Knee joint gonarthrosis: degrees, types, methods of treatment
What is gonarthrosis?
Gonarthrosis is a degenerative-dystrophic disease of the knee joint. The second name is osteoarthritis of the knee joint. The nature of the disease is not inflammatory, often leads to disability.
According to statistics, he is given one of the leading places among all types of arthrosis. In figures this is more than 20%.Of all the diseases that affect the knee joint, the frequency of manifestations of gonarthrosis is 53%.
Gonarthrosis is well known to doctors for more than 100 years, in everyday life it is called "salt deposition".In fact, with arthrosis, calcification occurs( deposition of calcium salts).However, such calcifications are of limited nature, of clinical importance. The painful process occurs after the pathology of the circulation in small bone vessels, after which changes in the cartilaginous cover of the joint begin.
In the initial stages, changes occur at the molecular level in the cartilaginous tissue, followed by changes in the hyaline cartilage: in some places it becomes cloudy, thinens, stratifies, splits in different directions. This process ends with the complete disappearance of the cartilage, larger and smaller, exposing the underlying bone. In turn, the bone reacts to the death of the cartilage by densification, that is, excessive overgrowth of the bone along the periphery, spines are formed, the foot is deformed and warped. For these reasons, this disease is called "deforming arthrosis".
Exchange processes in the cartilage tissue are carried out due to osmotic pressure. When squeezing the lubricant is released, and when unloading it absorbs. So, during the movement, the cartilage is constantly fed. With incomplete recovery, dictated by increased mechanical stress, metabolic processes are violated. In the place of greatest pressure, the cartilage begins to thin out.
There is a violation of the structure of collagen fibers, which leads to loss of damping properties, chondromalacia( softening of the patellar cartilage), disruption of the metabolic function of chondrocytes. The cartilage loses stability, elasticity.
There is a violation of congruence in the joint. The process is exacerbated by enhanced synthesis of bone substance, which manifests itself in the form of osteophytes( bone growths).The synovial membrane is irritated and inflammation begins. This leads to a restriction of mobility of the joint.
Arthrosis of the inner part of the knee joint and between the surface of the femur and the knee is more common. The disease is more susceptible to people of mature and advanced age, athletes.
Causes of gonarthrosis
The main causes of arthrosis of the knee joint include:
pathological changes in blood circulation, increased fragility of capillaries;
excess body weight, which leads to an increase in the axial load on the joint;
traumatization of the knee joints( ruptures of ligaments, menisci, fractures, cracks);
transferred inflammatory diseases( rheumatism, arthritis);
excessive load on the joint, which is more affected by athletes. Tennis players, football players, athletes, gymnasts are more often ill;
hormonal and endocrine disorders;
old injuries that are inadequately treated or whose treatment has not been completed;
abnormalities of the structure of the joint tissues;
Symptoms of gonarthrosis
The danger of gonarthrosis, like most arthrosis, is untimely diagnosis. At stage 1, the disease almost does not manifest itself at all, except for a slight pulling pain, which the patient writes off for fatigue.
A common symptom of gonarthrosis is a feeling of stiffness in the joint, "pulling" under the knee, pain in the knee after a long walk. Many patients with gonarthrosis( arthrosis of the knee joint) complain of difficulty in walking mostly in the morning, after a dream or after a long sitting. A person needs to "disperse" in order to become easier. With the development of gonarthrosis, pain in the knee, especially on the inner side, becomes more stubborn and permanent. Often, patients with gonarthrosis feel a crunch when moving the knee joint. Further, the limitations of flexion and extension of the leg develop. When the disease progresses, lameness develops. In more neglected cases, a person can not move without the help of outsiders, support or without crutches. Often in the lying position the pain subsides, but it happens that at night a person suffers from pain.
When examining the knee joint in the initial stage of the disease, external changes are usually not detected. With the course of the disease, the deformity of the knee joint, the contours of the bones forming the joint, the coarse, the contracture( incomplete flexion or extension), the curvature of the shin are very noticeable. Putting a palm on the front surface of the knee, you can feel the crunching or extensor movement crunch in the knee joint of varying intensity and duration. A similar sensation can be obtained by shifting the patella outward in the transverse direction( positive patello-cordillary symptom).
When you feel the joint of a patient with gonarthrosis, a painful area is detected, usually on the inside of the joint, at the level of the condyles of the thigh, the large burtz, and the joint slit. Often an effusion accumulates in the cavity of the knee joint, ie, synovitis is attached. Such a state is determined by the smoothness of the contours of the knee joint due to bulging, protrusion of the tissues above the patella and from the side of it and a sense of fluctuation when the protrusion is felt with both hands.
As the disease progresses, the symptoms appear brighter, become more pronounced. Timely correct diagnosis plays an important role in the further fight against gonarthrosis.
