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 diagnostic method 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 to remove 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 do sports, consult a doctor about the type recommended for you. Even some yoga asanas can be disastrous.
Eliminate from your diet salty, sharp, fatty dishes. 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 will not be able to 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
Knee joint gonarthrosis
Gonarthrosis is a deforming arthrosis of the knee joint, a degenerative-dystrophic disease in which the hyaline cartilage covering the articular surfaces of the tibial andof the femur. In the late stages of the pathology, when the cartilage tissue is completely destroyed, the bone tissue begins to suffer, the disease acquires the character of osteoarthritis. The bone becomes denser, cystic cavities are formed, osteophytes grow at the edges of the joint, which causes the loss of joint function and disability.
Gonarthrosis is in the first place in terms of prevalence among all arthroses. Mostly middle-aged and elderly people, mostly women, are ill. But gonarthrosis of the knee joint can also occur in young people. In such cases, it is often a secondary process and develops after the trauma of the knee joint( posttraumatic gonarthrosis).
Gonarthrosis develops gradually over many years. The main signs of the disease: pain in the knees, the integration of their mobility and the periodic development of synovitis( accumulation of fluid inside the articulation).At first, the symptoms of arthrosis are almost invisible, but as the joint deteriorates, it becomes more intense and negatively affects the quality of human life.
This is how the knee joint affected by arthrosis
Reasons and types of knee joint gonarthrosis
As a rule, it is impossible to single out one cause that led to the development of gonarthrosis. In most cases, there are 2-3 or more risk factors for the development of the disease.
The main groups of reasons are:
- Increased load on the components of the joint. This situation is observed in athletes, in people engaged in heavy physical labor, as well as in patients suffering from obesity.
- Knee injury, congenital or acquired deformities of the musculoskeletal system. In such situations, the load on the joint is distributed unevenly and some areas of the cartilage are under increased pressure, which causes their destruction. An example of such deformations may be flatfoot, kyphosis, scoliosis, incorrect fusion of bones after fractures, etc.
- Disturbance of the metabolism of cartilaginous tissue and its ability to self renewal. This situation leads to a shortage of substances in the body, necessary for the regeneration of hyaline cartilage, metabolic and endocrine disorders, a decrease in microcirculation in the tissues of the articulation.
- Disturbance of secretion of synovial fluid in the knee joint. As you know, the synovial fluid, which is produced by the synovial membrane of the joint, provides smooth movements, reduces the frictional force, and also nourishes the cartilage, which does not have its own vessels. If, for some reason, the synovia becomes smaller, degenerative changes develop in the cartilage, it cracks and collapses.
There are many more risk factors for gonarthrosis. Their definition is very important not only for treatment, but also for prevention. Having got rid of such negative influence, it is possible to completely stop the development of arthrosis and preserve the full function of the lower limb.
Depending on the causes of the onset, two types of gonarthrosis are distinguished:
- Primary - diagnose when the true cause remains unknown. At risk are women, elderly people, patients with obesity, with metabolic and endocrine diseases.
- Secondary - is established when there is a clear connection between arthrosis and its causative factor. For example, after a joint injury or surgery.
As a rule, the primary gonarthrosis is always bilateral, and the secondary one affects only one knee.
According to ICD-10( International Classification of Diseases 10 revision), gonarthrosis has an M17 cipher.
Strengthened loads of knee joints can cause the development of gonarthrosis
Degenerative gonarthrosis levels
Gonarthrosis is a chronic and slowly progressive disease. Symptoms, prognosis and tactics of treatment depend on the degree of pathological changes in the joint. There are three clinical stages of the disease:
- Arthrosis of the 1st degree is characterized by the appearance of pain or discomfort after an increased stress on the joints, at the end of the working day. After rest, all signs disappear on their own. The amplitude of the movements is not disturbed, there is no deformation of the joint.
- Gonarthrosis of the 2nd degree. At this stage, pathology is diagnosed in most people, because it constantly makes itself felt. Patients complain of pain in the joint even after minor loads. Rest does not give the desired relief, and you have to take various painkillers. There is a limitation of the amplitude of movements in the knee, begins muscle atrophy, you can see the initial stage of limb deformation.
- Osteoarthritis of the knee of the 3rd stage. The pain bothers the person round the clock, for its occurrence it is not necessary even to load a joint. Anesthetics do not help anymore. The mobility of the knee is partially or completely lost, its deformations develop, which is often the cause of disability. Treatment in this case is only surgical.
4 degrees of arthrosis does not happen, but there is a fourth X-ray degree of pathological changes in the joint, which coincides with the third, clinical stage.
Symptoms of the disease
It is difficult to diagnose the initial stage of the disease, as patients do not take the symptoms seriously and perceive them as ordinary fatigue. Most people can not even say that they are concerned about pain, most likely, unpleasant sensations in the knees after work or excessive load of joints, which completely and quickly disappear after rest.
A characteristic sign is pain during descent or ascent on stairs, as well as starting pain( occurs at the first steps after rest, then disappears).Outwardly, there are no changes. From time to time, patients may note some swelling( reactive synovitis).Also, most people complain of crepitation in the knee( crackling sounds with active and passive movements).
Pain in the knee joint is the first and the main sign of arthrosis
As arthrosis progresses, the pain becomes more intense, appears more often after minor loads. Independently does not pass, which often prevents a person from falling asleep. We have to take analgesics. Synovitis appears more often, have a more persistent current. Also a rough crunch develops during movements. The amplitude of movement decreases. It becomes difficult for a patient to perform familiar things, for example, to get off his knees. The knee joint begins to deform, it becomes wider, the shin bends( the beginning of the formation of O- or X-shaped deformation of the legs).
