Osteoarthritis of the knee joint

The knee joint experiences regular stress. Running and jumping, walking and climbing stairs or simply standing affect the condition of the cartilage tissue of the knee. If the cartilage balance is disturbed, the development of arthrosis of the knee joint begins - gonarthrosis.

Gonarthrosis is an arthrosis that deforms the knee joint, which is accompanied by chronic damage to the surfaces of the hyaline cartilage, as well as the bones - the femur and tibia. Symptoms of knee joint disease are pain that intensifies with movement. Due to the accumulation of liquid in it, movement is limited. Subsequently, there is a limitation of knee movements due to a violation of the support of the leg. Diagnosis of pathology is based on collecting the patient's anamnesis and complaints, the results of visual examination and hardware examinations of the knee joint. These age-related disorders of the musculoskeletal system appear in almost everyone in old age.

General information

Gonarthrosis (from the Latin articulatio - knee joint) is the most common arthrosis, which is a progressive degenerative-dystrophic lesion of the cartilage of the knee joint, of a non-inflammatory nature. Women and the elderly often suffer from gonarthrosis. But after injuries during intense sports, gonarthrosis occurs even in young people.

The cause of osteoarthritis lies in the change in the structure of the cartilage inside the joint, and not in the deposition of salts there. In gonarthrosis, salt deposits occur where the tendons are attached to the ligamentous apparatus, but they cannot be the cause of the pain symptoms. First, cracks appear in the cartilage, which reduce thickness in some areas. Gradually, the load is redistributed, the joint begins to come into contact with the bones, accelerating the painful process. As a result, the following changes occur in the knee joint:

• thinning of the knee cartilage until it disappears;
• changes in synovial fluid in composition and quantity;
• damage to the knee bones due to friction;
• the appearance of osteophytes;
• stiffness due to compaction of the joint capsule;
• muscle spasm.

As a result, the knee joint becomes deformed, its mobility is limited, which can lead to disability and loss of working capacity.

Osteoarthritis of the knee joint can be unilateral and affect only one knee of the right or left leg; In the case of bilateral osteoarthritis, both knee joints are affected.

Symptoms of osteoarthritis of the knee joint

The symptoms of knee arthrosis can be very different:

• At first there is a slight discomfort when climbing stairs, then the pain syndrome increases and torments even at rest;
• stiffness occurs in the morning, at first it lasts a few minutes, then it can last up to half an hour;
• an acute crisis occurs, which is already accompanied by pain in the second degree of damage;
• mobility is limited, it is difficult to bend and straighten the knee due to pain, bone friction and the growth of osteophytes; the joint may become blocked in the final stages (ankylosis);
• unstable gait due to muscle atrophy (reduction in muscle volume);
• deformation of the knee joint due to the growth of bones and changes in their shape, the occurrence of an inflammatory process in the muscles and ligaments increases swelling around the tissues of the joint;
• lameness as a result of the progression of knee joint disease, in the later stages the patient is forced to walk even with a walker.

Osteoarthritis disease begins gradually. In the 1st stage of gonarthrosis, patients experience mild sensations of stiffness and pain that occur when going up or down stairs. Possible tightness of the area under the knee. Characteristic are the initial pain sensations that arise from the sitting position during the beginning of the ascent. When the patient moves away, the pain decreases, but with effort it reappears.

There are no external changes to the knee. Sometimes swelling and the development of synovitis are possible - accumulation of fluid with increased, swelling of the joint, while heaviness is felt and movement is limited.

In stage 2, severe pain occurs with prolonged exercise and intensifies when walking. The pain is usually located along the anterior surface within the joint. After rest, the pain disappears, but when moving, it reappears.

As osteoarthritis progresses, the number of movements in the knee joint decreases, when you try to bend your leg as much as possible, pain and a harsh, sharp clicking sound appear. The configuration changes, the joint expands. Synovitis appears with an even greater accumulation of fluid.