Degrees of development of gonarthrosis
1 degree of gonarthrosis
With 1 degree of gonarthrosis fatigue of limb, slight discomfort. During movement, a small crepitation can be traced. Sometimes there is a subtle restriction of movement in the joint.
Knee bones at this stage are not subject to significant changes. On the X-ray, you can see a slight narrowing of the joint space.
2nd degree of gonarthrosis
The second degree is characterized by the onset of pain, especially after you have been standing for long or walk. The characteristic crunch becomes more pronounced. There are problems with extension and full bending of the limb. There is a so-called starting pain.
There may be atrophy of the quadriceps muscle of the thigh. The angle of full flexion and extension of the limb in the knee joint is severely limited. X-ray images clearly show a significant narrowing of the joint gap, the growth of osteophytes. The edges of the bones "flatten".
3 degree of gonarthrosis
At the third stage the character of the pain changes, it intensifies, it can manifest itself in rest. In the joint area, there is often swelling, a local increase in temperature. Due to the possible presence in the joint of the "articular mouse"( fragments of breakaway osteophytes), symptoms of joint blockade may occur. They manifest acute pain, accompanied by a sense of jamming.
The patient in this case may be deprived of the possibility of bringing the joint into motion. There is a deformation of the knee joints with a change in the axis of the limbs, which is clearly seen in the pictures. The instability of the joint may manifest itself.
Types of gonarthrosis
Gonarthrosis is divided into species for reasons of occurrence:
Primary gonarthrosis of the knee joint proceeds against a background of comparative health. Mostly elderly people, especially women, are ill. In the risk group are people with excessive body weight, that is, obese, they are most often affected by arthrosis of the knee joint.
Secondary gonarthrosis of the knee joint develops mainly after a traumatized knee injury or after a previous illness. In the case of timely treatment of all of the above diseases of gonarthrosis can be avoided.
By localization of origin:
right-side gonarthrosis - affects the right knee joint. This type of arthrosis is more common for athletes, people whose professional activities are associated with excessive static and dynamic loads on the right leg;
left-sided gonarthrosis - affects the left knee joint. Also more characteristic of athletes, middle-aged people with excessive body weight;
bilateral gonarthrosis - destroys the joints of both legs. This species is the heaviest, since it significantly increases the risks of disability. Most often it affects older people, since the nature of bilateral gonarthrosis in most cases is idiopathic( age).
All these species do not differ from each other in the nature and origin of the disease. Double-sided gonarthrosis in advanced form can be more pronounced, since both patients suffer simultaneous axial load.
Diagnosis of gonarthrosis
There are many diagnostic methods, but their effectiveness can be greatest only with a comprehensive approach.
Orthopedic examination is the first and very important diagnostic exercise. This includes:
palpation of the joint;
linear measurements of bones;
angular measurement( determination of mobility in the affected joint at various angles).
Clinical trials include:
study of blood formula, erythrocyte sedimentation rate;
levels of fibrinogen, urea and other biochemical indicators of blood and urine;
The main method of diagnosis is the examination of the patient's joint radiographically. In the initial development of gonarthrosis, an x-ray examination can show nothing, and if it does, it will show minor changes. In the late stages of the disease, there is a narrowing of the joint gap, cartilage sclerosis, bone damage, and the deposition of salts.
Ultrasound examination of the
Ultrasound examination of the aching joint gives the best results, however, it can not completely replace the radiographic examination. Therefore, people suffering from joint disease must have an X-ray examination of the affected joint.
MRI - Magnetic Resonance Tomography
The most progressive diagnostic method that allows you to layer-by-layer examine all parts and tissues of the joint, determine the earliest change in the cartilage tissue. The disadvantage of the method lies in the rather high cost of examining each segment. Therefore, it often turns out that gonarthrosis in a patient is far from the only disease of the musculoskeletal system.
How to treat gonarthrosis?
The procedure for the treatment of arthrosis of the knee differs little from the treatment of arthrosis of other joints.
Step 1 - we remove inflammation
For this traditionally used:
NSAIDs are non-steroidal anti-inflammatory drugs that are prescribed intramuscularly or intravenously. In the form of injections or candles, medications give a longer and stronger effect. These include drugs such as diclofenac, olfen, diclac, ibuprofen, indomethacin, ketoprofen.
NSAIDs COX-2, are the most effective and sparing compared to the COX-1 NVPD.They can be used for a long time, for several months. These are meloxicam, celecoxib, nimesulide.
Preparations of hormones. This group is used for intraarticular injections in the presence of synovitis. The purpose of the application is the removal of inflammation and pain syndrome as soon as possible. Minus of application is a damaging effect on cartilage tissue, a large number of contraindications and side effects. The most commonly used for gonarthrosis are representatives of this group: hydrocortisone, kenalog, diprospan.
