Osteoarthritis of the knee joint

The knee joint is regularly stressed. Running and jumping, walking and climbing stairs or just standing affect the condition of the cartilage tissue in the knee. If the balance in the cartilage is disturbed, osteoarthritis of the knee joint begins to develop - gonarthrosis.

Gonarthrosis is an arthrosis that deforms the knee joint and is accompanied by chronic damage to the surfaces of the hyaline cartilage and bones - femur and tibia. Symptoms of the disease in the knee joint are pain that increases with movement. Movement is restricted due to the accumulation of fluid within it. Later, due to an injury to the support function in the leg, knee movements are restricted. The diagnosis of pathology is based on collecting the patient's history and complaints, the results of a visual examination and hardware studies of the knee joint. Such age-related diseases of the musculoskeletal system occur in almost everyone as they get older.

General information

Gonarthrosis (from Latin articulatio genus - knee joint) is the most common arthrosis, which is a degenerative-dystrophic progressive damage to the cartilage of the knee joint of a non-inflammatory nature. Women and older people usually suffer from gonarthrosis. But gonarthrosis also occurs in young people after injuries during intensive sports.

The cause of osteoarthritis lies in a change in the cartilage structure inside the joint and not in the deposition of salts there. In the case of gonarthrosis, salt deposits occur at the attachment of the tendons to the ligaments, but these cannot be the cause of pain symptoms. First, cracks appear in the cartilage, which leads to a reduction in thickness in some places. Gradually, the load is redistributed, the joint begins to come into contact with the bones, which accelerates the painful process. This leads to the following changes in the knee joint:

• Thinning of knee cartilage to the point of disappearance;
• Changes in synovial fluid composition and quantity;
• Damage to the knee bones due to friction;
• the appearance of osteophytes;
• Stiffness due to compaction of the joint capsule;
• Muscle cramp.

This causes the knee joint to become deformed and its mobility is restricted, which can lead to disability and loss of ability to work.

Osteoarthritis of the knee joint can occur unilaterally and affect only one knee of the right or left leg; With bilateral osteoarthritis, both knee joints are affected.

Symptoms of osteoarthritis of the knee joint

The symptoms of knee osteoarthritis can be very different:

• When climbing stairs, slight discomfort initially occurs, then the pain syndrome increases and torments even at rest;
• Stiffness occurs in the morning, it initially lasts a few minutes, then it can last up to half an hour;
• a sharp crunch occurs, which is accompanied by pain even in the second degree of damage;
• Mobility is limited, it is difficult to bend and straighten the knee due to pain, bone friction and osteophyte growth; the joint can become blocked in the final stage (ankylosis);
• unstable gait due to muscle atrophy (reduction in muscle volume);
• Deformation of the knee joint due to bone growth and changes in their shape, the occurrence of an inflammatory process in the muscles and ligaments increases swelling around the joint tissue;
• Lameness as a result of the progression of the disease of the knee joint; in later stages the patient is forced to even walk with a walking aid.

Osteoarthritis begins gradually. In the 1st stage of gonarthrosis, patients experience slight feelings of stiffness and pain that occur when walking up or down stairs. Possible tightening of the area under the knee. The beginning of pain sensations that arise from a sitting position at the beginning of the ascent are characteristic. The pain decreases when the patient moves away, but recurs upon exertion.

There are no external changes to the knee. Sometimes swelling and the development of synovitis are possible – fluid accumulation with enlargement, swelling of the joint, while feeling of heaviness and limitation of movement occur.

In stage 2, severe pain occurs with prolonged exertion and increases when walking. The pain is usually localized along the front surface in the joint. The pain disappears after rest, but recurs with movement.

As osteoarthritis progresses, the number of movements in the knee joint decreases; When trying to bend the leg as much as possible, pain and a rough, sharp crunch occur. The configuration changes, the joint expands. Synovitis occurs with an even larger accumulation of fluid.

In stage 3, the pain becomes constant and disturbs not only when walking but also at rest. Painful sensations also occur at night; To fall asleep, patients need a long time to find a position for their leg. Flexion and extension of the joint are restricted. Sometimes the patient cannot fully straighten the leg. The joint is enlarged and deformed. Sometimes patients experience valgus deformity of the legs; they become X-shaped or O-shaped. Due to the leg deformity and limitation of movement, the patient's gait becomes unstable and waddles. In severe cases of gonarthrosis, patients move with the support of crutches.

