Gonarthrosis, or deforming arthrosis of the knee joint, is a degenerative dystrophic disease of the hyaline cartilage of the knee, which covers the condyles of the tibia and femur.
The symptoms of osteoarthritis of the knee joint develop over the years, gradually, and the main manifestation of the disease is stiffness of movement and pain.Among arthrosis of other joints (phalanges of the fingers, shoulder and elbow joints, hip joints), gonarthrosis is the most common disease.
The category of the population most susceptible to arthrosis of the knee joint is women, as well as people over 40 years old.In some cases, gonarthrosis can develop in athletes (due to increased stress) and in young people (against the background of previous injuries).
Causes of gonarthrosis
Knee joint osteoarthritis does not develop from a single cause;In most cases, the development of the disease depends on a combination of several negative factors, which worsen with age and can lead to such a disorder.Medicine identifies the following mechanisms for the occurrence of arthrosis:
Primary – occurs in old age due to the aging of body tissues, as well as against the background of some factors that provoke this disease (constant increase in stress, heredity, obesity).
Secondary – is responsible for 30% of all cases of gonarthrosis, occurring mainly after meniscus injury, ligament rupture, tibial fracture and other injuries.In most cases, symptoms of knee osteoarthritis begin to appear after 3-4 years.However, if the injury is severe enough, it may take 2 to 3 months for symptoms to appear.
Around 7-8% of cases of osteoarthritis of the knee joint occur when, after forty years, the person begins to actively practice physical exercise, namely squatting and running.However, due to age, weakening of the tone of the knee joint tissue and characteristic age-related changes under sudden loads can provoke the appearance of rapid degenerative and dystrophic changes in the joints.
Another reason for the development of gonarthrosis in a person may be concomitant diseases - varicose veins, excess weight, ankylosing spondylitis, gout, psoriatic, rheumatoid or reactive arthritis.
Constant critical loads on the knees, long-term regular climbing of stairs in old age or heavy lifting, as well as professional sports can lead to arthrosis of the knee joint.The risk of arthrosis of the knee joint increases significantly with genetic weakness of the ligamentous apparatus, diabetes mellitus and other metabolic disorders, neurological diseases and spinal injuries.
Spasm of the muscles in the anterior part of the thigh is the cause of 50-60% of cases of arthrosis of the knee joint.This muscle spasm may not manifest itself for a long time before knee pain appears, while the person may feel heaviness in the legs, fatigue and pain in the lower back.When the iliopsoas and rectus femoris muscles are in a state of constant spasm, with age this leads to “tightening” of the knees, which limits their free movement.
Degrees of gonarthrosis
In most cases, the development of osteoarthritis of the knee joint occurs in one of the knees.Medicine distinguishes 3 degrees of gonarthrosis depending on the intensity of pathological processes:
The first is that there is no deformation of the joint bones;Periodic dull pain in the knee is characteristic after physical stress on the joint.A small swelling of the joint may occur, which disappears on its own after some time.
The second degree is characterized by an increase in osteoarthritis symptoms.The pain is long-lasting and intense and occurs with minimal effort (weight lifting, walking), and a grinding sound may also appear in the joint.In the second degree of gonarthrosis, deformation of the knee joint may occur, as well as moderate limitation of movement.
Third degree – presents pronounced symptoms of arthrosis of the knee joint.Noticeable deformation of the joint and constant pain lead to disturbances in the patient's gait and there is limited mobility of the joint.In the third degree of gonarthrosis, the pain can intensify depending on the weather and reach such intensity that the patient's sleep is disturbed, the limitation of mobility is reduced to a minimum, which makes it impossible to find a comfortable position for the leg.
Diseases and pathologies with which gonarthrosis is confused
Blocking the knee joint in case of meniscus injury.
The disease develops after an unsuccessful movement, accompanied by a crisis in the knee, intense pain appears, which subsides after 15 minutes, and the next day there is swelling of the knee.
Ankylosing spondylitis, gout, joint rheumatism, arthritis - psoriatic, reactive, rheumatoid.
To distinguish gonarthrosis from arthritis, it is necessary to do a general blood test.With arthritis, test results will indicate the presence of an inflammatory process in the body, while with arthrosis, no changes occur in the blood test.
Inflammation of the knee tendons.
It develops in most cases in women over 40 years of age, when carrying heavy objects or going down stairs.The pain is localized on the inner surface, but knee movement is not limited.
Vascular pain in the knees.
The pain is characterized by symmetry and occurs in both knees at the same time.Characteristic of young people during a period of accelerated bone growth, they can occur during physical activity, a cold or a change in weather.To describe their own condition, patients use the term “twisted knees.”
Stages of arthrosis of the knee joint
The disease is insidious due to its gradual development.Initially, the patient only feels minor discomfort, pain when moving, going up or down stairs.In some cases, the patient's sensations are reduced to slight stiffness of the joint and tightness in the popliteal region.A characteristic feature of arthrosis of the knee joint is considered to be an initial pain symptom, which consists in the fact that after a sharp transition from a sitting position to movement, a person begins to feel pain during the first steps, which gradually disappear, only to appear again after a heavy load.
The appearance of the knee joint with first-degree arthrosis does not differ from a healthy knee, only in some cases patients notice slight swelling.Furthermore, in some cases, fluid begins to accumulate in the knee joint, it swells and becomes spherical, and synovitis begins to develop, which leads to a feeling of heaviness and limited movement of the joint.