Antiferment preparations. They neutralize the synthesis of certain enzymes and prevent further degeneration of the joints. The most famous drugs: counter-kal, ovomin, gordoks. When gonarthrosis they are administered intra-articularly.
Step 2. We have anabolic and anti-catabolic effect of
This group replaces the substances necessary for the synthesis of cartilage, has a narrowly specific effect on cartilaginous tissue. They are also called chondroprotectors. They contain substances that are part of the matrix of cartilage. These medicines are natural and well perceived by the body. Stimulate the synthesis of collagen.
To justified use of drugs include: structum, DONA, alflutop, rumalon, mucosate. All of them are slow-acting drugs that use long courses. Some of them are used as injections. This form of application is the most effective.
Step 3. Mage, heat, rub
We use various kinds of gels, ointments, creams. In their majority they are warming and anti-inflammatory. The purpose of their application is to activate local blood circulation, remove inflammation. The most famous of them: apizartron, finalgon, doloben, feloran, fastum gel, nicofleks.
Step 4. Improve blood circulation
Vasodilator drugs are used to reduce the tone of intravascular muscles. Allow to improve the internal blood flow, improve trophic tissue located near the joint. When gonarthrosis is recommended: Cavinton, Trental, Actovegin. To strengthen the vascular walls: upsavit, ascorutin.
Step 5. Remove excess tone
Such antispasmodics as: midolkalm, sirdalud, no-shpa, tyzalud, can remove unnecessary muscular tension in the damaged segment. Often it arises as a compensatory reaction of the body.
Step 6. Introduce synovial fluid prosthesis
The most progressive treatment in recent years has been the inclusion of hyaluronic acid-based drugs in the treatment protocol. It is a natural component of articular cartilage and synovial fluid. Therefore, its administration does not cause inflammation, rejection and other negative reactions.
At the same time, the use of such drugs as: otrovisk, sinocorm, hyalual, allow to soften movements in the joint and relieve the pain caused by friction of the joint surfaces. In gonarthrosis, the most recommended drug of this group is the fermatron.
The treatment sequence is determined by the attending physician, and leads him, according to the current protocols. At the same time, anti-inflammatory therapy can be conducted, a course of chondroprotectors, and a course of physiotherapy. Preparations of hyaluronic acid are allowed to enter the joint only when the inflammation is completely removed. Otherwise, instead of a curative effect, the course of the disease can be aggravated.
Author's and innovative methods of treatment of gonarthrosis
Author's methods include:
All of them have different principles of influence, but have proven themselves as effective means of supporting joints affected by gonarthrosis. Unfortunately, there is no question of recovery.
Oxygenotherapy is a method of filling the joint cavity with medical oxygen. It helps to eliminate puffiness, reduce pain syndrome. Can be used as an alternative to hormone therapy.
Treatment with stem cells .The essence of the method is the transplantation of the patient's stem cells into the joint. The method is developed in Germany and allows to postpone conservative treatment for many years. It is used only in large medical centers in Germany.
Method of intra-articular laser therapy. Performed with a low-intensity helium-neon laser, which penetrates into the joint with the help of a waveguide introduced into the needle. It allows to reduce painful sensations, to increase the amplitude of motion in the joints. The method was developed in Russia, clinically investigated, but not widely used.
Ortokin is a biological technique for the treatment of gonarthrosis, which has been used in Europe since 2003.Autologous serum obtained by selecting specific proteins from the patient's own blood. These proteins have an anti-inflammatory effect. After the selection of blood and production of serum, the drug is again administered to a person intra-articularly, under the supervision of ultrasound or computed tomography.
The drug allows:
to slow down the process of destruction of cartilaginous tissue;
reduce pain syndrome;
to stop inflammation;
to increase mobility in the joint.
One or two injections are sufficient for treatment. About 70% of patients experience pain after the first injection.
At different stages of gonarthrosis, conservative therapy may not give positive dynamics. In such cases, they begin to consider the need for surgical intervention.
There are several types of operations for gonarthrosis:
Arthrodesis. With this technique, remove the deformed cartilage tissue with the joint. The method does not allow preserving the physiological mobility of the limb. They resort to it quite rarely.
Arthroscopic debridement. The technique is to release the joint from the deformed cartilage tissue with the help of an arthroscope. It is used in the early stages of the disease. Thanks to arthroscopy, pain is eliminated. The operation is simple. The effect of the procedure is temporary, 2-3 years.
Periarticular osteotomy. This is a technically complex and rare type of surgical intervention. It lies in the preliminary filing and fixing the bones of the joint from a different angle. This is done to redistribute the load. Rehabilitation is long enough, the effect is from 3 to 5 years. It is used rarely in the early and middle stages of gonarthrosis.
