Treatment of knee joint gonarthrosis - medications, chondroprotectors, sport and diet
Knee joint gonarthrosis is a common disease that is a step-by-step drying of cartilage causing joint deformation with loss of its functions.
This violation is also called osteoarthrosis and deforming gonarthrosis.
Classification of the disease
Types of the disease:
- primary - it affects older people, although it is impossible to trace the pathogenesis of the disease in this case;
- ptorichny - appears due to mechanical damage to the knee or its lesion due to inflammation in the body, has no age restrictions.
Regardless of the type of deviation, 3 stages are distinguished:
- On the , the initial stage of the , the patient feels a slight knee pain that appears after a prolonged load or when walking. Joints in this period are not subject to deformation.
- In the second stage, the pains of start to increase and become more frequent, and not necessarily because of the loads. The mobility of the joint is worsened, it looks slightly swollen and deformed.
- At the last stage of , the process is characterized by acute pain syndrome. The patient may have meteosensitivity, and the pain then becomes unbearable. The deformity of the joint can be seen with a conventional look, and the knee has a bloated and cyanotic appearance.
Details about gonarthrosis of 2nd degree:
What is the peculiarity of
grade 2 knee joint gonarthrosis? Under gonarthrosis is meant the defeat of cartilage and bony proliferation arising on the joint, xytotic irritation of the articular tissue. Knee arthrosis - deg. ..
Details about gonarthrosis of 3rd degree:
Is it possible to treat gonarthrosis of the knee joint of the third degree and why does the disability occur
Gonarthrosis of the third degree of the knee joint is the heaviest. The disease significantly complicates the life of patients, severely limits work capacity....
Goals and objectives of treatment
The goals of treatment of deforming knee joint gonarthrosis:
- to neutralize pain;
- , if possible, restore the affected cartilage and ligaments;
- to increase the mobility of the joint.
How to cure the disease
Modern medicine offers several techniques.
All medicamental treatment of gonarthrosis can be divided into 2 types: for internal and external use. Among other things, solutions for injections are also used.
In cases of arthrosis, non-steroidal anti-inflammatory drugs are usually used to neutralize pain and inflammation,against a background of severe pain, one can not begin treatment.
Only by eliminating the acute pain, you can subsequently go to massage, gymnastics and those physiotherapy activities that because of the pain would be unbearable.
Among other things, using these tools, it is necessary to take into account that they all have serious contraindications and with long consumption can give tangible side effects.
Therefore, for long-term use it is better to use selective drugs( movalis).
Application of chondroprotectors
Chondroprotectors - glucosamine and chondroitin sulfate - substances that feed cartilage tissue and restore the structure of affected cartilage, the most useful type of treatment for violations.
They affect the cause of the disease: it favors the restoration of cartilage, the improvement of the production of joint fluid and the normalization of its properties.
This effect of the drugs makes them indispensable in the treatment of the initial phase of arthrosis.Chondroprotectors are not very effective at stage 3 of the disorder, when the cartilage is almost destroyed. After all, it is impossible to grow a new cartilage or to return the form to bones by means of glucosamine and chondroitin sulfate.
Treatment with these substances requires competent and long-term administration in combination with other methods of exposure.
Of all the drugs used in the treatment of arthrosis, it is this group that brings the greatest benefit. In addition, they have almost no side effects.
To achieve a powerful therapeutic effect, chondroprotectors should be applied by courses, regularly, for a long period. It makes no sense to take glucosamine and chondroitin sulfate from case to case.
Ointments and creams can not cure arthrosis of the knees. But they can alleviate the condition and reduce pain in the affected area. To this end, ointments are extremely useful.
So, with arthrosis flowing without synovitis, warming ointments improve the blood flow in the joint. For this use of menovazine, gevkamen, etc. These ointments usually cause the patient a feeling of pleasant warmth. They rarely give side effects.
Ointments based on non-steroidal substances( indomethacin, butadione, dolgite) are used when the course of the disorder is combined with synovitis.