In stage 3, the pain becomes constant and uncomfortable not only when walking, but also at rest. Painful sensations appear even at night; in order to fall asleep, the patient takes a long time to find a position for the leg. Flexion and extension of the joint are limited. Sometimes the patient cannot straighten the leg completely. The joint is enlarged and deformed. Sometimes valgus deformity of the legs occurs in patients; they become X- or O-shaped. As a result of deformation of the legs and limitation of movement, patients' gait becomes unstable and staggering. 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 a variety of reasons. These factors include:

• Injuries.25% of gonartosis occurs due to injuries: meniscal damage, ligament ruptures. Gonarthrosis usually occurs three to five years after the injury, sometimes the disease can develop earlier - after two to three months.
• Physical exercise.Often, gonarthrosis occurs after forty years of age due to professional sports and excessive physical stress on the knee joint, which leads to the development of degenerative-dystrophic changes. Fast running and intense squats are especially dangerous for your joints.
• Overweight.Excess weight significantly increases the load on the knee joints, causing injuries. Gonarthrosis is especially difficult if there are metabolic disorders and varicose veins.
• Sedentary lifestyle.

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

Pathogenesis

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

There are 4 stages of osteoarthritis:

• 1st stage.There is a disturbance in blood circulation in the vessels that feed the hyaline cartilage. Its surface becomes dry and small cracks appear, the cartilage gradually loses its smoothness, the cartilaginous tissue becomes thinner and, instead of sliding smoothly, it sticks together, losing its shock-absorbing quality. There are no visual symptoms of arthrosis, the x-ray shows a slight deviation.
• 2nd stage.Changes occur in the structure of the bones and the joint area is flattened to accommodate greater loads. The part of the bone located under the cartilage becomes denser. Along the edges of the joint, manifestations of initial calcification of the ligaments appear - osteophytes that resemble spikes on an x-ray; the narrowing of the gap in the joint is also visible. The synovial capsule of the joint degenerates, becoming wrinkled. The fluid in the joint becomes thicker, its viscosity increases and its lubricating properties deteriorate. The process of cartilage degeneration accelerates, it becomes thinner and in some places it disappears completely. After its disappearance, friction in the joint increases and degeneration progresses markedly. Patients experience pain during exercise, when climbing stairs, when squatting, and when standing for a long time.
• 3rd stage.Radiographs show a noticeable, sometimes asymmetrical, narrowing of the joint space. Due to the deformation of the meniscus, the bones become deformed and pressed against each other. Movement in the joint is limited due to the large number of large osteophytes. There is no cartilaginous tissue. Constant pain haunts the patient at rest, it is impossible to walk without support.
• 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 occurs without lesion, generally in elderly patients and is bilateral. Secondary develops as a result of diseases and developmental disorders or against the background of injuries to the knee joint. It can occur at any age and is usually unilateral.

Diagnosis

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

• The consultation begins with collecting anamnesis – main complaints and symptoms that worry the patient. The doctor finds out complaints, the presence of chronic diseases, previous injuries, fractures and injuries and asks additional questions.
• On examination, characteristics of joint mobility, deformation and pain are revealed. In stage 1 of gonarthrosis, the patient has no external changes. In the 2nd and 3rd stages, deformations and thickening of the joint contours, limitation of movement and curvature of the legs are detected. When the patella moves, a sharp sound is heard. On palpation, the doctor detects pain in the inner part of the joint space. The joint may increase in size. Joint swelling is detected. When palpating the joint, fluctuation is felt.
• The patient is sent for laboratory tests. When taking a general blood test, inflammation is detected, while a biochemical examination reveals possible causes of the problems.
• Next, instrumental diagnosis of the patient is necessary. X-rays are used for this. Radiography is a diagnostic method that allows you to detect signs of knee arthrosis: narrowing of the joint gap, osteophytes and bone deformities. Joint radiography is a technique that clarifies the diagnosis of pathological changes and the dynamics of osteoarthritis. At the onset of gonarthrosis, changes are not visible on radiographs. Subsequently, the narrowing of the joint space and the compaction of the subchondral zone are determined. Gonarthrosis can only be diagnosed with x-rays and clinical examinations.
• Nowadays, in addition to radiography, to diagnose arthrosis, computed tomography (CT) is used, which allows you to study bone changes in detail, and magnetic resonance imaging (MRI), which allows you to visually assess the state of the joint and is used to identify changes in muscle tissue and ligaments.
• When carrying out an ultrasound examination (ultrasound), the condition of the tendons, muscles and joint capsule is assessed.
• Fluid is drained from the affected joint to allow a camera to be inserted to view the inside of the joint (arthroscopy).