Nowadays it is the most common and effective type of surgical intervention. It allows you to keep the mobility of the limb, which provides the patient the opportunity to lead a full life. Prosthetics in gonarthrosis is a complex operation. It lasts about an hour, but after it it is necessary to undergo a course of rehabilitation and joint development. This is one of the main features of knee arthroplasty. The effect is retained for up to 20 years, depending on the modification of the material. After this, the joint will have to be changed again, since the prosthesis is blown under the influence of axial and mechanical loads.
Do not forget about possible complications such as:
marginal necrosis of the skin
paresis of the peroneal nerve;
thrombosis of the subcutaneous femoral vein;
risk of rejection.
Similar troubles occur extremely rarely and account for about 1% of the total number of transactions. Therefore, it must be taken into account that the effect of endoprosthetics, sometimes, is the only way to improve the quality of life.
Physical training in gonarthrosis - curative and not only
The goal of physical exercises with gonarthrosis is several factors:
preservation and increase of joint mobility;
formation of compensation by strengthening the musculoskeletal system;
increased blood circulation and improved trophism of adjacent tissues and the joint itself;
preservation of the physiological tone of the muscles.
Exercises and the method of their execution are selected depending on the surviving active movements.
exercises with violent interventions, accompanied by pain;
performing exercises with the maximum load;
sharp and high-amplitude execution of exercises with great speed;
exercises with full axial load on the affected joint.
Complex of exercises for gonarthrosis
Shaking. Standing, try to relax completely, hands down. Perform shaking movements with your whole body. Make sure that your knees are shaken with a small amplitude.
While holding the support, bend the leg in the knee, point the heel to the buttock, then straighten the leg forward, put it on the heel in front of you. Execute 15-20 times. Then make the other leg.
Put your palms on your knees. Perform small circular movements in the knee joint in one and the other side. Amplitude adjust for sensations. Do at least 20 times.
Exercise on the folded blanket. The surface should not be too hard. Stand on your knees and perform shaking as in 1 exercise.
From the position, as in the previous exercise, go on your knees, following several steps in different directions.
Stand at point-blank position, lying on your lap( the floor should touch the palms and knees).Drop your chest on the floor, stretching your arms forward, then move the hips and buttocks to the heels, making the heel on the heels, without lifting the chest from the floor. Again, go straight up and repeat the exercise several times.
Lie down on the left side, take the right leg up, bend the leg in the knee, straighten and stretch the heel to the wall as much as possible. Perform up to 12 times and change your foot.
Sit down, put your bent legs in front of you. Stretch the knee of the right leg to the left, then straighten it, unbending the knee up, bend and return to the starting position. After 12 repetitions, change your leg.
From the same initial position, straighten the legs alternately without lifting the heels off the floor, then simultaneously bend again, also without tearing off the floor. Repeat 12-14 times.
Lie on your back, pull your bent leg to your chest, grip your toe of the foot and smoothly move your legs as straight as possible. Try to do it without jerks.
Also, lying on your back, tie a rubber shock absorber to the ankles, and fix the other end to the battery. Smoothly bend and unbend your legs, pulling your knees to your chest.
Stand on the knees. One end of the rubber damper is tied to the ankle foot, the other is fixed to the battery. Slowly( smoothly) bend and unbend the leg at least 10-15 times. The shock absorber should not be too rigid.
Physiotherapy for gonarthrosis
All types of physiotherapy can be prescribed in the phase of remission or a slight exacerbation, but not in the most acute phase, with inflammation.
The most effective are:
electrophoresis with such drugs as bischofite, caripain. Deeper penetration of the drug in such cases is provided with the help of dimexide;
application of radon and hydrogen sulfide baths;
To maintain and prolong the phase of remission, it is necessary to undergo a course of physiotherapy 2-4 times a year. Depending on the degree of the disease.
Electrophoresis with karipainom allows you to remove excess tone, promotes resorption of contractures and adhesions. It is necessary to perform at least 20 procedures, since the drug is cumulative. It works only when the body receives the maximum concentration. A course of 10 procedures does not justify the costs spent.
The course of mud therapy for gonarthrosis should be performed 2 times a year, for 10-15 procedures. You can carry it at home using the dirt bought in the chemist's system. Before use, it must be heated to 38-40 degrees.
Massage, manual therapy for gonarthrosis
These kinds of effects on the knee joint are aimed at stretching, warming and improving blood circulation in the joint area. Massage is performed in the region of the knee, along the lymph flow from the periphery to the center, but without affecting the popliteal fossa. Manual therapy is performed after the massage, an experienced specialist. Its main thrust is the traction and stabilization of the joint. The following exercise can be performed independently.
Stand up with a healthy side to the support. Take your foot off the aching joint forward, then back, then with a sharp movement, "throw it" out of the way.
Prevention of deforming gonarthrosis
Gonarthrosis belongs to a group of diseases that are better and easier to prevent than expensive and long to treat.
