weather conditions;
- limb deformations continue so intensely 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 severe 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 have at least some signs of this 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 to:
Gonarthrosis of the 1st degree of the knee joint: left-sided, bilateral, deforming, treatment
The term gonarthrosis in medicine denotes degeneration of the cartilaginous tissue of the knee joint, which leads to destructive changes in the bone tissues of the bone heads entering this articulation. In this article, we consider gonarthrosis of the first degree, in which a rapid and complete restoration of damaged tissues is possible with the subsequent restoration of the physiological volume of mobility of the lower limbs. It is very important to recognize the pathology at the initial stage of development, this allows us to apply non-surgical methods of treatment.
Gonarthrosis of the first degree of the knee joint can manifest itself with minimal symptoms, which are difficult enough to formulate to the patient at the primary address to the doctor. Typical signs can be short-term pain, crunching and clicks during sudden movements. These symptoms intensify after a busy working day, during which increased physical stress on the knee joints appeared.
Destructive changes do not appear in any way. When the radiograph is taken, the thickness of the cartilaginous layer is seen to decrease. There may appear a decrease in the amount of synovial fluid and a decrease in its biochemical properties.
Causes of bilateral first-degree gonatrosis
As mentioned above, bilateral gonarthrosis of the 1st degree is well suited to conservative treatment, pathology can be completely stopped. With the right approach, it is possible to achieve a stable remission, the beginning of a complete regeneration of damaged tissues. But as with any other disease, an important factor of therapy is the elimination of probable causes that contributed to the destruction of cartilaginous tissue. Therefore, it is worth investigating the causes that cause gonarthrosis. They can include the following pathogenic factors:
- excess body weight, which is accompanied by a deficiency in the development of muscle mass of the femoral and gastrocnemius muscle groups;
- incorrect placement of the foot, which leads to an incorrect position of the heads of bones in the cavity of the knee joint;
- heredity and the presence of systemic connective tissue diseases;
- concomitant diseases of the hip, ankle, spine;
- injuries and predisposing working conditions;
- infection during medical manipulations.
This is not an exhaustive list of possible causes, but they are highly likely to provoke destructive processes. Therefore, they should be excluded first.
What is a bilateral deforming gonarthrosis of the 1st degree?
Double-sided gonarthrosis of the 1st degree is the most common diagnosis in case of systemic involvement of the joint tissues. In the traumatic nature of the disease, a one-sided degenerative process arises. In the initial diagnosis it is important to understand how much the cartilage tissue is weakened and whether there are reliable signs of a change in the bone structure.
Deforming gonarthrosis of the 1st degree differs in that with a significant change in the depreciation properties of cartilage there is an increased mechanical stress on the head of the bones. As a result, microscopic cracks may appear, which are filled with deposits of calcium salts. Radiographically, it can look like outgrowths, thorns, roughness. There are no external signs at the initial stage. Pain during movement can occur after severe physical exertion.
Double-sided deforming gonarthrosis of the 1st degree can be diagnosed already at the age after 30 years. The risk group includes persons engaged in manual labor with the primary load on the knee joints. Symptomatically, this can manifest as a slight stiffness in the morning hours after awakening. After a short walk, all the pains disappear. In the evening and at night, there may be cramps in the calf muscles, pulling pains, restless legs syndrome.
To answer the question about what is deforming gonarthrosis of the 1st degree, it can be very simple. This pathology, which in the absence of timely treatment can go into the pronounced destruction of the articular tissues. This inevitably leads to disability and significant difficulties in the independent movement of a person.
Left-sided gonarthrosis of the 1st degree and its distinctive features
Left-sided gonarthrosis of the 1st degree is not common. Usually, the predecessor of the disease is a trauma in the form of stretching of the ligamentous apparatus, dislocation of the knee joint, stroke, inflammation of the meniscus, detachment of the kneecap and much more. In a number of patients, pathology may occur after medical intervention for arthroscopy or an operation to restore the integrity of the meniscus.
On the right side, a pathological process occurs in a similar way. It is worth noting the inflammatory component in the development of subsequent destruction. An aseptic inflammatory reaction with a compensatory purpose is possible if the physical properties and volume of the synovial fluid are disturbed.
Differential diagnosis is performed with various forms of arthritis, bursitis, traumatic lesions. It is not necessary to exclude the possibility of irradiation of the pain syndrome in the hip joint lesion.
Treatment of gonarthrosis of the 1st degree by methods of manual therapy
For the treatment of gonarthrosis of the 1st degree, official medicine suggests using mainly non-steroidal anti-inflammatory drugs in combination with chondroprotectors. Additional methods of therapy can be therapeutic exercise, massage physiotherapy. However, often the measures taken are not sufficient to stop the destructive process.
We recommend that you use manual therapy techniques in addition to traditional methods of treatment. In our clinic, effective programs have been developed that allow the restoration of knee joints to be started at the expense of hidden reserves in the human body.