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

Treatment of osteoarthritis of the knee joint

Treatments for osteoarthritis can be divided into three groups:

• medicinal;
• physiotherapy;
• surgical.

Osteoarthritis is treated by traumatologists, rheumatologists and orthopedists. Conservative treatment starts early. When osteoarthritis worsens, doctors recommend maximum rest for the joint. Patients receive the necessary procedures: exercise therapy, massage, mud therapy.

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

Drug treatment

Proper administration of medication can stop pain and inflammation, as well as slow down the process of destruction of cartilage tissue. Therefore, it is important to see a doctor immediately.

Important - do not self-medicate. The wrong medications, chosen independently and without consulting a doctor, can only aggravate the situation and lead to serious complications.

Drug therapy for arthrosis includes taking the following medications:

• anti-inflammatory:relieve inflammation and relieve joint pain;
• hormonal:prescribed when anti-inflammatories are ineffective;
• antispasmodics:help eliminate muscle spasms and alleviate the patient's condition;
• chondroprotectors:improve metabolic processes in the joint and help restore joint function, as well as drugs that replace synovial fluid;
• medicines to improve microcirculation:improve nutrition and oxygen supply.

Depending on each specific situation, tablets, intra-articular injections of steroid hormones and local forms of medications are used. The selection of medications is made by the attending physician. Sometimes a patient with arthrosis is sent for treatment in a sanatorium and is recommended to walk with crutches or a cane. To alleviate the load on the knee joint, individual orthoses or special insoles are used.

Additionally, complex non-drug methods for the treatment of arthrosis are used:

• physiotherapy (physiotherapy)carried out under specialist supervision;
• massage coursesin the absence of an inflammatory process;
• osteopathic effectin the treatment of arthrosis, it is 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 in the body as a whole. During an osteopathic session, work is carried out with the musculoskeletal system as a whole to achieve maximum restoration of innervation and mobility of the spine, pelvic bones, sacrum and eliminate compression of nerves and blood vessels throughout the body!

Physiotherapy

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

• shock wave therapy:ultrasound eliminates osteophytes;
• magnetotherapy:the magnetic field affects 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:gas injection into the joint cavity.

Surgery

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

• endoprostheses:replacement of the entire joint with a prosthesis;
• arthrodesis:fixation between the bones for their immobility, to reduce pain and give the person the opportunity to lean on the leg;
• osteotomy:cutting a bone to place it at an angle in the joint to reduce stress.

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

Prevention

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

• practice special physical activities: physiotherapy and gymnastics without unnecessary joint loads;
• avoid strenuous physical activities;
• choose comfortable orthopedic shoes;
• Monitor your weight and daily routine - alternate special exercises and rest time.

Diet

The condition of the affected cartilage largely depends on nutrition. In case of arthrosis, it is necessary to exclude:

• carbonated drinks;
• alcoholic beverages;
• fatty and excessively spicy foods;
• canned food and semi-finished products;
• products with dyes, preservatives, artificial flavors.

The diet must contain: proteins, fatty acids, for example, omega-3, collagen, which is contained in gelatin. It is necessary to eat without increasing body weight.

Consequences and complications

Osteoarthritis of the knee joints develops slowly, but if left untreated, serious complications arise:

• joint deformation and change in the general configuration of the knee due to muscular restructuring and curvature of the bone structure;
• shortening of the lower limbs;
• ankylosis – complete immobilization of the knee joint;
• damage to the musculoskeletal system.