To the list of preventive measures it is possible to attribute:
doing dances, sports, try to beware of serious injuries( ruptures of ligaments, fractures, severe knee injuries);
moderately engage in sports, since movement is the mechanical basis of cartilage nutrition;
correctly make up the diet;
watch the body weight;
When getting injured, or showing discomfort in the knee area, immediately seek qualified medical attention;
since 35 years, pass preventive courses of treatment with chondroprotectors;
daily, drink plenty of water.
Useful advices for
Begin the treatment of gonarthrosis with accurate diagnosis. It is better to get advice from several leading experts.
Do not self-medicate. All drugs, their dosage and duration of use should be prescribed and monitored by a physician.
Begin and end your day with gymnastics.
If you want to play sports, consult a doctor about the type recommended for you. Even some yoga asanas can be disastrous.
Eliminate from your diet salty, sharp, fatty foods. Give preference to natural home products. Lactic acid products should have an average fat content, otherwise calcium will be poorly absorbed. Include in the diet low-fat jelly( cooked on turkey meat), natural jelly. Do not forget about the need to eat sea fish, seafood.
If a week of use of the anti-inflammatory drug does not bring relief, consult a doctor to review the treatment protocol.
If there is a remission and the disease does not bother, do not exceed the permissible loads. The absence of pain does not mean that you are completely healed.
Try not to overcool the joints. Although, gonarthrosis and non-inflammatory disease, the joint can react to hypothermia with a new relapse.
The main thing, remember! You can not help even the best doctor, if you do not want to make an effort and help yourself. In case of need of an operative intervention, it is better to delay this moment to more mature or advanced age. It is important that by the time of the surgery you were in good physical condition, so that postoperative rehabilitation was easier. And it depends only on you.
Author of the article: Candidate of Medical Sciences Volkov Dmitry Sergeevich, surgeon
Symptoms, diagnosis and treatment of knee joint gonarthrosis 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 osteoarthrosis of the knee, is a degenerative-dystrophic joint injury 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 separation and absorption of lubricant when the joint moves, but the disease leads to a change in osmotic pressure and impaired 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 starts, 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 a 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, there is a one-sided and two-sided gonarthrosis. 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 injury 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 slit 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 muscles under the knee and a slight pain after a long hiking trip. 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 flexing 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 is decided by the doctor, taking into account the stage and severity of the disease.
In general, the treatment is carried out in a complex way, but usually includes the following steps:
- Elimination of the inflammatory response: Non-steroidal anti-inflammatory drugs are prescribed: Diclofenac, Olfen, Diclac, Ibuprofen, Indomethacin, Ketaprofen, Meloksikam, "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", "Upsavit", "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 another 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 capacity for work and a group of disabilities are not threatened if the prevention is carried out with folk remedies. 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.
A degenerative-dystrophic disease that affects not only the articular cartilage of the knee, but also the subchondral bone, capsule, ligaments, periarticular muscles and synovial membrane called gonarthrosis of the knee joint. According to statistics, this is the most common type of arthrosis joint damage, also called "salt deposition".
Factors provoking the development of
The specialists conventionally divide gonarthrosis into primary( idiopathic gonarthrosis) and secondary, depending on the etiology. The primary occurs more often in the elderly, but in the risk group are also women over 40 who are obese.
Secondary can occur and progress for a number of reasons:
- Injury of the knee, associated with a disruption in the integrity of the ligaments or damage to the meniscus.
- Presence in the anamnesis of inflammatory and non-inflammatory diseases of various etiology( chondromatosis, arthritis).
- Untimely or incorrect treatment of joint lesions, which provoked the development of pathological changes.
- Combination of a suffered knee injury with changes occurring in the body of a woman during menopause.
Knowing the causes of the pathology, you can minimize or completely prevent the risk of its development.
The development of the disease
The destruction of the knee joint is gradual, the process is quite long and almost invisible in the initial phase. The reason is not the deposition of salts, but the dystrophy of the hyaline cartilage covering the condyles of the tibia and femur. The disease can only occur in the left knee( left-side gonarthrosis) or only in the right( right-sided), and also be bilateral.
Over time, the hyaline cartilage is completely destroyed and the subchondral surfaces of the bones are exposed. Then the bone tissue begins to grow, osteophytes( spines) are formed, and the gonarthrosis passes into deforming arthrosis. Similar changes are detected during X-ray examination and even during palpation of the patient's knee. The synovium also suffers, as a result of which exudate accumulates in the joint cavity.
Depending on the extent of damage or destruction of the joint, three degrees of disease are distinguished.
Gonarthrosis is manifested by limited movements and slight pain in the knee, especially in the morning. After a short pacing, the symptoms disappear. Defeat of 1 degree does not deform the joint and does not disturb its mobility. External changes are also not observed.
Glandarthrosis is characterized by a tumor of the knee joint and an unnatural enlargement of the joint surfaces, which the specialist can identify. Pain in the knee appears not only after sleep, but also due to stress, the leg does not bend to the end and crunches while moving.