At the last stage the pain is intense and constant, it is not removed even by medications. Significantly difficult movements in the knee, especially flexion. The leg is in a forced position. The knee is enlarged in volume. There may be varus or valgus deformities of the legs.
Because of the described changes, gait and limb support function are disrupted. This leads to the fact that a person moves only with the help of an additional support( crutches, walking stick) or is not able to walk at all.
At the 2 nd and 3 rd stage, it is not difficult to establish a diagnosis. You can do this at the first, but only if you suspect a disease. Diagnostic program includes:
- examination by a doctor orthopedist or rheumatologist;
- clarifying complaints and identifying risk factors;
- objective examination of knee joints, determination of the amplitude of their movements;
- X-ray examination;
- joint ultrasound;
- in severe cases for diagnosis use MRI or CT;
- standard laboratory tests for blood and urine.
Radiography is a valuable and informative method for diagnosing gonarthrosis
Conservative treatment of
Knee arthrosis therapy consists of several methods, individually they are ineffective, but if you use the whole treatment complex, very soon you will start moving without pain.Read more: How to cure arthrosis of the knee joint?
The main tasks of treatment of gonarthrosis:
- relieve a person from pain;
- to adjust the supply of cartilaginous tissue and accelerate its recovery;
- to improve microcirculation;
- reduce the load and pressure on diseased hyaline cartilage joints;
- to develop a good muscular knee joint corset for protection and support;
- to increase the mobility of the joint;
- prevent deformation and ankylosis.
This can be done using the methods described below.
Not essential, but allows you to quickly eliminate pain and signs of inflammation. Most often prescribe drugs from the group of NSAIDs( diclofenac, meloxicam, ibuprofen, ketoprofen, celecoxib, aceclofenac, etc.).These drugs are used for both systemic therapy( tablets, injections), and for topical treatment( ointments, gels, creams, patches).They quickly and effectively relieve the pain, but they are forbidden to take long courses, as severe adverse reactions may occur.
Chondroprotectors are on the second place. These medicines in their composition have chondroitin and glucosamine( the main structural elements of the cartilage).Thus, it is believed that chondroprotectors with long-term admission can stop the progression of the disease and contribute to the restoration of already destroyed cartilage. Among the most popular drugs worth noting: Arthra, Dona, Structum, Teraflex, Hondrolon, Alflutop. Treatment should start with a monthly course of intramuscular or intra-articular injections, and then switch to 3-4 months of maintenance therapy with tablets. Only in this case it is possible to achieve a positive result.
Dona is a modern and effective chondroprotector
A popular method of treating gonarthrosis are intraarticular injections. Inside the knee can introduce chondroprotectors, as well as glucocorticoid anti-inflammatory drugs of long-term action( Diprospan, Kenalog).The pain passes even after 1 injection, the effect can last for several months.
Also today, the introduction of so-called liquid transplants of synovial fluid( Fermatron, Hyastat, Synvisc, Ostenil) is popular. These drugs are based on hyaluronic acid, which compensate for the synovial deficiency in the joint and promote the resumption of cartilage.
Therapeutic exercises are the most important element of arthrosis therapy. Without regular special physical exercises, it is almost impossible to achieve improvement. Complex exercise therapy is selected individually, depending on the stage of arthrosis, the age of a person, his physical fitness, the presence of concomitant diseases.
A simple and effective complex of exercise therapy for arthrosis of knee joints:
methods Among other conservative therapies are:
- Massage and physiotherapy. They are used during remission, when acute pain is absent. Allow to improve blood circulation in the tissues of articulation, which contributes to the regeneration of damaged structures.
- Orthopedic aids. To protect the joint and prevent the progression of arthrosis, you can use special knee pads for physical work or sports. They perfectly support the articulation and protect it from damage. At the last stage of gonarthrosis, a cane can be used to facilitate movement and reduce pain.
- Treatment with folk remedies. Folk methods of therapy are very popular among the population. There are not one dozen recipes that can help reduce pain, improve the mobility of knee joints. But we must not forget that such treatment should be used only as an additional one, and not replace all other methods. Also, before using any prescription, you need to consult a doctor about possible contraindications.
Operation with gonarthrosis is prescribed in the following cases:
- inefficiency of conservative therapy;
- constant pain, which can not be eliminated in other ways;
- deformity or ankylosis of the joint;
- loss of leg function;
- patient desire.
Before and after arthroplasty of the knee joint
There are 2 groups of operations that are performed with gonarthrosis:
- organ preserving,
- knee arthroplasty.
All modern organ-preserving surgeries are performed by arthroscopy. There are several options for surgery: arthrodesis, arthroscopic debridement, periarticular osteotomy. The surgeon chooses the necessary procedure depending on the individual characteristics of the patient.
Endoprosthetics is the most effective and widespread type of operation for gonarthrosis. Replacement of the destroyed joint with an artificial prosthesis( in some cases, and bilateral prosthesis) allows you to save the mobility feet and live a full life without pain. It is also important to know that success depends not only on the operation, but also on the correctness of the rehabilitation period. Sometimes only such cardinal measures can help a person to move again without pain.
Gonarthrosis of the knee joint of the 2nd degree: treatment with medications and folk remedies
Degenerative and dystrophic joint disease is called gonarthrosis. Today, this ailment is the leader in the group of various lesions of articulations in humans. The symptomatology of the disease, according to statistics, occurs in 15-20% of the total population. In this case, it is most often in women who are diagnosed with gonarthrosis of the knee joint of the 2nd degree. Treatment of the disease is difficult. Because the disease is incurable.