Compressors for compresses are more effective than ointments. Of the topical agents used today, the most common dimexide, bischofite, medical bile.
Sport and gymnastics
Many people think that physical activity is forbidden in case of illness. For the normal operation of the joint, he needs strong developed muscles, which is whymoderate exercise in case of a disorder only brings good.
Two-sided gonarthrosis of the knee joint can and should be treated with leisurely exercises. It should be borne in mind that the patient joints can not be subjected to sudden movements and heavy loads.
Except gymnastics, long walks in the fresh air are useful.
The diet for gonarthrosis is a powerful way to influence the course of the disease.
Food should be balanced, but too high-calorie food needs to be removed, tk.they can lead to excess weight, which is one of the main causes of gonarthrosis.
The peculiarity of nutrition is that it must be saturated with animal proteins, because they are involved in the structure of muscles. But to feed the cartilage is necessary to use jelly, broth, brewed from the bones.There is also a list of products not recommended for arthrosis of the knees. This alcohol, fatty meat, cabbage, tomatoes, pepper, milk, sour fruit.
Manual therapy for violations of I and II stages gives a remarkable result. Sometimes several sessions are enough to make the patient feel better.This method of treatment is especially effective in combination with joint extension, chondroprotective consumption and intra-articular administration of Ostenil.
Osteoarthritis of knee joints is a deviation passing through 3 stages of development.
And if at first you can cure by means of drugs from arthrosis, gymnastics and massages, then if there are already changes in the joint, the way out is the operation.
Today, there are several types of interventions that can eliminate pain and discomfort due to a violation. Some of them, for example, artodes, give a certain immobility to the joint, rather than neutralize the pain.
More modern techniques involve the use of prostheses, which can replace the joint or improve its work through a special plate.How and how to treat polyarthritis of the hands with traditional and traditional medicine.
What sections of the population are at risk of getting trochanthitis and what should be known about the prevention and treatment of this unpleasant disease.
Popular treatment of knee joint gonarthrosis
In many situations, folk remedies are extremely effective. Tinctures and ointments on herbs give a good effect. So, you can rub a sore spot with camphor oil or make a compress with apple cider vinegar and honey.
Many recipes for the treatment of disorders are used as the basis of the leaves of burdock. It is necessary to attach the sheet to the joint, wrap with a film and a warm scarf for the night.
By the same principle, you can use white cabbage leaves. To enhance the effect it is necessary to grease the cabbage leaf with honey.
It is necessary to understand the danger of diseases of knee joints. Means for treatment should be selected carefully, given all the nuances.
At the first manifestations of pain in the knees of , it is worth to find an experienced doctor , which will give effective guidance on preventing this problem.
In the initial stages of gonarthrosis is better treated than late. If you want to live without pain and unnecessary complications, take care of your health and the health of your joints.
Video: Exercises for gonarthrosis
What if the knee is sore and there are suspicions of gonarthrosis? You need to visit a doctor to make a correct diagnosis, and also to study these exercises.
Knee joint gonarthrosis of 2nd degree - treatment
Gonarthrosis - arthrosis of the knee, deforming arthrosis is a disease in which progressive destruction of articular cartilage is observed.Symptoms and stages of gonarthrosis
In the development of the disease, doctors distinguish 3 degrees:
- With gonarthrosis of 1 degree, pain occurs only after prolonged physical exertion. In the region of the knee, there may be a slight swelling, which quickly passes by itself. At this stage, it is possible to cope with the problem of traditional medicine methods.
- With gonarthrosis of the knee joints of the 2nd degree, the pains become frequent or constant, arise even in a state of rest and are intensified after the exercise. When walking, flexing and unbending the leg in the knee, there may be a crunch and clicks. The knee is swollen almost constantly, its apparent deformation is observed. In addition, there is a joint stiffness, which can decrease throughout the day. At night, there may be pain in the calf muscles. Treatment of gonarthosis of the 2nd degree requires the reception of a number of potent drugs, and folk remedies can only be used as ancillary drugs.