Gonarthrosis of 3rd degree
Has more pronounced symptoms. The pain becomes permanent, the motor function of the joint is severely limited, the person begins to limp, and sometimes even completely loses the ability to move independently, especially if he has a bilateral gonarthrosis. Deformation of the knee joint is clearly pronounced.
At any stage, the development of the disease can be stopped.
To diagnose gonarthrosis of the knee joint, the following characteristics can be detected on an X-ray:
- joint space narrowing;
- acuminate on the tibia;
- cystic reconstructions in the condyle of contiguous bones;
- ossification on the back of the joint.
This disease is directly related to overeating. Lovers of delicious food often suffer from pathologies in the knee joints. Therefore, the first thing to do is to normalize the diet and lose weight. Also, therapeutic gymnastics helps to achieve results.
The success of treating gonarthrosis depends not only on the literacy of the doctor, but also on the patient's efforts. The process is rather complicated and time-consuming, includes taking medications, proper nutrition, massage and exercise therapy. Detailed instructions are given by the doctor on the basis of a comprehensive examination of the patient. Treatment of gonarthrosis should begin when the first symptoms appear. Gastarthrosis of the knee joint: symptoms, causes.
Knee joint gonarthrosis: symptoms, causes. Treatment of gonarthrosis of the knee in St. PetersburgGonarthrosis is a disease of the knee joint. This is the most common form of arthrosis, with its symptoms familiar to one-fifth of the world's population. Most often, gonarthrosis develops at the age of 40 to 60 years. Women are more prone to this disease than men. We remove pain in the knee for 1-2 visits to the clinic. We treat gonatrosis without surgery. Primary reception of orthopedist. Free of charge.
. How does gonarthrosis of knee joint develop?
Gonarthrosis is also called arthrosis of the knee joint. In the people this disease is known as "deposition of salts".The disease affects the hyaline cartilage, which leads to disruption of the joint.
Hyaline cartilage ensures smooth sliding of the joint surfaces, reduces friction between them. Cartilage is multilayered. This structure allows it to maintain elasticity and withstand loads. Due to gonarthrosis of the knee joint in the cartilaginous tissue changes occur. As a result, the hyaline cartilage becomes thinner, delaminated and cracked.
When the gonarthrosis progresses, the cartilage disappears completely, exposing the bone. In response, bone tissue thickens, on it appear outgrowths - osteophytes. They lead to deformation of the joint and cause pain when loaded on the knee.
The main symptom of gonarthrosis is knee pain
Symptoms of knee arthrosis
The main symptom of gonarthrosis is pain in the knee. It does not appear immediately. A person feels pain in the knee after a long walk or standing on his feet for several months. Pain appears later in the evening and after rest passes. The disease manifests itself when walking on the stairs, there are painful sensations in front of the joint and the side.
In the case of gonarthrosis of the knee joint, a person in the morning feels stiffness in the knee, the leg is bent with difficulty. The movements are accompanied by a crunch and a crackle in the knee. Usually after half an hour the leg is developed and the symptoms disappear. If you leave symptoms of the disease without attention, it will progress.
With progression of gonarthrosis, the pain becomes stronger. A person quickly gets tired from walking, feels weak in the muscles of the legs, instability. There are difficulties with bending and extension of the leg. In neglected cases, the patient develops limp, he can move only with the help of strangers or crutches. A person suffers from pain in the knee and at night.
Who is at risk of
? Most often gonarthrosis is affected:
- men and women with trauma or leg surgery;
- full people - they suffer from gonarthrosis 3 times more often than others;
- professional athletes;
- men who work hard physically;
- relatives of patients with gonarthrosis.
If you are at risk, pay attention to the prevention of gonarthrosis. We will talk about it at the end of the article.
Patient and healthy joints
Types and causes of gonarthrosis
Knee joint gonarthrosis can be of two types: primary and secondary.
Primary gonarthrosis most often occurs due to metabolic disorders in the tissues of the joint, intense stress on the knees and natural aging of the body. The disease usually develops after 40 years. It appears due to the curvature of the legs, hormonal disorders.
Secondary gonarthrosis appears due to injuries or fracture of the knee, infectious disease, metabolic disorders, knee development. Secondary gonarthrosis can occur at any age.
There is a one-sided and two-sided gonarthrosis. The latter affects the knee joints of both legs. Left-sided gonarthrosis causes pain in the left knee, and right-sided - in the right.
Degrees of gonarthrosis
There are three degrees of disease.
Grade 1 is the initial stage of the disease. At this stage, periodically there is pain in the knee after a long walk or after a great physical exertion. After rest, the pain passes. Sometimes the knee joint swells. Gonarthrosis of the knee joint of the 1st degree can not be noticed by the patient.