Causes of osteoarthritis of the knee joint

Most cases of osteoarthritis occur for several reasons. These factors include:

• Injuries.25% of gonarthroses are caused by injuries: meniscus damage, ligament tears. Gonarthrosis usually occurs three to five years after the injury, but sometimes the disease can develop earlier - after two to three months.
• Physical movement.Often, gonarthrosis occurs after the age of 40 due to professional sports and excessive physical stress on the knee joint, which leads to the development of degenerative-dystrophic changes. Fast running and intensive squats are particularly dangerous for the joints.
• Overweight.Being overweight significantly increases the load on the knee joints and leads to injuries. Gonarthrosis is particularly difficult if metabolic disorders and varicose veins are present.
• Sedentary lifestyle.

The development process of gonarthrosis increases with arthritis due to gout or ankylosing spondylitis. The risk of gonarthrosis lies in genetic weakness of the ligaments and impaired innervation in neurological diseases.

Pathogenesis

The knee joint is formed by the surfaces of the femur and tibia. The patella is located in front of the surface of the knee joint. It slides between the grooves of the femur as it moves. The articular surfaces of the tibia and femur are covered with very strong, smooth and elastic hyaline cartilage up to six mm thick. When you move, the cartilage reduces friction and acts as a shock absorber.

There are 4 stages of osteoarthritis:

• 1st stage.There is a circulatory disorder in the vessels that supply the hyaline cartilage. Its surface becomes dry and small cracks form, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner and sticks instead of sliding smoothly and loses its shock-absorbing properties. There are no visual signs of osteoarthritis; a slight deviation can be seen on the x-ray.
• 2nd stage.Changes occur in the structure of the bones and the joint area becomes flattened in order to be able to absorb higher loads. The part of the bone that is under the cartilage becomes denser. The first manifestations of calcification of the ligaments appear along the edges of the joint - osteophytes, which look like thorns on the X-ray; A narrowing of the joint space is also visible. The synovial capsule of the joint degenerates and becomes wrinkled. The fluid in the joint thickens, its viscosity increases and its lubricating properties deteriorate. The degeneration process of the cartilage accelerates, it becomes thinner and in some places disappears completely. After its disappearance, friction in the joint increases and degeneration progresses rapidly. Patients experience pain when exercising, climbing stairs, squatting and standing for long periods of time.
• 3rd stage.The x-ray shows a noticeable, sometimes asymmetrical narrowing of the joint space. As the meniscus deforms, the bones deform and press against each other. Due to the large number of large osteophytes, movement in the joint is restricted. There is no cartilage tissue. Constant pain plagues the patient at rest and walking without support is impossible.
• 4th stage.Movements in the knee joint are impossible, X-rays show complete deformation of the cartilage and destruction of the articular bones, many osteophytes and the bones can fuse together.

classification

Considering the pathogenesis of the disease, two types are distinguished: primary - idiopathic and secondary gonarthrosis. The primary disease occurs without injury, usually in older patients, and is bilateral. Secondary arises as a result of diseases and developmental disorders or against the background of injuries in the knee joint. It can occur at any age and is usually one-sided.

diagnosis

The diagnosis of joint arthrosis is made by an orthopedist or traumatologist in a medical clinic.

• The appointment begins with taking anamnesis - the main complaints and symptoms that worry the patient. The doctor determines complaints, the presence of chronic diseases, past injuries, fractures and injuries and asks additional questions.
• During the examination, joint mobility, deformation and pain characteristics are noted. In stage 1 of gonarthrosis, the patient shows no external changes. In the 2nd and 3rd stages, deformation and coarsening of the joint contours, restricted movement and curvature of the legs are noted. When the patella moves, a sharp crunch is heard. When palpated, the doctor notices pain in the inner part of the joint space. The joint may increase in size. Swelling of the joint is noted. Fluctuations can be felt when palpating the joint.
• The patient is referred for laboratory tests. A general blood test detects inflammation, while a biochemical test uncovers possible causes of problems.
• Next, instrumental diagnostics of the patient is required. X-rays are used for this. X-ray is a diagnostic method that allows you to detect signs of knee arthrosis: narrowing of the joint space, osteophytes and bone deformations. X-ray of the joint is a technique that clarifies the diagnosis of pathological changes and the dynamics of arthrosis. At the beginning of gonarthrosis, changes are not visible on the X-ray. Subsequently, a narrowing of the joint space and a compaction of the subchondral zone are noted. Gonarthrosis can only be diagnosed through x-rays and clinical tests.
• Nowadays, to diagnose osteoarthritis, in addition to radiography, computed tomography (CT) is also used, which allows a detailed examination of bone changes, as well as magnetic resonance imaging (MRI), which allows a visual assessment of the condition of bones of the joint and is used to detect changes in themuscle tissue and ligaments.
• During an ultrasound examination (ultrasound), the condition of the tendons, muscles and joint capsule is assessed.
• Fluid is drained from the affected joint so that a camera can be used to view the inside of the joint (arthroscopy).