- With grade 3 gonarthrosis, visible significant joint deformity, permanent pain, limitation of mobility up to the impossibility of stepping on the aching leg, pronounced lameness. Conservative treatment at this stage is usually ineffective and surgical intervention is required.
How to treat gonarthrosis of the knee joint of the 2nd degree?
At the 2nd degree of knee joint gonarthrosis, treatment with conservative methods is still possible, but it should be performed under strict medical supervision. Treatment of gonarthrosis includes a whole complex of measures:
- Drug intake.
- If possible, reduce the load on the affected joint. With unilateral gonarthrosis of the 2nd degree, the use of the cane is a good way to reduce the load, but in the bilateral form of the disease, when both knees are affected, this method is not available and it is necessary to limit oneself to special knee pads.
- Physiotherapy - laser, magnetotherapy, electrophoresis, low frequency vibration. Helps reduce puffiness, pain and inflammation.
- Massages, manual therapy and therapeutic gymnastics. They help improve blood supply, joint development and restoration of normal mobility.
- The diet for gonarthrosis of the knee joint of the 2nd degree is an obligatory component of the treatment and is designed to normalize the weight( since the fat deposits create additional stress on the joints) and ensure the supply of the necessary vitamins and minerals. The food should be fractional( 4-5 times a day), contain a small amount of fats and as little salt as possible, be rich in plant and animal proteins, B, C and D. Vitamins.
Knee Joints Grade 2
Standard Schemetreatment of gonarthrosis prescribes the use of medicines of such groups:
1. Non-steroidal anti-inflammatory drugs:
They are used primarily to relieve the pain syndrome and to a greater extent eliminate symptoms than have a prolonged therapeutic effect.
- Chondroitin sulfate.
These are medicines containing synthetic analogues of the substances that make up the cartilaginous tissue of the joint. Contribute to the restoration of cartilage, but should be taken regularly, long courses. To the same group include preparations of hyaluronic acid, which is an analogue of articular lubrication.
3. Intra-articular injections of corticosteroids. They are used in short courses for acute symptoms and severe pain.
4. Ointments and compresses - used to relieve swelling and reduce pain. Of the ointments, the most effective are preparations based on non-steroidal anti-inflammatory drugs:
For compresses most often used drugs such as Bischofite and Dimexid.
Knee joint gonarthrosis: symptoms and medical gymnastics
All information on this site is for informational purposes only and should not be accepted by you as an instruction for self-diagnosis or self-treatment. Remember that you have only one health, so only qualified specialists - doctors should take care of it!
This disease most often causes discomfort in the knee joint of people who have crossed the 40-year threshold. And although many suggest that the cause of pain in the legs when walking is the deposition of salts, in fact, it can be deforming arthrosis. With this disease, thinning of the cartilaginous tissue of the knee joint occurs at the expense of deterioration of its blood supply, which leads to complete destruction of cartilage and denudation of bones. As a result of rubbing the bare bones against each other, during the movement of the legs, a person suffering from gonarthrosis experiences terrible pain. Over time, if the disease is not treated, it leads to deformation of the knee joint and curvature of the entire limb.
Factors causing the development of the disease
Physicians call several reasons that mainly cause the onset of gonarthrosis of the knee:
- the presence of excess weight in humans;
- 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 man who has changed his 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;
- the presence of a certain type of disease in a person, for example, diabetes, gout and others.
In this case, the primary and secondary types of 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;
- 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;
- shows the first visible deformities of the foot;
- 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 intensively that they become visible to the eye;
- amplitude of mobility of the knee joint is sharply reduced;
- appearance of lameness during walking.
4 degree: in principle - very neglected state of the third degree of the disease, characterized by a strong deformation of the surfaces of the joint bones, as a result of which the gap between them is almost absent. This causes the patient to continuously intense pain.
If you 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 it to:
Two-sided gonarthrosis of the knee joint, treatment of any degree, diagnosis and prevention of the disease.