For the treatment of gonarthrosis of the 1st degree, osteopathy and therapeutic massage, a course of gymnastics and reflexotherapy are widely used. For each patient an individual technique is developed that takes into account possible causes leading to this disease. In particular, the specialists of our clinic work with overweight the patient, recommend changes in the diet, develop a program to increase physical activity.
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Knee joint gonarthrosis 1, 2, 3 degrees: symptoms and features
- Knee joint gonarthrosis of the third degree
A degenerative-dystrophic disease characterized by the defeat and alteration of cartilage tissue, a decrease in its functions, is called gonarthrosis of the knee joint. This insidious disease is associated with the slow destruction of connective tissue. Developing, gonarthrosis can affect all the elements of the joint: directly cartilage, ligaments, bone, articular membrane and periarticular muscles.IMPORTANT TO KNOW!A new means of restoring joints in 99% of subjects. The pain goes away 100%!Read more here - & gt;
Consider the beginning of the development of knee disease can be a time when under the influence of an unfavorable internal or external factor, there is a disturbance in the supply of cartilage. There is a shortage of nutrients with a decrease in the capacity of the vessels as a result of their spasm or blockage. This process can be combined with a malnutrition of the inner layer of the joint bag.
Changing important biological processes leads to degeneration and death of cellular cartilage elements. The elasticity and elasticity of the connective tissue decreases, defects appear in it. The so-called "dry joint" is formed, the deadly particles of which are capable of causing inflammation. Accompany this process will be ingress into the cartilage of substances capable of splitting and changing the composition of tissues.
Degeneration and destruction of the joint structure will constantly provoke further development of gonarthrosis. As a result, an important cushioning body will become incapable of performing its functions. On the surfaces of the cartilage, the growth of the growths will increase. The adjacent bone will change its shape, and the ligaments become shorter. There will be contracture - restriction of mobility. In the advanced stage, muscles are atrophied.
When reaching 60 - 70 years of age, such a disease as deforming gonarthrosis of the knee joint is diagnosed in almost 70% of people. But according to scientists, in recent years, the ailment has become noticeably "younger".
Symptoms of gonarthrosis of the knee joint
At the initial stage of the disease, minor knee pain is felt, especially after a load. Patients, as a rule, pay little attention to this discomfort, since after rest everything passes. Sometimes the pain is felt in the thigh. Strengthen and acquire a permanent character discomfort will be in damp and wet weather. With inflammation, the joint of the knee increases in volume and swells.
As a typical representative of such an ailment as arthrosis - the knee joint gonarthrosis has symptoms typical of it:
- edema of the periarticular zone;
- pain in connective tissue during movements;
- a sense of instability in the cartilage;
- articular changes( lead to the formation of O-shaped and X-shaped legs).
Many patients are forced to "pacing" the affected leg in the morning or after a long sitting on a chair. At the same time, they feel pain, a crunch in the knee joint and limited flexion-extensor movements. Gradually develops lameness, the patient loses the ability to move independently. When the disease passes into the final stage, a person can simply lay in a layer.
There is one feature that characterizes gonarthrosis of the knee joint - the symptoms of the disease are expressed regardless of the degree of progression of the process. Only with a steady increase in the signs of the disease, they will correspond to a certain stage.
Types of gonarthrosis
In traumatology and orthopedics, two types of knee joint gonarthrosis are distinguished, taking into account the pathogenesis of the disease: primary( idiopathic) and secondary. The first type of disease occurs usually for no apparent reason and in most cases is bilateral. Secondary gonarthrosis is formed already on the existing platform of pathological changes or knee injuries. It can occur at any age, often on the one hand.
Approximately 40% of cases are diagnosed as primary gonarthrosis of the knee joints. The causes of this type of illness are metabolic disorders and disorders of the endocrine system. It is believed that any process that leads to damage to the cartilage can become a provoking factor in the development of the disease. Most of the gonarthrosis is bilateral, that is, it affects both knees.
Usually, primary gonarthrosis is diagnosed in the elderly. A variety of circulatory disorders in the limbs, such as varicose veins or atherosclerosis, also contribute to the occurrence of knee arthrosis. Favorable conditions for the disease creates a sedentary lifestyle . A sharp increase in the physical load on the joints( prolonged running, jumping) also often leads to cartilage damage.
Two-sided gonarthrosis of the knee joint usually develops in such people:
- patients with diabetes mellitus;
- patients with thyroid disease;
- people with excess weight;
- of women in the menopause and after it, due to the decrease in the amount of estrogens.
Secondary gonarthrosis is observed on one of the knee joints. And the left side lesion is formed when the right leg is injured, and vice versa. This occurs at a time when the weight of the body is unconsciously transferred to one side, exposing the intraarticular tissue heavily to the load. When research is usually found narrowing the gap, cartilage damage, deposition of salts, sharpening the edges of the condyles of the bones.