The main causes of
In gonarthrosis, there are degenerative processes of cartilage that covers directly the intraarticular surface of each bone. Uncomfortable sensations in this disease arise precisely because of this.
At first, blood circulation in all small vessels is disturbed. The nutrition of the joint worsens. After a fairly long so-called starvation, the cartilage is thinned, and later completely destroyed.
Partial exposure of bones creates a kind of friction between them when walking. This causes very severe pain. A person can no longer fully bend or unbend the joint. In the most severe cases, thorns appear. Because of this, the bone deforms, which, in turn, leads to the curvature of the leg.
When gonarthrosis is sometimes observed rapid deposition of calcium salts. As a result, calcification of the soft tissues of the knee occurs. However, this manifestation does not stand out in a separate clinical situation. Usually it does not extend directly to the joint itself.
The main types of disease
This disease is divided into primary and secondary.
Primary gonarthrosis of the knee joint of the 2 nd degree, the treatment of which is directed mainly at the elimination of unpleasant symptoms, can occur even in an absolutely healthy person. Many doctors believe that such a disease is provoked by a violation of metabolism, the presence of excessive weight, as well as age-related changes in the joints. There are situations in which primary gonarthrosis has developed as a result of taking some contraceptive hormonal medications. Also, the cause may be poor heredity.
Most often the primary gonarthrosis affects both knees, but it can begin to develop in any of them. Pathological changes over time cover the entire joint and pass to the other leg. One-sided malaise can occur with an uneven load on the legs.
Secondary gonarthrosis of the knee joint of the 2nd degree, the treatment of which should begin in time, almost always one-sided. He has a clear reason.
The most common source is joint trauma. This can be as a hemorrhage in the joint, and a severe bruise or dislocation. The disease sometimes develops after some surgical interventions, with various inflammatory processes and neoplasms in the knee.
The situation can only get worse if you do not go to the doctor on time. Also, one should not engage in self-medication, as often it is fundamentally wrong. And this will only lead to even greater complications.
The main symptoms of
The disease begins with the appearance of pain in the joints after walking, as well as physical activity. But many people do not attach importance to this symptom, because discomfort passes if you rest a little. Sometimes there are mild pains in any one hip.
Characterized by knee joint gonarthrosis:
- increased pain in the knee joint;
- does not go through unpleasant sensations even after rest or sleep;
- severe discomfort when loaded on the knees;
- joint pain after a long walk;
- there is a significant underdevelopment of muscle tissue in the lower extremity of the corresponding side;
- appears a certain crunch in the knee;
- violation of the main function of the joint;
- appearance of the first signs of joint deformation.
By the time when the second degree of gonarthrosis is already determined, the disease covers both joints. One-sided malaise occurs when excessive load on any one leg. In this situation, a person unconsciously begins to shift all his weight to the other side. As a result, the degeneration of the cartilaginous tissue of the articulation develops.
Degrees of disease
There are several degrees of the disease according to the intensity of their development:
- 1 degree( initial).Quite insignificant swelling and pain in the knee after physical exertion. The shape of the joints does not change.
- 2 degree. There is a slight crunch in the joints, the pain becomes stronger. There is a certain stiffness in the joint. The outlines of the knees begin to change outwardly.
- 3 degree. All symptoms manifest themselves in full. Gonarthrosis of the third degree of the knee joint is characterized by pain, which is permanent. The joint is strongly deformed and increases in size. It becomes difficult for a person to walk.
- 4 degree. On X-rays, a strong deformation of the joint is clearly visible. Practically complete absence of joint space. The pain does not stop, the knee is limited in movements.
Diagnosis of the disease
The diagnosis of the particular difficulties is not caused and is carried out on the basis of symptoms indicative of the rapid development of the disease:
- deformation of the knee joint;
- appearance of crunch;
- pain enhancement;
- limitation of joint mobility.
The most clear picture can be seen on radiographic shots. Deforming gonarthrosis of the knee joint of the second degree is characterized by specific edge enlargements and strong narrowing of the slit.
Treatment of altered joints
It is rather difficult to fight this disease. Before examining how to treat gonarthrosis of the knee joint, it should be understood that the disease is considered incurable. After all, no one is able to return the joints to their joint mobility. The most that will be possible to do at all is to reduce the pain sensations only slightly and try to suspend the process for a while.
Only timely diagnostics of the disease will achieve these goals. However, any intervention will be ineffective if you do not learn to unload the affected joints.
Treatment of gonarthrosis should be carried out according to strict rules. To do this, stock up with a lot of patience. It is recommended to completely abandon all bad habits, observe a special diet, as far as possible, completely eliminate all heavy loads.
For gonarthrosis apply:
- Nonsteroidal anti-inflammatory drugs for pain relief( Nimesulide, Movalis, Diclofenac, etc.).
- Preparations, which contain components of articular cartilage( "Chondroitin-sulfate", "Glucosamine", etc.).
- Drug injections in the joint of hyaluronic acid preparations( Synvisc, Fermatron, Duralan).This acid is an analogue of an articular lubricant, which covers the cartilage, thereby reducing friction when moving in the joint.
Special support devices are used that can reduce the load on the joint. It can be like an ordinary cane, and hard knee pads, as well as special orthopedic insoles. Such a device is chosen by the doctor individually for each patient, relying on the degree and severity of his illness.
If the patient does not already have a chance to save the joint, surgery is recommended. Gonarthrosis of the knee joint is often treated with complex therapy, resorting to surgical intervention only in extreme cases.