With gonarthrosis of grade 2 , the symptoms increase. Pain in the knee increases and becomes longer. There is a crunch in the knee joint. With gonarthrosis of the knee joint of 2nd degree, it is difficult to bend and unbend the knee, especially in the morning. The knee joint is enlarged and deformed.
Grade 3 is the most severe manifestation of the disease. The knee hurts not only when walking or exercising, but also at rest. It is difficult for a person to walk, the gait changes. With gonarthrosis of the knee joint of the third degree, the pain in the knee often appears when the weather changes. The knee joint deforms, the knee increases in volume. It is difficult to find a position in which pain is not felt.
Diagnosis will help determine the gonarthrosis of the knee joint and not start the disease.
You will make it easier for the doctor to solve the problem if you describe in detail the nature of the pain when it started. The specialists of our clinic will give you an accurate diagnosis with the help of a comprehensive examination. We use the following diagnostic methods:
mz-clinic.comHome / Diseases / Gonarthrosis / Gonarthrosis 1 degree Gonarthrosis is a chronic degenerative lesion of the knee joints. If the deformation of the articular cartilage at the initial stage, it is a gonarthrosis of the 1st degree. At this stage of the disease, a person does not have strong pain and there is no restriction in movement, so it is difficult to determine, but with timely access to a doctor and proper treatment, the development of the disease at this stage can be stopped.
Gonarthrosis - symptoms ofGonarthrosis, at the initial stage, has no clear symptoms. The first thing a person feels is light discomfort. There is a feeling of fatigue in the knee joints. After some time, a slight pain begins to appear in the knee joints. Especially it manifests itself in the morning hours. The pain is accompanied by some stiffness of movements. Once the joints are developed, the pain goes away and, for the rest of the day, no longer bothers the person. Another symptom that you can pay attention to is the pain in your knees while walking the stairs. During the movement on the stairs, the person makes an emphasis on the knees bent at the knees, it is with these associated pain. It is worth paying attention also to the crunch in the knees. Sometimes it can also be a symptom of gonarthrosis 1 degree of the knee joint. The crunch can be caused by deformation of the joint surfaces. When moving the surface can cling to each other, and then separate, which causes the crunch.
How to diagnose gonarthrosis of 1 degreeTo determine gonarthrosis by appearance of the joint and according to initial symptoms, only an experienced doctor can. In any case, for an accurate diagnosis it is necessary to take an x-ray of the knee joints. Only he can confirm or disprove the alleged diagnosis. It can also show the onset of sclerosis of bone tissue. Gonarthrosis of the 1st degree of the knee joint can be bilateral, or it can hit only one knee. Then it is divided into right-sided and left-sided.
Treatment ofOnly at stage 1, the progression of gonarthrosis can be completely stopped and treatment can give noticeable results. Depending on the degree of symptoms, only an experienced doctor is able to prescribe the correct treatment. Before an orthopedist, the following tasks become:
- Maximize the man's knee joints.
- If possible, remove pain in the knee joints.
- Stop the further development of the disease.
- In gonarthrosis, it is very important to significantly reduce the joint load by reducing the body weight of a person;
- necessarily involve medication;
- also connects folk medicine.
Body weight correctionWeight reduction is especially important when bilateral joint damage occurs. Even a slight reduction in weight can reduce pain and significantly slow the progression of the disease.
Knee joint gonarthrosis: treatment of all kinds of the disease
In most cases, gonarthrosis is manifested by pain in the knee joint region, which is why non-steroidal anti-inflammatory drugs( NSAIDs) are included in the treatment of this pathology. As a rule, they are prescribed short courses, the dosage is selected individually, depending on the severity of the pain syndrome.
Also, when selecting a preparation, it matters which process: primary or secondary, bilateral or unilateral. The advantage is given to selective inhibitors of cyclooxygenase-2( meloxicam, nimesulide, celecocosib).
In diseases of the knee joint they are used twice a day, more frequent administration is not recommended because of the possibility of side effects. In this case, a diet that reduces the irritant effect of medications on the gastrointestinal tract can be recommended. Of nonselective non-steroidal anti-inflammatory drugs, diclofenac, ibuprofen, has been used.
Traumatologists do not recommend indomethacin for gonarthrosis, as it increases the degeneration of cartilaginous tissue. The second group of medications, which are included in the treatment of degenerative joint damage, are chondroprotectors.
Glucosamine and chondroitin-sulfate are used. When gonarthrosis must comply with the following conditions: take these drugs need a long time, at least 2-3 months, and repeat such courses throughout the year several times with a break of 1 month.
In severe cases, with gonarthrosis with severe pain syndrome and ineffectiveness of NSAIDs, intraarticular injections are made to the knee joint area with the introduction of glucocorticoid hormones( Kenalog, diprospan).
