Gonarthrosis of the knee joint is the most common localization of degenerative-dystrophic disease, which is characterized by gradual destruction of cartilage with subsequent changes in joint surfaces, which is accompanied by pain and reduced mobility.
The disease is more likely to affect women over the age of 40, especially those who are overweight and have varicose veins in the lower extremities.
The knee joint consists of three compartments:
- medial tibiofemoral;
- lateral tibiofemoral;
- suprapatellar-femoral.
These compartments can be affected by deforming osteoarthritis (DOA) either individually or in any combination. 75% of all cases of gonarthrosis are the destruction of the medial tibiofemoral department (during movement he experiences a load exceeding the body weight 2-3 times).
In young patients, only one joint is more often destroyed - the right or left (right or left gonarthrosis).
Causes of DOA of the knee joint
Several factors may be involved in the development of degenerative changes in cartilage simultaneously:
- mechanical overload of the knee joint (some specialties, sports) with microtrauma of cartilage;
- consequences of injuries, surgical interventions (meniscectomy);
- inflammatory diseases of the knee (arthritis);
- anatomical discrepancies of joint surfaces (dysplasia);
- violation of statics (flat feet, curvature of the spine);
- chronic hemarthrosis (accumulation of blood in the synovial cavity);
- metabolic pathology (gout, hemochromatosis, chondrocalcinosis);
- overweight;
- disorders of the blood supply to the bones;
- osteodystrophy (Paget's disease);
- neurological diseases, loss of sensation in the limbs;
- endocrine disorders (acromegaly, diabetes mellitus, amenorrhea, hyperparathyroidism);
- genetic predisposition (generalized forms of osteoarthritis);
- impaired type II collagen synthesis.
But in 40% of cases it is impossible to determine the root cause of the disease (primary osteoarthritis).
Pathogenesis of gonarthrosis
beginning phase
In the initial stage of the disease, the processes of cartilage metabolism are disrupted. The synthesis and quality of the basic structural unit of cartilage tissue, proteoglycans, which are responsible for the stability of the structure of the collagen network, are reduced.
As a result, chondroitin sulfate, keratin, hyaluronic acid are washed out of the network and structurally defective proteoglycans can no longer retain water. It is absorbed in collagen, whose swollen fibers reduce the resistance of cartilage to stress.
Pro-inflammatory substances accumulate in the synovial cavity, under the influence of which the cartilage is destroyed even faster. Fibrosis of the joint capsule develops. The change in the composition of the synovial fluid makes it difficult to deliver nutrients to the cartilage and disrupts the sliding of the joint surfaces during movement.
Progression of the pathology
In the future, the cartilage gradually thins, becomes rough, cracks are formed along its entire thickness. The pineal glands of the bones experience an increased load, which provokes the development of osteosclerosis and compensatory proliferation of bone tissues (osteophytes).
This reaction of the body is aimed at increasing the area of joint surfaces and redistribution of the load. But the presence of osteophytes increases discomfort, deformity and further limits limb mobility.
Microfractures form in the thickness of the bone, which damage the vessels and lead to intraosseous hypertension. In the last stage of osteoarthritis the joint surfaces are completely exposed, deformed, the movements of the limbs are sharply limited.
Symptoms of gonarthrosis of the knee joint
Osteoarthritis of the knee joint is characterized by a chronic, slowly progressive course (months, years). The clinic is growing gradually, without pronounced exacerbations. The patient cannot remember exactly when the first symptoms appeared.
Clinical manifestations of gonarthrosis:
- pain. Initially diffuse, short (with prolonged standing, walking up the stairs), and with the progression of osteoarthritis the pain becomes local (front and inner surface of the knee), their intensity increases;
- local sensitivity on palpation. Mostly on the inside of the knee along the edge of the joint space;
- crunching. In stage I it may not be heard, in stage II-III it accompanies all movements;
- increase in volume, deformity of the knee. As a result of the weakening of the lateral ligaments, a person develops an O-shaped configuration of the limbs (this is clearly visible even in the photo);
- restriction of mobility. At first there are difficulties with bending the knee, later - with unfolding.
Causes of DOA pain:
- mechanical friction on damaged joint surfaces;
- increased intraosseous pressure, venous congestion;
- joining synovitis;
- changes in the periarticular tissues (stretching of the capsule, ligaments, tendons);
- thickening of the periosteum;
- phenomena of dystrophy in neighboring muscles;
- fibromyalgia;
- compression of nerve endings.
Unlike coxarthrosis, DOA of the knee may show spontaneous regression of symptoms.
Clinical manifestations of gonarthrosis depending on the stage:
> zxtable border = "1" cellpadding = "0" >A common complication of osteoarthritis of the knee is secondary reactive synovitis, which is characterized by the following symptoms:
- increasing pain;
- puffiness;
- effusion in the synovial cavity;
- increase in skin temperature.