There is such an operation option as endoprosthetics. It consists in the fact that the prosthesis is replaced by the whole joint or some of its parts. The operation is most often done when a unilateral gonarthrosis is post-traumatic in nature. This includes the rupture of ligaments, fractures of the knee joint.
Surgical treatment is performed only if the disease is not accompanied by osteoporosis. Another taboo to the operation is the increased fragility of bones.
Comprehensive treatment is complemented by some fairly effective methods:
- special massage;
- thermal therapy and laser physiotherapy;
- exercise therapy;
- UHF, electrophoresis.
Special Therapeutic Exercises
With gonarthrosis of the knee joint, it is impossible to completely exclude physical activity. The individual curative gymnastics program will help to strengthen the weak muscles surrounding the joint, and improve blood circulation.
Since the joints need movement, then physical exercise should be practiced constantly. During such exercises, not only the affected muscles are trained, but the entire musculoskeletal system is trained.
Gymnastics in gonarthrosis of the knee joint can be performed by patients at home. But it is always worth remembering that physical exertion on sick joints is allowed only during the remission of the disease. The presence of edema and pain will simply make any movement unrealistic. Ignoring this nuance can exacerbate the condition to some extent.
When gonarthrosis is strictly prohibited squats, long walking, running, stress knee joints. They will always cause acute pain.
For each degree of the disease, its individual treatment is applied
1 degree - massage, easy medical gymnastics, physiotherapy. To reduce the load on the joints, it is recommended to reduce weight.
At grade 2, the load on the joint should be minimized. Physiotherapy, physiotherapy exercises are prescribed. Anesthetics, anti-inflammatory drugs and some chondroprotectors are used.
Gonarthrosis of the third degree of the knee joint requires therapeutic symptomatic treatment. The patient may be referred for surgical treatment. At the same time, all bone growths are removed, osteoplasty of the cartilage is done. On the last - the fourth - the stage the arthroplasty of the joint is increasingly performed.
We use folk remedies
Various decoctions and rubbers made from medicinal plants are used in case if 1 or 2 degree of such a disease as gonarthrosis of the knee joint is diagnosed. Folk remedies with a serious degree of disease, unfortunately, will not have absolutely no effect.
This is one of the most common methods of combating the disease, widely used by patients who are diagnosed with gonarthrosis of the knee joint of the 2nd degree. Treatment involves the use of blue or red clay. It should be applied only with a plastic or wooden spatula. No contact with metal is allowed.
Clay is diluted with water to a consistency of liquid sour cream. The mixture is spread on a cloth. They put it on a sore knee and wrap it with cellophane or with a warm woolen shawl. This compress is held for a couple of hours, after which the clay is washed off.
Tincture made of ficus
A special tincture from gonarthrosis is prepared from the most common domestic ficus. His leaves are passed through a meat grinder and add a little vodka. Insist for 3 weeks in a dark place. The dishes should be very tightly closed.
First of all you need to take a salt bath. Prepared infusion slightly warmed, and then applied to the affected joint and wrapped in a warm kerchief. Do this for 10 days in a row.
Knee joint gonarthrosis treatment, symptoms, causes
For the first time this disease appears after forty years and most often it is diagnosed in women who complain of pain in the knee.
Knee joint gonarthrosis
No one pays special attention to this and everything is written off to the deposition of salts.
But in fact the cause of pain is gonarthrosis of the knee joint. The essence of the development of this disease lies in the dystrophic changes of the hyaline cartilage, which are covered with the tibial condyles, as well as the femur. In the future, gradual destruction of the cartilage takes place and as a result the subchondral surface of the bones forming the knee joint is exposed.
Causes of the appearance of the disease
The causes of this disease are different, it all depends on whether primary or secondary gonarthrosis is diagnosed.
This type of disease appears most often in the elderly, and against a background of complete health. It is suggested that the cause of the disease is a disturbed metabolism, because gonarthrosis is more often diagnosed in patients with obesity and overweight.
There are suggestions that the cause of the disease is a hereditary factor, and this can be influenced by the long reception of hormonal drugs and much more. In this case, do not forget that the presence of anomalies in the structure of the joint tissues, not only cartilaginous, but also bone may be the cause of gonarthrosis. Also, the appearance of the disease can significantly affect the various pathologies of the ligament apparatus.
In this type of disease, the causes are more obvious:
- knee injury - bruises, dislocations and the like;
- surgical operations that a person suffered after a knee injury, removal of the meniks;
- joint disease - arthritis or swelling and other inflammatory diseases in the joints;
- untimely appeal for medical assistance after the received knee injuries, which leads to the development of gonarthrosis;
- hormonal imbalance. This can be a slow metabolism or a malfunction of metabolic processes in the body;
- excessive intensity of physical exertion on the joint. As a rule, it manifests itself in people engaged in professional sports;
- diseases that adversely affect the muscle tone, muscle spasms and clamps, stiffness of the muscles.
Symptoms and stages of the disease
Symptoms of gonarthrosis of the knee depends on its stage. There are three main stages of the disease.
Each stage characterizes a certain period of the course of the disease - from the moment of slight changes, to serious lesions of the cartilaginous tissue and its complete disappearance.
Gonarthrosis 1 degree
In the initial stage, the disease manifests itself stiffness in the knee joint in the morning hours after sleep and a little pain.
Grade 1Gonearthrosis A person notices that pain and stiffness are aggravated by long walking or prolonged stays in a sitting position. However, with the first degree of gonarthrosis, there is no deformation of the cartilage in communication, with which the pain syndrome is not strongly manifested, and the mobility of the joints remains the same. It is for this reason that in many cases the disease remains unnoticed;
Gonarthrosis of 2nd degree
Gradually the pains become stronger and more persistent. They appear not only after sleep, but also with a prolonged load on the knee - for example, if you stand on your feet or climb the stairs for a long time.