The orthopedic physician is being manipulated, taking into account the presence of concomitant somatic diseases in the patient, as glucocorticoids can cause serious side effects. After the administration of prolonged corticosteroid hormones, the pain syndrome rapidly decreases, the edema is eliminated and the volume of movements of the knee joint is increased. Do such injections no more often than once in 2 weeks. The effect of the drug is maintained for up to 3-4 weeks.
If after such treatment it is not possible to achieve positive dynamics, it is recommended to replace the drug with another one, similar. For the treatment of articular pathology quite often use various ointments containing analgesics and chondroprotectors. In the pharmacy they are represented a great many, the correct choice of a drug will help the attending physician-traumatologist. Some ointments are used when a therapeutic massage is performed.
Non-pharmacological methods of
One of the main conditions for the correct treatment of gonarthrosis is a change in the whole way of life, as this disease is very often caused by immobility and the presence of excess weight in the patient. Therefore, it is very important to ensure a balanced and nutritious diet.
Compliance with the diet is a prerequisite for the treatment of knee joint gonarthrosis
It is compulsory to follow a diet, especially in patients with excess weight. Nutrition for gonarthrosis should be low-calorie and, at the same time, include a sufficient amount of protein and microelements necessary for the synthesis of cartilage elements.
The diet of a patient with a left-sided or right-sided gonarthrosis, provides low-fat varieties of meat, vegetables, sour-milk products. In this case, the food should be fractional, small portions. Exclude the following foods: flour and sweet dishes containing a large number of calories. Also, the diet prohibits alcoholic, carbonated drinks, canned food, smoked products.
What Traditional Medicine offers
Medicine has long been treating folk remedies for patients with various joint diseases, including those with bilateral gonarthrosis. You can use them both independently and in combination with traditional therapy.
One of the effective ways of treating folk remedies for knee joint diseases is the mummy, especially it is effective in case of pain syndrome. Before use, the mummy is mixed with honey( 3 g of substance and 150-200 g of honey).The mixture is applied to the joint area and light massage is done, then left overnight. From above the joint can be covered with a warm kerchief or a terry towel.
Left-sided or right-sided gonarthrosis is also treated with a burdock compress. To do this, take the leaves of a medium-sized plant( 4-5 pieces).On the leaves put a saucepan with boiling water and leave for 2-3 hours. Leaves are applied to the affected joint( you can both), top covered with a plastic wrap and then with a towel. Leave such a two-sided compress at night.
For treatment, alcoholic tincture of ficus can also be used;it is used when the massage of a diseased joint and adjacent tissues is done. For preparation take 2-3 small leaves of ficus, crush them with a blender or in a meat grinder. The resulting gruel is filled with 100 ml of alcohol or vodka. Insist 2-3 weeks.
Application of exercise therapy
Mandatory in diseases of the knee joint is treatment with the use of special physical education, since immobility refers to one of the etiological factors of the disease. Walking during the day is highly recommended. Also, a patient with right-sided or left-sided gonarthrosis is prescribed special exercises aimed at strengthening the ligament apparatus and muscle tissue.
Gymnastics must be gentle and not cause pain. It is recommended to perform exercises lying on the back, it is better to do it on the floor.
In this position, the load on the knee joints is reduced. Duration of exercise therapy at the initial stage should be 10-15 minutes, in the future you can increase the time of classes and introduce additional new exercises. Also, when performing exercise therapy, sharp and jerky movements should be avoided, they should be smooth;after classes you can have a massage.
Often recommend swimming lessons in the pool. Exercises performed in the water, contribute to an increase in the volume of movements of the knee joint and, at the same time, do not load the muscles and ligament apparatus.
Massage and manual therapy
A noticeable effect in the treatment of gonarthrosis is obtained when combined massage, manual therapy and gymnastics. The first two techniques allow to strengthen the muscles located periarticularly, and promote better fixation of the joint.
For grade 3 gonarthrosis and severe restriction of motion,
endoprosthetics are shown. Manual therapy also helps increase the volume of movements in the joint. Massage improves blood circulation in periarticular tissues and reduces their edema. It is best if this procedure is performed by a massage therapist. In his absence, you can perform massage yourself or ask someone to make a relative. Manual therapy should always be done by a certified specialist. Otherwise, there is a risk of serious complications.
Physiotherapy methods use magnetotherapy, thermal procedures, laser therapy. Obligatory condition: this treatment is used only not at exacerbation. Otherwise, physiotherapy can cause increased pain in the affected joint.
Surgical intervention is recommended for patients with grade 3 gonarthrosis and with severe movement limitations. The operation consists in replacing the joint with an artificial implant. The service life of such an artificial joint is 15-20 years.
At present, low-traumatic arthroscopic techniques for the installation of the knee implant in gonarthrosis have been developed, and its physico-mechanical characteristics have been improved. Therefore, the rehabilitation period after surgery is minimal and allows the patient to quickly return to normal motor activity. During the rehabilitation period, you can also apply therapeutic exercises, massage, physiotherapy.