Gonarthrosis is a disease related to the degenerative-degenerative type. This is the most common type of arthrosis. It is characterized by progressive destruction of the knee cartilage, accompanied by deformation and dysfunction of the entire joint. This disease is observed, as a rule, in people in old age. Most often they suffer from women.
The development of the disease leads to a narrowing of the joint cracks, which causes the rapid deterioration of the cartilage. The process is accompanied by the restructuring and deformation of bone tissue. As a result, there are osteophytes, called spines. Increasing, they cause pain. If the treatment of knee gonarthrosis does not begin on time, then the most unfavorable consequences can be expected in the form of destruction of the cartilage and exposure of the bones under it. The result is a complete deformation of the joint.
This disease has a common name - "salt deposition".And for this there are grounds. Indeed, arthrosis of the knee joints can be accompanied by the deposition of calcium salt in soft tissues, but this process is of an organic nature and does not have clinical significance.
Causes of the disease
Depending on the origin, gonarthrosis is of two types:
Primary or idiopathic
Scientists have not yet been able to identify its cause. As a rule, this is a bilateral gonarthrosis that occurs in elderly people with excess weight.
It is the result of an earlier knee pathology: trauma, infection, chondromatosis. As a rule, this is a one-sided affliction that appears in people outside of any dependence on age.
The main symptoms of
The insidiousness of the disease lies in the absence of pain at an early stage. Therefore, it may take years before the patient seeks help from a specialist. At first, people feel barely noticeable pain that occurs after long walks or in other situations when their legs experience increased loads, for example, when walking on a ladder.
This disease has 3 degrees of
On the first occasionally shows dull pain. It occurs only after exercise and may be accompanied by swelling of the knees. At this stage, the knee does not yet have a pronounced deformation.
Gonarthrosis of the 2nd degree has already more pronounced symptoms. The pain intensifies and becomes longer in time. Patients complain of stiffness in the morning, they use analgesics. There is a crunch when walking, and the joint increases in size, its flexion or extension is very limited.
GG 2 nd degree has already more pronounced symptoms. The pain intensifies and becomes longer in time. Patients complain of stiffness in the morning, they use analgesics. There is a crunch when walking, and the joint increases in size, its flexion or extension is very limited.
In the third stage of the disease, patients experience almost unceasing painful sensations, which increase with weather changes. Their gait is disturbed. The knee acquires a larger volume and changes shape. There are valgus - X-shaped deformations and varus - O-shaped.
This disease is diagnosed with the help of X-ray research, which allows you to put a fairly accurate diagnosis to find out the stage of the disease, and also to track the dynamics of its development. With a disease such as gonarthrosis of the knee, treatment requires a mandatory change in the lifestyle of the patient. It is important to start eating right, and also get rid of bad habits.
To people with a diagnosis of gonarthrosis, gymnastics helps stop pathological processes and increase muscle tone. There are special sets of exercises, which you need to learn from a specialist, and then do them several times a day. It is necessary to rest lying down after work for at least 40 minutes.
You can reduce pain, and also relieve inflammation with anti-inflammatory non-steroid drugs. For this, medicines from a number of chondroprotectors are used, they replace the synovial fluid. For warming, apply half-alcohol compresses, as well as warm baths with pine needles or sea salt.
Physiotherapy techniques are also effective in the fight at the initial stage. Patients are treated with phonophoresis with hydrocortisone, diadynamic currents, ultraviolet irradiation, electrophoresis with novocaine, laser and magnetic therapy, UHF, foot massage.
Orthopedic treatment of
Patients are assigned to wear individual insoles. They use when walking the cane to unload their joints. Sometimes special orthoses are used to relieve pressure on certain bone areas.
When conservative therapy has no effect, one of three operations is performed: arthroplasty, arthrodesis or corrective osteotomy.
- Arthroplasty can restore the lost motor function of the knee. During the operation, a new joint surface is modeled and special pads are placed in it, which replace the affected parts. They are produced from the patient's own tissue or artificial material.
- For arthrodesis, bone fixation is performed using various devices( screws, plates, transplants).After that they fuse. But the restrictions in the movement will still remain. An arthrodesis allows to forget about a pain at an arthrosis.