Such changes in the joint in the first degree of arthrosis occur due to interruption of blood circulation in the small intraosseous vessels that nourish the hyaline cartilage.This leads to changes in the surface of the cartilage, drying out, loss of smoothness and the appearance of cracks.Because of this, smooth and unhindered movement between the cartilages is difficult and is accompanied by constant microtraumas when the cartilages cling to each other.Cartilaginous tissue, in a constant state of microtrauma, begins to lose its shock-absorbing properties and become thinner.
The development of pathological processes leads to changes in bone structures.The joint area is flat and spine-like protuberances (osteophytes) appear along the edges.The joint capsule degenerates, the joint fluid thickens, and the synovial membrane shrinks.This leads to a significant deterioration in the nutritional process of the cartilage and accelerates its degeneration.
As the disease progresses to the second stage, the symptoms begin to intensify, pain occurs even with light loads and is localized in the inner front part of the joint.Rest brings relief, but resuming movement causes severe pain.
The mobility of the joint is significantly reduced, attempts to bend the leg as much as possible cause sharp pain, and a distinct harsh crunch is heard during movement.Synovitis is more common;the joint increases in size and changes configuration due to the large accumulation of liquid.
The third degree of arthrosis of the knee joint is accompanied by significant deformation of the bones, in which they seem to be pressed against each other.There is practically no cartilaginous tissue and the limitation of joint movement increases.Straightening the joints becomes quite problematic and the pain begins to bother the patient all the time, both when walking and at rest.Due to the strong deformation of the joints, the legs acquire an O or X shape, the gait becomes unstable, waddling and the patient is often unable to live without a cane or crutches.
Diagnosis and treatment of gonarthrosis
During a routine examination, it is impossible to determine whether a patient has first-degree arthrosis of the knee joint.If there is grade 2 or 3, on examination there is swelling, edema (with synovitis), a crunching sound is heard, stiffness of movements is observed, a change in the axis of the limbs and deformation of the joints is noticeable.
Today, in addition to radiography, computed tomography and magnetic resonance imaging methods are widely used to diagnose arthrosis, thanks to which it is possible to study disorders of bone structures in more detail and examine pathological changes in soft tissues.
Treatment of the disease involves a complex of orthopedic procedures and drug therapy.An orthopedist prescribes mud therapy, therapeutic exercises, massage and physiotherapy.
Drug treatment involves the use of chondoprotectors, these are medications that replace synovial fluid.In some cases, intra-articular injection of steroid hormones is performed.Patients are also recommended to undergo sanatorium treatment.
If the treatment of a young patient with severe limitation of movement and pain is ineffective, a joint replacement method can be used, which provides for a rehabilitation period of 3 to 6 months.
What happens to the knee joint with osteoarthritis?
Articular cartilage plays an important role in human movement and is a smooth, elastic and durable coating, thanks to which the articulated bones move smoothly with each other, as well as absorb and distribute the load when walking.
But with regular excessive loads, genetic predisposition, metabolic disorders in the body, prolonged muscle spasms and injuries, the cartilage loses its smoothness and begins to thin.The smooth sliding of the articulating bones is replaced by strong friction, and the first degree of gonarthrosis develops, in which the cartilage loses its shock-absorbing properties.
The degradation process continues to progress and poor shock absorption leads to the flattening of bone surfaces with the formation of osteophytes in the form of bone growths.In this case, the disease already has a second degree and is accompanied by degeneration of the synovial membrane and joint capsule.The lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the process of nourishing the cartilage is disturbed, which leads to an even greater deterioration in the patient's condition.
The thinning of the cartilage leads to a reduction in the distance between the articulating bones by up to 80%.When walking, due to abnormal friction and the absence of a shock absorber, destructive processes in the joint rapidly increase, which quickly leads to the development of the third degree of arthrosis with pronounced symptoms:
Pain when moving, especially when going up or down stairs.
Pain during exercise and at rest, morning stiffness.
The patient begins to limp, trying to spare the painful joint.
Severe cases of the disease require the use of crutches or a cane.
The third degree of arthrosis of the knee joint is characterized by an almost complete absence of cartilaginous tissue, which leads to a minimal decrease in joint mobility.Therefore, no magical methods, supermedicines or ointments can restore worn-out cartilaginous tissue, and given the degree of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.
Gymnastics for arthrosis of the knee joint
Any treatment option for osteoarthritis of the knee joint should only be carried out as prescribed by a doctor.Therapeutic gymnastics involves slow, measured exercises that exclude squats, joint twisting and jumping.It is best to do gymnastics in the morning, sitting or lying down, for 20 minutes, repeating each exercise 10 times.
The main goals of therapeutic exercise are to relax muscle spasms that cause pain, increase blood supply to the joint, slow the progression of the disease, and prevent further cartilage destruction.During the period when the disease worsens, physical exercise is prohibited.
Lying on your back, you can perform the bicycle exercise, but you need to stretch your legs parallel to the floor, make circular movements with your feet, move your legs to the sides, sliding them alternately across the floor, stretch your feet and count to 10.
Sitting on a chair with your legs lowered, straighten your legs, simultaneously bending your feet, and maintain this position, counting to 10, alternately pull each knee to your stomach with your hands and slowly return to the starting position.
Focusing on the wall, standing on the floor, alternately swing your legs back and forth.
Placing your leg straight on a chair, perform inclined and elastic movements, while resting your hands on your thigh, as if trying to stretch your leg further.
Lying on your stomach, alternately lift your straight leg and hold it for up to 3 counts.
Sitting on the floor, spread your legs to the sides, moving them along the floor, pull your knees to your stomach as you inhale and return them to the starting position as you exhale.