Less common and more dangerous complications include: joint blockage, osteonecrosis of the condyle of the femur, subluxation of the patella, spontaneous hemarthrosis.
Diagnosis of DOA of the knee joint
The diagnosis of gonarthrosis is based on the patient's typical complaints, the changes found during the examination and the results of additional tests.
To confirm osteoarthritis is prescribed:
- radiography of the knee joint in two projections (anterior-posterior and lateral): the most accessible way to confirm the diagnosis at an advanced stage of the pathology;
- Ultrasound: determining the presence of effusion in the joint, measuring the thickness of cartilage;
- synovial fluid analysis;
- diagnostic arthroscopy (visual assessment of cartilage) with biopsy;
- Computed tomography and magnetic resonance imaging (CT, MRI): the best method for diagnosing DOA in the early stages.
If the doctor has doubts about the diagnosis, he may prescribe:
- scintigraphy: scanning of the joint after introduction of a radioactive isotope;
- thermography: study of the intensity of infrared radiation (its strength is directly proportional to the strength of inflammation).
Treatment of gonarthrosis of the knee joint
The osteoarthritis treatment scheme combines several approaches: non-drug methods, pharmacotherapy and surgical correction. The ratio of each method is determined individually for each patient.
Non-drug treatment
In the latest ESCEO (European Society for the Clinical Aspects of Osteoporosis and Osteoarthritis) guidelines on how to treat osteoarthritis of the knee, experts place particular emphasis on patient education and lifestyle change.
The patient needs:
- explain the nature of the disease, tuned for long-term treatment;
- learn how to use aids (canes, orthoses);
- prescribing a diet (for patients with a body mass index over 30);
- give a set of exercises to strengthen the muscles of the thighs and unload the knee joint;
- explain the importance of increased physical activity.
In the early stages of osteoarthritis of the knee physiotherapy treatments give good results:
- massage;
- magnetic therapy;
- UHF therapy;
- electrophoresis;
- hydrogen sulfide baths;
- paraffin applications;
- acupuncture.
Pharmacotherapy of gonarthrosis
The use of drugs in DOA is aimed at relieving pain, reducing inflammation and slowing the rate of cartilage destruction.
Symptomatic treatment:
- analgesics;
- non-steroidal anti-inflammatory drugs (NSAIDs) from the group of COX-2 inhibitors in the form of tablets or suppositories;
- non-narcotic analgesics (with resistant pain syndrome).
Structurally modifying drugs (chondroprotectors):
- chondroitin sulfate;
- Glucosamine sulfate.
These drugs can be taken in the form of capsules in courses several times a year, injected intramuscularly or directly into the synovial cavity.
Topical therapy includes intra-articular injections of glucocorticosteroids, hyaluronic acid preparations.
In stages I-II of DOA, the use of anti-inflammatory ointments, gels and creams based on NSAIDs occupies an important place in complex therapy. They help reduce the patient's need to take NSAIDs orally, thus reducing the risk of damage to the digestive tract.
Folk remedies
The use of tinctures, decoctions, extracts, topical applications of medicinal plants should be considered as ancillary methods for the treatment of DOA, folk remedies can not replace the therapy prescribed by a doctor.
Plants used in osteoarthritis: dandelion, ginger, Jerusalem artichoke, burdock, garlic, sea buckthorn.
Surgery
Surgery may be required at all stages of gonarthrosis with insufficient effect of medical measures. The most common are endoscopic procedures, in the most severe cases, replacement of the endoprosthesis is indicated.
Types of endoscopic interventions:
- revision and rehabilitation of the joint: extraction of inflammatory contents from the synovial cavity, fragments of cartilage;
- plasma or laser ablation: removal of mechanical obstructions in the synovial cavity;
- chondroplasty.
Corrective periarticular osteotomy is indicated in patients with initial manifestations of axial limb deformity (not more than 15-20%).
The purpose of the operation is to restore the normal configuration of the joint, to evenly distribute the load on the joint surface and to remove the damaged areas. This procedure allows you to delay arthroplasty.
Indications for replacement of the affected area (or the whole joint) with an artificial one:
- DOA II-III degree;
- severe axial deformity of the limb;
- aseptic necrosis of the subchondral bone layer;
- constant pain syndrome.
Contraindications for knee arthroplasty:
- complete joint damage;
- unstable ligament apparatus;
- DOA as a consequence of inflammatory arthritis;
- constant flexion contracture, severe muscle weakness.
In this case, the patient undergoes arthrodesis - a comparison of the knee joint in a physiological position with the removal of joint surfaces. This relieves pain but shortens the legs, causing secondary lesions in the contralateral knee, thigh and spine.
Prevention
Prevention of premature cartilage degeneration should begin in childhood.
Precautions:
- prevention of scoliosis;
- correction of flat feet (shoes with arch supports);
- regular physical education (limit heavy sports);
- exclusion of fixed postures during operation.