- An osteotomy is called dissection of bones and their subsequent fixation in a functionally correct position. Due to this operation, the distribution of loads on the joint bones will be more even, with normalization of intraosseous pressure, and pain disappears.
Osteotomy is the dissection of bones and their subsequent fixation in a functionally correct position. Due to this, the distribution of the load on the joint bones becomes more uniform and, as a consequence, intraosseous pressure normalizes, and the pain disappears.
In arthrodesis, bone fixation occurs with the help of special devices( transplants, plates, screws).After that, they grow together. Although the motor limitations still remain, but this allows you to get rid of the pain with deforming arthrosis.
Arthroplasty will restore the lost motor functions of the knee. During the operation, new articular surfaces are modeled and special spacers are placed between them, which will replace the affected areas. The gasket is made of an artificial material or the patient's own tissue.
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 appearance and speed of progression of the degenerative-dystrophic process always directly depends on the severity and extent of the knee joint injury, as well as on the methods of treatment used for its correction. In most cases, gonarthrosis occurs three to five years after injury. Sometimes the characteristic changes occur much earlier - two or three months after the fracture or dislocation of the knee.
The development of gonarthrosis is facilitated by pinching, tearing and tearing of the meniscus, accompanied by wedging of the knee joint, especially when it was not quickly and timely eliminated. For possible causes of arthrosis can be attributed to cartilage and ligament injuries.
minor, minor 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, knee instability, 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 are various injuries of the knee joint. They suffer mainly the able-bodied category of citizens, to prevent and timely diagnosis of this pathology should be approached extremely scrupulously. This will help in the future to avoid early disability and social disadaptation of such persons. Particular attention should be paid to patients who underwent partial or complete removal of the meniscus during the treatment of injuries. As this leads to increased pressure on the articular cartilage.
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.
Osteoarthritis of the knee joint( gonarthrosis)
Gonarthrosis, arthrosis of the knee joint, deforming arthrosis of the knee joint - in fact, these are the three names of the same disease. According to statistics, deforming joint diseases suffer from 10 to 16% of the world's population. Deforming osteoarthritis of the knee joint in the group of dystrophic joint diseases takes a leading place along with coxarthrosis and humeropathy periarthritis. The share of arthrosis of the knee joint accounts for 30% of all forms of osteoarthritis. At the same time, the proportion of gonarthrosis among all diseases of the knee joint is 50%.In this article, we will try to explain as much as possible to the layman the reasons, the mechanism of development and tell about the existing methods of treating this disease. As far as possible, the article decrypts special medical terms, and the information is presented in an accessible form for the understanding of the layman.
Osteoarthritis of the knee joint( gonarthrosis) - description of the disease and risk factors
Osteoarthritis of the knee joint is a serious chronic disease that significantly reduces the quality of life, and in some cases( about 6.5%) leading to disability. If we explain the essence of the disease at the simplest level, then in the failed stages of gonarthrosis, instead of the ordered structure of the joint( here the bones, here the cartilage, there are ligaments, there articular fluid), we get porridge from unstructured elements, when they are all in an altered state and often not"His" place. In fact, the joint can not function because it does not even have the structure necessary for this. The picture that the doctor sees in severe cases of arthrosis of the knee joint is worse than any horror film.
Gonarthrosis is widespread among elderly patients, more often they suffer from women. After reaching 60-70 years, the disease "arthrosis of the knee joint" is diagnosed in 60-70% of people. Unfortunately, in recent years the disease has become noticeably "younger".
Gonarthrosis is a degenerative-dystrophic disease of the knee, characterized by progressive destruction of the cartilaginous tissue, deformity of the joint and a violation of its function. Osteoarthritis of the knee joint is associated with slow degeneration and destruction of intraarticular cartilage. When gonarthrosis affects all elements of the joint: cartilage, ligaments, articular membranes, periarticular muscles and bone.