If necessary, the doctor prescribes studies and additional consultations with more specialized specialists.

Treatment of arthrosis of the knee joint

Treatment of osteoarthritis can be divided into three groups:

• medical;
• Physical therapy;
• surgical.

Osteoarthritis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment begins early. If osteoarthritis worsens, doctors recommend maximum protection of the joint. Patients are prescribed the necessary procedures: exercise therapy, massage, mud therapy.

When a patient is diagnosed with stage 1 and 2 disease, medication and physical therapy are used; if the lesion is large, surgical intervention and surgical intervention are used.

Medication

Proper administration of medication can stop pain and inflammation and slow down the process of destruction of cartilage tissue. It is therefore important to see a doctor promptly.

Important – do not self-medicate. Incorrect medication, taken independently and without consulting a doctor, can only aggravate the situation and lead to serious complications.

Drug therapy for osteoarthritis includes taking the following medications:

• anti-inflammatory:Relieve inflammation and relieve joint pain;
• hormonal:prescribed when anti-inflammatory drugs are ineffective;
• antispasmodics:help get rid of muscle spasms and alleviate the patient's condition;
• Chondroprotectors:Improving metabolic processes in the joint and helping to restore joint function, as well as drugs that replace synovial fluid;
• Drugs to improve microcirculation:Improving nutrition and oxygenation.

Depending on the specific situation, tablets, intra-articular injections of steroid hormones and local forms of medicine are used. The medication is selected by the attending physician. Sometimes a patient with arthrosis is sent to a sanatorium for treatment and is recommended to walk with crutches or a cane. Individual orthoses or special insoles are used to relieve the knee joint.

In addition, complex non-drug methods are used to treat arthrosis:

• Physiotherapy (Physiotherapy)which is carried out under the supervision of a specialist;
• Massage coursesin the absence of an inflammatory process;
• osteopathic effectin the treatment of arthrosis, aimed not only at the affected area, but also at restoring the resources of the entire organism, since the pathological process occurring locally in the joint area is the result of many processes occurring throughout the body. During the osteopathic session, the entire musculoskeletal system is worked to achieve maximum restoration of innervation and mobility of the spine, pelvic bones and sacrum, eliminating compression of nerves and blood vessels throughout the body!

physical therapy

Physiotherapeutic methods are used to improve blood circulation in the joint, increase its mobility and enhance the medical effect of medications. The doctor may prescribe the following procedures:

• Shock wave therapy:Ultrasound eliminates osteophytes;
• Magnetic field therapy:the magnetic field influences metabolic processes and stimulates regeneration;
• Laser therapy:Laser heating of deep tissues;
• Electrotherapy (myostimulation):electric shock to muscles;
• Electrophoresis or phonophoresis:Administration of chondroprotectors and analgesics using ultrasound and electric current;
• Ozone therapy:Injection of gas into the joint cavity.

surgery

Even with correctly selected treatment methods, treatment methods are ineffective in some cases. Then the patient with severe pain syndrome is prescribed surgical treatments and operations for knee arthrosis:

• Endoprosthetics:replacement of the entire joint with a prosthesis;
• Arthrodesis:Fastening between bones for their immobility, to relieve pain and allow a person to lean on the leg;
• Osteotomy:Cut a bone to place it at an angle in the joint to reduce stress.

If endoprosthesis replacement is not possible, arthrodesis and osteotomy are used.

prevention

Preventive measures and compliance with medical recommendations play an important role in the development of gonarthrosis. To slow down the processes of joint degeneration, it is important to follow the following rules:

• engage in special physical activity: physiotherapy and gymnastics without unnecessary stress on the joints;
• avoid strenuous physical activity;
• choose comfortable orthopedic shoes;
• Monitor your weight and your daily routine - alternate special exercises and time to rest.

diet

The condition of the affected cartilage depends largely on diet. In the case of osteoarthritis, the following must be ruled out:

• Carbonated drinks;
• alcoholic drinks;
• fatty and overly spicy foods;
• canned food and semi-finished products;
• Products with colorings, preservatives and artificial flavors.

The diet should contain: protein, fatty acids, for example Omega-3, collagen, which is contained in gelatin. It is necessary to eat without gaining weight.

Consequences and complications

Osteoarthritis of the knee joints develops slowly, but if it is not treated, serious complications arise:

• Joint deformation and change in the overall configuration of the knee due to muscle restructuring and curvature of the skeletal structure;
• shortening of the lower limbs;
• Ankylosis – complete immobilization of the knee joint;
• Damage to the musculoskeletal system.