Often after injuries, secondary gonarthrosis of the knee joint develops - the reason for this is not enough correct treatment of fractures and permanent microtraumas of cartilage:
- shock impacts on the knee joint during running, water and mountain skiing, snowboarding, when jumping, playing football, basketball;
- trauma of the meniscus( detachment, pinch, tear) as a result of unsuccessful movement;
- prolonged static load on the cartilage of the knee, for example, with prolonged squatting.
Secondary gonarthrosis usually develops on the background of an inflammatory process of an autoimmune or infectious nature. People who have too loose or weak ligaments from birth are at risk. This is due to the development of tissue dysplasia and uneven distribution of the load on the cartilage. Often gonarthrosis of the knee develops due to a trauma of the rounded bone forming part of the cartilage.
Degrees of gonarthrosis of knee joint
In medicine, it is accepted to distinguish 3 degrees of gonarthrosis - from the moment of minor changes, to catastrophic cartilage damage and its disappearance. It is established that at some stages of the disease people do not feel pain and discomfort when moving. Therefore, it is rather difficult to independently determine the gonarthrosis of the knee joint - that such things are not known to everyone. Stiffness helps to recognize the ailment.
Knee joint gonarthrosis 1 degree
Even today, it is very difficult for physicians to detect 1 degree of gonarthrosis. It is impossible to detect the changes that have begun in the tissue of cartilage even with X-ray examinations. Diagnosis of the disease relies primarily on an individual description of the patient's condition. For example, gonarthrosis of the knee joint of the 1st degree can be manifested by morning stiffness or slight pain in the cartilage.
Many note the disappearance of unpleasant sensations when overcoming a short distance and their renewal after a long walk. However, only a few know that with such symptoms it is necessary to go straight to the doctor immediately. Neglecting the first signs is risky. At this time, there may already be a slight narrowing of the joint gap, a crunch and tingling. Then the disease will only develop.
At the first degree of gonarthrosis of the knee joint, the cartilage does not deform, which is why people usually do not feel pain. In this period, the disease can be overcome not only with the help of medicines. Help preventive gentle charging, full and balanced nutrition.
Knee joint gonarthrosis of 2nd degree
With gonarthrosis of the 2 nd degree, the narrowing of the gap and the growth of osteophytes, osteophytes, over the surface of the joint becomes evident. Visually, one can observe a slight inflammation in the knee area, feel a pain syndrome while walking. X-ray method diagnoses reliably. The emergence of degenerative gonarthrosis of 2 degrees leads to a disruption of the nutritional process of the cartilaginous tissue.
The following factors can lead to the development of second degree gonarthrosis:
- heavy work;
- vascular disease;
- problems with the absorption of nutrients by the body.
Because of the lack of ability to fully bend the leg, gonarthrosis of the knee joint of the 2nd degree leads to curvature of the spine. The danger of this pathological process lies in the gradual formation of changes, while treatment removes inflammation and pain syndrome. The morphological changes that have occurred in the joint remain. Therefore, therapy should be started as soon as possible.
Knee joint gynarthrosis of 3 degree
Significant, sometimes irreversible changes in the joint occur at the third degree of knee gonarthrosis. On the X-ray, a rough deformation of the cartilage structure is seen. Patients constantly feel cutting pain. They do not stop day nor night, nor after loads, nor at rest. At this stage, people are practically immobilized, joints cease to bend, lameness develops.
Treatment of such patients is carried out in a complex manner. To defeat gonarthrosis of the knee joint of the third degree, drug therapy is used in combination with various physiotherapy procedures, such as electrophoresis, laser therapy, magnetotherapy, etc. In severe third degree gonarthrosis of the knee, when intraarticular injections do not help, surgical intervention is also used.
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.
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.
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 a dream. 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 reappear. 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.
Roentgenography of the knee joints should be performed to confirm the diagnosis. When using this method, a narrowing of the joint gap is usually found.
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.
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.
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.
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.
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 who have 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 "hinder" the joint to work 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.
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 said when there is already a problem in the joint( for example, inflammation, trauma, etc.), and osteoarthrosis, as it were, layers 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 the development of knee arthrosis.
The first group of reasons: hereditary and age factors.
The second group of causes: congenital and acquired diseases of the musculoskeletal system.
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.
In the II stage of arthrosis of the knee joint, there are restrictions of movement. 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, knee pain 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.
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.
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, as 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.
Posttraumatic gonarthrosis can be a consequence of both chronic trauma of the knee joint and acute acute mechanical damage.
The degree and severity of knee injury, as well as the treatment methods used to correct it, always directly determine the occurrence and rate of progression of the degenerative-dystrophic process. 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, instability of the knee joint, often due to 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 is 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.
Primary bilateral gornatros - 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.