Approximately 40% of cases are primary gonarthrosis, that is, arthrosis of the knee joint is the main disease, and not a consequence of other diseases or destructive factors. The reasons for the development of the primary osteoarthritis of the knee are not fully understood, it is believed that metabolic( i.e., metabolic-related, tissue-feeding) disorders in the body, and in particular in the cartilaginous tissue, can lead to this disease. Primary gonarthrosis is more common in the elderly, mostly it is bilateral, that is, it affects both knees. Any process that damages articular cartilage can lead to the development of arthrosis of the knee joint: metabolic disorders, endocrine disorders.
Osteoarthritis of the knee joint more often develops people with excess weight, in patients with diabetes, thyroid diseases, in women in the menopausal period and after it due to a decrease in the amount of estrogens. Various circulatory disorders in the limbs, such as varicose veins or atherosclerosis, also contribute to the development of arthrosis of the knee joint. In conditions of hypodynamia, even a normal physical load can lead to the development of gonarthrosis( lack of physical activity in the proper volume leads to muscle weakness and weight gain, respectively, the load on the joints increases).This should be remembered for people who want to get rid of excess weight by running - for knee joints, such activity can be quite dangerous. In order to avoid the risk of developing gonarthrosis, instead of running it is worth choosing walking or aerobic exercise that does not impact the knee and ankle, as in running( ellipsoid, hiking, slide will be preferred).
Secondary deforming arthrosis of the knee joint can develop after insufficiently properly treated intra- and periarticular fractures, permanent microtraumas of the joint surfaces:
traumatic meniscus lesions( jamming, tears, detachments) from unsuccessful movement during normal walking, if a person stumbles, stumbles, slightly twisted the leghit the knee
shock loads on the knee joint during the running, jumping, skiing, snowboarding, in football, basketball
a long one hundrednical load on the knee joints( e.g., long squatting)
secondary gonarthrosis may also develop as a result of inflammatory processes in the joints( arthritis infectious and autoimmune nature);congenital inferiority of the joints( connective tissue dysplasia) - it occurs in people who have too weak ligaments or too loose joints from birth, due to the uneven load on various parts of the articular surfaces;as a result of aseptic necrosis of one of the epiphyses( rounded end of the bone, forming part of the joint) of the articular surfaces.
Mechanism of development of arthrosis of the knee( gonarthrosis)
In the development of gonarthrosis, the major factor is the disturbance of the supply of cartilage of the knee joint.
Nutrition of the knee joint carries cartilaginous joint tissue, it is heterogeneous and resembles a sponge with very thin pores. When moving, under the weight of the body, the articular cartilage of the lower extremities is squeezed like a sponge, while part of the joint fluid is forced out and squeezed out of it into the periarticular space. When unloading, the pressure in the cartilage decreases, it expands and re-absorbs from the periarticular space the synovial fluid saturated with nutrients. The synovial membrane itself( the tissue lining the inner surface of the joint and ligaments) is lined with microvilli - their oscillation and diffusion( movement of the synovial fluid) in them occur when moving in the joint. Therefore, at every step the cartilage is supplied by natural biological mechanisms.
The beginning of the development of arthrosis of the knee joint can be considered the moment when under the influence of unfavorable external or internal effects( possible causes can be found in the previous section of the article) there is a disruption of nutrition as a result of decreased vascular capacity, sometimes even spasm or thrombosis( obstruction) of the vessels of the subchondral bone zone(part of the bone that forms the joint immediately adjacent to the articular cartilage and carries out nutrition and innervation).This process can be combined with a similar disruption of the supply of the synovial membrane, followed by a worsening of microcirculation and the development of chronic hypoxia( deficiency of oxidation-reduction processes) of the cartilage. Disturbance of cartilage nutrition leads to its degeneration with the death of cellular cartilage elements. This leads to loss of elasticity and elasticity of cartilage, the appearance of defects in it. The development of degenerative changes in the synovial membrane is accompanied by a decrease in the production of synovial fluid and leads to the so-called "dry joint".Along with this, active cartilage substances and its particles( detritus, ie dead particles of destroyed tissues) can cause reactive synovitis( inflammation of the synovial membrane), which is accompanied by the release of lysosomal enzymes into the joint( substances that can split and alter the composition of body tissues).These enzymes in turn cause lysosomal degeneration of cartilage, destroying the structure of its tissues and provoking further development of arthrosis of the knee joint.