Gonarthrosis of 2nd degree
In the recumbent position the pain decreases. The knee deforms and increases in volume, the patient feels a characteristic crunch when flexing the leg. Bony outgrowths - osteophytes - grow on the surface of the joint. Also, there is no full possibility of bending the leg, which leads to a curvature of the vertebra.
Gonarthrosis of 3rd degree
Symptoms are all the same, but they are more pronounced. The pain in the knee is permanent, it tortures a person both during walking and at night, preventing them from falling asleep normally.
Gonarthrosis of 3rd degree
The function of the joint is severely disrupted - the patient can not bend the knee even at ninety degrees.
There is lameness, a person falls on an affected leg or is unable to move without help at all.
Deformation of the joint can be seen immediately, on the X-ray, a change in its structure is diagnosed. The bone surfaces are so deformed that there is practically no gap between them, which is necessary for movements and the person has to experience continuous cutting pain.
Treatment with medical and folk remedies
Gonarthrosis of the knee joint is treated for a long time, and treatment requires doctors to be highly professional, and the patient must be patient. But you can not get rid of the disease forever, but it is quite possible to slow its development.
Medication therapy involves the appointment of the following drugs:
- means for getting rid of pain. To do this, anti-inflammatory non-steroid drugs are prescribed: diclofenac, indomethacin, paracetamol and others. But they are taken according to the doctor's prescription, a long reception of these medicines can cause an exacerbation of gastritis or stomach ulcers. It should be noted that the action of these drugs is aimed at reducing inflammation and the manifestation of a feeling of pain. Therefore, they only hide the unpleasant symptomatology and do not relieve the disease;
- chondroprotectors. These drugs contain chondrocytes, which will restore the structure of the cartilage. The drugs help to increase the mobility of the affected joint and stop the development of the disease. However, chondroprotectors have a positive effect on the initial stages of the development of pathological changes in the knee joint. They are absolutely useless in the complete destruction of cartilage. These medications are very slow acting and need to be systematically used in certain doses for several courses over a period of one to one and a half years;
- anti-inflammatory drugs. These are corticosteroids, which are hormonal drugs with a strong effect. When the cartilage tissue is destroyed, an inflammatory process occurs and a fluid forms in the joint, and corticosteroids are injected into the joint itself. This hydrocortisone, Kenalog and much more. Assign and hormonal gels with ointments - Diclofenac, butadione and others;
- preparations of hyaluronic acid. A film is formed on the damaged joint, which prevents further destruction of the cartilage by reducing the friction between the articular cavities. As a result, the cartilaginous tissue becomes much more elastic and elastic, including its depreciation abilities. The treatment of gonarthrosis with hyaluronic acid preparations is carried out by courses.
Methods of treatment without the use of medications
This is a physiotherapy that can reduce pain in the affected joint and relieve inflammation. In most cases, electrophoresis is used, because with its help, external drugs penetrate much deeper than the usual application to the skin. Also, to improve nutrition and microcirculation of tissues in medicine, magnetic devices, ultrasound, laser radiation are used.
Medical gymnastics together with manual therapy will relieve overexertion from muscles and joints, improve the condition and mood of the patient. Wellness gymnastics is an indispensable component of successful treatment of gonarthrosis. Exercise helps to strengthen the muscular system of the lower leg and thigh, thereby increasing mobility of the limb and improving the condition of the ligaments.
In some cases, surgical treatment is prescribed. As a rule, it is necessary in cases when pronounced deformity of the knee joint is observed and its complete immobilization arises and at the same time conservative methods of treatment are not effective. This is endoprosthetics and arthroscopic debridement. In the first case, the patient is placed with a ceramic, metal or plastic prosthesis. In the second case, with the help of an arthroscope, the painful, broken parts of the cartilage are removed.
Folk recipes do not lose their relevance. The joint use of "grandmother's recipes" and medications will have a good therapeutic effect.
It is recommended to rub the joint joint with camphor oil, apply a mixture of apple cider vinegar and honey, or apply a compress from the burdock leaves to the affected knee.
Also, the section of traditional medicine advises you to tie a heated shredded horseradish root at night to your knee, and with pains, drink three times a day a glass of broth from onions, which is prepared by calculating two onions per 1 liter of boiling water. In addition, it is useful to take a bath twice a week with a decoction of grass hay and malt. If there is a pronounced inflammatory process, wipe the knee joint with a lemon wedge.
Prevention of gonarthrosis
The most important thing in the prevention of this complex disease is muscle training and constant maintenance of them in tone. Very often, having heard advice from a doctor to do gymnastics, a person neglects this and very much in vain. Exercises will help to adapt the body to constant loads, because when they are performed, the muscles of the legs are strengthened.
Prevention of gonarthrosis
Excess weight is also a risk factor for the onset of gonarthrosis. This same gymnastics will help him to fight, because the fat people are constantly stressed by joints due to weight.
One of the causes of the disease is trauma. Therefore, while skating, skiing should be cautious and if you do not imagine your life without it, then take care of good protective equipment and use quality knee pads.
Vitamins are especially useful for prevention. This vitamin E, D and C, so you need to periodically use vitamin complexes.
Calcium fortress will take care of calcium fortress, a high amount of calcium is found in eggs, sesame and celery.
The right diet will help the joints. The food should be balanced and correct, for the prevention of gonarthrosis you need to consume a lot of fresh vegetables, cakes and sweets replace with fruits. In winter it is useful to eat cranberries with honey. Homemade cottage cheese, milk and cheese will also help to strengthen joints with bones.
Knee joint gonarthrosis( arthrosis): treatment of 1 degree, 2 degrees, 3 degrees.
Along with this, the bone tissue is restructured and deformed, so-called spines or osteophytes are formed. It is they that limit the movement of the joint and cause pain.
If, in the presence of a man diagnosed with knee joint gonarthrosis, the treatment should be started, this may result in the disappearance of the cartilage, deformation of the joint and exposure of the underlying bone.
Knee joint gonarthrosis 1 degree
The first signs are the appearance of a feeling of discomfort in the joint and periodic pains. As a rule, the disease develops gradually and pain over time is more periodic.
Especially it is necessary to pay attention to a joint condition in the morning, after a dream. Most people complain about morning pains( after a long period of immobility), but leaving and developing joint pain goes away.
Also a person feels discomfort when climbing and descending the stairs, becausethe weight of the body rests on one leg and the articular cartilages in the knee joint are compressed. It is worth paying attention to crunches in the joints.
Gonarthrosis of the knee joint of the 1st degree characterizes such features:
- fatigue of the limb
- moderately restricted movement in the joint
- a slight crunch
can be heard. In the gonarthrosis of the knee joint, 1 degree of pain will occur at the beginning of the walk, after a prolonged load, and at rest or a small load theyare absent. At this stage, the knees still retain their natural form and are practically not deformed. In the joint space, there will be some narrowing.
Knee joint gnatroz of 2nd degree
Knee joint gonarthrosis of the 2nd degree already restricts in the movement of a person. At this stage, pain will accompany any movement associated with the affected knee. Especially severely affected knee will hurt after a long walk and wearing a light weight.
The pain syndrome can only be reduced after a long rest. Check the joint for flexion right now - if you can not bend your leg in your knee, serious deformations have already begun.
In the second stage, a knee crunch will be well audible, joint deformation will also be visible, the patient will begin to limp and muscle malnutrition will develop. On the x-ray, you can see the narrowing of the joint gap in comparison with the norm 2-3 times.
A pathological fluid may also accumulate in the joint. At the second degree, drug treatment becomes necessary, it is impossible to cope with the disease alone with one's folk remedies.
knee joint gonarthrosis Grade 3 knee joint gonarthrosis will further strengthen the patient's pain syndrome. The mobility of the knee joint will decrease to a minimum. Pain will bother a person even when the knee joint is at rest. Deformation of the joint bones becomes very noticeable.
It will be difficult for the patient to find a comfortable position for rest. In the case when the destruction of the joint is observed and a violation of blood circulation, the joints will twist at night and on the weather.
In the structure of the knee joint articular cartilage is practically absent, because of the sharp sealing of the articular surfaces. Pain relieves patients even when lying down. The likelihood of gait disturbance due to X or O-deformity is very high.
At this level it is advisable to perform arthroscopic surgery of the knee to remove outgrowths and deformed elements, as well as joint replacement - replacement of native elements with artificial analogues
. On the x-ray, the joint gap will be practically absent.
How to treat gonarthrosis of the knee joint? Treatment of gonarthrosis should be started as early as possible, as the patient's recovery process will be quite long.
The main task in the treatment is to remove the load on the joint as much as possible. Get rid of excess weight( diet and proper nutrition), do regular massage of the affected part of the joints, practice physical exercises on the recommendation of a doctor( exercises and gymnastics).
In the first stage, the treatment can be conservative and include:
Knee joint gonarthrosis of 1, 2 and 3 degrees: treatment, causes, symptomsWhat is it - gonarthrosis is a non-inflammatory disease in which the knee joint is not affectedblood supply of cartilage covering the joint surfaces of the femoral and / or tibia. As a result, the cartilage is destroyed, the parts of the bones begin to rub against each other, as a result of which they become denser and expand. This is often accompanied by inflammatory phenomena. Symptoms of the disease are due only to the above processes;calcium salts, if they are deposited in the joints, the cause of the pathology is not. Pathology most often develops in individuals 40 years and older, mainly women and people who are engaged in professional sports or having knee injuries. Articular cartilage does not regenerate, so the disease must be detected and treated early in the early stages.
Causes of gonarthrosisThe disease develops with a combination of several causes:
- fractures of the bones of the lower leg involving the knee joint;
- trauma of cartilage interlayers of the joint - meniscus;
- knee ligament tears;
- increased load on the joint - running, squatting, lifting weights from the vertical position of the body - after 40 years of age, especially if a person does not exercise regularly;
- excess weight
- joint inflammation( arthritis), which has a different - psoriatic, gouty, rheumatoid or reactive - etiology;
- genetically determined weakness of the ligamentous-capsular apparatus of the joint, because of which its loosening occurs;
- pathology of joint innervation, characteristic for craniocerebral and spinal cord injuries;
- metabolic disease.
- 1) Primary. It occurs against the background of full joint health( without pre-injury or inflammation).It is based on metabolic diseases, long reception of hormonal means, genetic predisposition of articular cartilage. The process is usually two-sided( although it can begin as one-sided).It develops more often in the elderly.
- 2) Secondary. Develops due to injuries, inflammations, tumors transferred to the joint operations. Can develop at any age. The process is usually one-sided.
Symptoms of knee joint graft diseaseHow the disease manifests itself will depend on how far the degenerative process has progressed. Depending on this, three stages of the disease are distinguished, each of which has its own symptomatology. As a rule, the first degree of gonarthrosis of the knee joint is manifested by certain symptoms, which are worth paying attention to: the
- feeling of contraction under the knee;
- stiffness in the knee, which manifests itself after sleep, prolonged sitting or prolonged immobility of the joint;
- joint pain:
- arising during prolonged walking, squats, walking on stairs;
- aggravated after standing or physical exertion
- joint swelling may occur for a short time, passes by itself.
- joint pain becomes more intense, lasts longer. It disappears after rest.
- pain is felt inside the joint or on the inside of the knee.
- there is a crunching in the knee when walking.
- in the morning it is impossible to unbend the knee.
- closer to night and at night there are pains in calves. The
- does not fully extend the leg.
- joint swells, acquires signs of initial deformation.
- 1) Pain in the joint is worried constantly, regardless of the physical activity of the person.
- 2) Pain syndrome increases with changing weather.
- 3) The mobility of the joint is limited, due to which the person limps.
- 4) The knee is enlarged and deformed. When the process progresses, the joint becomes an X-shaped or O-shaped.
Diagnosis of gonarthrosisIt is possible to suspect the presence of gonarthrosis of the knee in the patient already on the basis of his complaints and objective examination data. The diagnosis is confirmed with the help of such instrumental studies:
- 1) Radiography. This method may be uninformative at the first stage of the disease, but subsequently it visualizes the narrowing of the joint gap, the compaction of the bone zone below the articular cartilage, and the sharpening of the edges of the condyles.
- 2) Computed tomography of the joint. This is more expensive, but more informative( even at stage I) method based on x-ray radiation. Visualizes the joint itself and surrounding tissues in more detail and layer by layer.
- 3) Magnetic Resonance Tomography - a method based on a non-radiological, considered harmless radiation, which can be used for contraindications to CT.Also layer-by-layer displays the picture in the joint, but is more informative regarding the surrounding soft tissues.
- 4) Arthroscopy is an invasive technique for joint research, when a fiber optic device is inserted into the hole made under local anesthesia, allowing the specialist to examine the joint from the inside.
- 5) The knee ultrasound is informative for the diagnosis of such complication of gonarthrosis as synovitis.
Treatment of knee joint gonarthrosisA doctor who is treating this disease is an orthopedist. Drug therapy of the disease includes the following groups of drugs:
- 1) Non-steroidal anti-inflammatory and pain medications: Voltaren, Celebrex, Rofika, Nimesil, Movalis.
- 2) Chondroprotectors: "Artra", "Arthron", "Dona", "Teraflex", "Chondroitin complex".These drugs are taken for at least six months in the dosage prescribed by the doctor.
- 3) In the joint with pronounced inflammatory phenomena, enter "Hydrocortisone" or "Kenalog" no more than 3 times.
- 4) The preparations of hyaluronic acid are shown, which must be inserted into the joint when the inflammatory phenomena in it subsided: "Hyalurum", "Ostenil", "Sinocrom".These medications show a very good effect, they are administered only a few times, while having a fairly high cost.
- 5) Heating compresses with "Dimexid", "Bischofite", medical bile to improve the blood supply of the joint, increase the production of "lubricating" liquid in it.
- 6) The preparation on the basis of drawing from soya and avocado plants - "Piascladin" - has also proved to be an effective tool in the treatment of gonarthrosis of the knee joint. At the same time, the treatment course is not less than six months.
Physiotherapy for gonarthrosisIn an acute period a person needs to provide complete peace for a diseased knee. Then proceed to the gradual introduction into his regime of the day of physical exertion. Exercises are carried out in the position of the patient lying on his back, they consist mainly in lifting the straightened legs, keeping them in the raised position. It is important to perform exercises smoothly, carefully, so that they do not cause pain. Begin with 10 minutes, gradually, 2 minutes a day, increasing the duration of classes. Increase and the amplitude of movements, which should be selected by specialists individually for each.
Gonarthrosis of the knee joint is the most common disease affecting every fifth person on the globe, most often this pathology affects older women, and the number of sick men in this age group is approximately 2 times less. Often, after injuries or intense sports, problems with the knee joint also arise in very young people. Unfortunately, even the most modern treatment is not able to permanently rid the patient of this disease, but with the early detection of gonarthrosis, with the help of conservative therapy, it is possible to achieve persistent remission and stop the development of the disease.
Osteoarthritis of the knee joint or gonarthrosis is a degenerative-dystrophic disease of the cartilaginous tissue that arises due to increased loads on the knee joint, genetically caused changes in the cartilaginous tissue or injuries that damage the cartilage and ligaments.
The disease develops due to disruption of the normal supply of hyaline cartilage, creating a "layer" between the head of the femur and the bones of the shin. Gradual destruction of the cartilaginous tissue leads to a narrowing of the joint gap, the bones begin to "crush" against each other, further increasing the load on the affected joint and causing the patient pain and restricted movement in the joint. If the gonarthrosis is not treated, the cartilage can completely disappear, and the bone tissue - deform, they form osteophytes( bone spines along the edges of the articulations), which limit movement in the joint and cause severe pain. In the future, the leg can become completely immobile, also at this stage of the disease, aseptic inflammation arises in the joint, fluid accumulates in the cavity, it is possible to attach a secondary infection and develop complications.
Causes of gonarthrosis disease
Gonarthrosis is a chronic disease that is conditionally divided into 2 types:
Primary - resulting from a metabolic disorder in the articular tissue, this type is typical for the elderly, who suffer from excess weight and chronic diseases of the internal organs. In this case, the cause of degenerative-dystrophic changes is a gradual "wear", galling of cartilage as a result of increased load on the knee joints with excess weight and insufficient blood supply.
The risk group includes:
- people suffering from excess weight and lack of physical activity;
- persons, due to professional or other features, spending a lot of time standing on their feet;
- patients with metabolic disorders, for example, with diabetes mellitus;
- with violation of venous circulation in the lower limbs;
- women in the menopause due to hormonal disorders and so on.
Secondary gonarthrosis develops after a trauma or after a knee joint illness. A similar disease can occur in athletes who have repeatedly received microtraumas of the knee, or too greatly increase the load on the lower limbs in training. Also, secondary gonarthrosis affects people suffering from arthritis and other inflammatory diseases.
The symptoms of gonarthrosis depend on the degree of damage to the hyaline cartilage:
1 degree - the initial stage of the disease can last for several months or even years, the patient periodically experiences minor pain in the leg, appearing after a long walk, with a sharp straightening of the knee joint or if it becomes necessary to quickly get up from the sitting position and so on. Then the morning stiffness joins, the leg is bent with difficulty, there is a restriction of movement in the knee, during the day the diseased leg "diverges" and the unpleasant sensations disappear. At this stage the cartilage is gradually thinner, but continues to perform its functions, the bones are not deformed and the joint is not changed externally. It is most effective to start treatment at this stage, when there are no structural changes in the cartilaginous tissue and with the help of conservative methods it is possible to achieve its regeneration.
2 degree is a developed stage, characterized by pain intensification, they occur even after a minimal load on the aching leg or immediately after it. During the rest, the pain disappears, but when walking or lifting, the severity of the patient may be greatly disturbed. There is a characteristic sound - a rough, loud crunch in the knee joint with bumps to bend the leg or to unbend it, a restriction in the movements increases, the leg can be bent only up to 90 degrees or less, the gait of the patient changes, he tries to instinctively save the leg, transferring the support to a healthy limb. Arthrosis of the 2nd degree is easy to determine visually - the knee increases in size, deformed, possibly redness and swelling of the tissues.
3 degree - severe - the pain intensifies, becomes permanent, tortures the patient even at rest. The intensity of pain increases, now they do not allow the patient to sleep, walking becomes a real torture, limiting movement reaches a maximum: it is almost impossible to bend or unbend the leg. At this stage, the patient moves with the help of a cane, crutches, or generally loses the ability to walk independently. The deformation of the joint is visible to the naked eye, the joint is greatly enlarged, like a ball.
Diagnosis of the disease on the basis of patient complaints, examination of the damaged joint and the presence of characteristic changes on the radiograph of the joint.
Principles of treatment
Treatment of gonarthrosis should be comprehensive, it is necessary not only to reduce pain and relieve inflammation in the joint, but also to restore lost mobility by improving cartilage nutrition, increasing blood circulation, reducing pressure on the damaged joint and strengthening the knee muscles.
The standard of therapeutic treatment of gonarthrosis is the use of:
- non-steroidal anti-inflammatory drugs - NSAIDs - diclofenac, piroxicam, indomethacin, ketoprofen and others - they allow you to quickly remove pain and inflammation, but do not affect the cause of the disease;
- chondroprotectors - glucosamine, chondroitin sulfate - are indispensable drugs in the early stages of the disease, they affect the cause of the disease. These substances nourish and repair damaged cartilaginous tissue, enabling the repair of damage;
- intra-articular injections - means for emergency care, most often the joints are injected with corticosteroid hormones, which provide a quick analgesic and anti-inflammatory effect. Hyaluronic acid preparations are also introduced, which replace the intra-articular fluid, facilitating gliding of the bones along the cartilaginous tissue;
- external means - various creams, ointments and compresses - refer to symptomatic treatment, allowing to alleviate the condition of the patient;
- additional methods of treatment: physiotherapy, manual therapy - in the initial stages of the disease are able to produce a significant therapeutic effect, restoring the mobility of the joint, improving its nutrition and circulation;
- curative gymnastics is an obligatory element of the disease treatment, it should be performed at any stage of the disease, its main purpose is to "develop" the knee joint, restore lost mobility, strengthen muscles, stimulate blood circulation and nutrition. For each patient an individual exercise program is prepared, taking into account his condition and degree of gonarthrosis, but even at stage 3 of the disease, in a serious condition, once the inflammatory processes are eliminated, the patient must begin to exercise, gradually increasing the load. If the doctor does not contact the doctor in time, when the deformity of the bones has already occurred, constant pains make the patient spare his leg, thereby only aggravating the situation. The muscles of the diseased limb are gradually atrophied, the blood supply and nutrition of the tissues deteriorates, and the degree of restriction of movement increases. Therapeutic gymnastics is one of the most effective therapeutic methods, it is absolutely financially inexpensive, does not require special devices or simulators, but regular and correct exercise is necessary to improve the patient's condition.
In case of severe disease, in the case of ineffective therapeutic treatment, patients with gonarthrosis are offered a small surgical intervention: meniscus replacement, plastic surgery to replace ligaments, removal or transplantation of damaged cartilage or an operation to replace a deformed joint with an endoprosthesis. The volume of surgical interventions depends on the degree of deformation of bone tissues, but modern operations allow almost completely to restore the lost mobility and significantly improve the patient's standard of living. Indications and contraindications for the surgical operation are determined individually.
Gonarthrosis is a chronic disease that can completely change a patient's life, turning a healthy, full of human strength into a helpless invalid who is unable to move independently. To avoid the development of the disease and the occurrence of complications, it is necessary to consult a doctor and begin treatment when the first signs of the disease appear. Early diagnosis and timely treatment of gonarthrosis in 90% of cases guarantee the preservation of all functions of the knee joint.