At an early stage of gonarthrosis, when pathological manifestations are unobtrusive and insignificant, metabolic disturbances occur, which are manifested in changes in the chemical composition and amount of synovial fluid. As a result of a decrease in the production of synovial fluid, atrophy( cessation of nutrition and recovery) of the meniscus and knee cartilage is observed. In this case, the cartilage, providing mobility of the joint, loses its elasticity, becomes thinner, becomes brittle - its dystrophy develops.
Changes in the cartilage that occur in the course of further development of arthrosis of the knee joint lead to a decrease in its resistance even to normal load. The loss of cartilage elasticity and the violation of congruence( the correspondence of the adjacent surfaces) in the joint lead to the macro- and microtrauma of the subchondral plate, which reacts to this by the enhanced production of bone substance, manifested as osteosclerosis( a kind of "ossification" of the joint, which reduces the range of motion in it).
Excess bone substance in this zone with continued loading on articular surfaces causes further development of gonarthrosis and spread of bone substance to the places of least pressure. On x-ray photographs of knee arthrosis, this manifests itself in the form of osteophytes( calcareous outgrowths inside the joint, similar to stalactites and stalagmites).They lead to mechanical irritation of the synovial membrane, the appearance of various types of restriction of movements in the knee joint affected by arthrosis. Simultaneously, on the surfaces of the joint, the growth of osteophytes increases - the joint and bone are deformed, and the ligaments are shortened. In the course of further development of gonarthrosis, contractures( mobility limitations), joint instability( this phenomenon can be observed at earlier stages), pronounced bone deformation are observed. In the advanced stage of arthrosis of the knee joint, degenerative changes are also reflected on the joint muscles, leading to their atrophy( transition to a completely non-working state).
Clinical stages of arthrosis of the knee( gonarthrosis)
I( initial) stage of gonarthrosis
Patients with gonarthrosis at this stage are periodically disturbed by dull pain in the depth of the knee, which appears after a long walk or other stress on the joints. Sometimes the knee joints swell, after which the symptoms disappear on their own.
II stage of gonarthrosis
The pain syndrome becomes more prolonged and intense. Patients with gonarthrosis note a crunch in the joint with motion of the knee. Many complain of joint stiffness in the morning, which takes place after a short walk, patients periodically use analgesics. There is an insignificant limitation of flexion and extension in the knee joint. The joint is enlarged and defiguated( its normal shape is changed).
III stage of gonarthrosis
A patient with gonarthrosis is concerned about pain in the joint that is constant when walking and at rest, often joint pain appears when weather changes. Gait at this stage of arthrosis of the knee joint is severely impaired. Restrictions of movements in the joint are sharply outfitted. Visually the knee joint is enlarged in volume, deformed. Develops X or O-shaped curvature of the legs. Progression of gonarthrosis is accompanied by: periodic inflammation of the joint area( swelling and swelling, pain, fever), exertion of the periarticular muscles, joint blockade( discomfort and pain during movement), osteonecrosis condyle( supporting thighbones in the knee joint) of the thigh, subluxation of the patella, spontaneoushemarthrosis( hemorrhage into the joint cavity).
Treatment of gonarthrosis should be started at the first sign of the disease. Eliminating the cause of arthrosis of the knee joint, you can gradually eliminate the inflammatory changes and restore the lost function of the joint. The therapy of gonarthrosis is aimed at increasing mobility and reducing the morning stiffness of the joint, normalizing the metabolic processes in the affected tissues, preventing and eliminating the contractures that have already arisen and disorders in the function of the joint, slowing the further progression of the disease.
Methods for the treatment of arthrosis of the knee( gonarthrosis)
The main methods of treatment of arthrosis of the knee joint can be considered: