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Gonarthrosis of the knee joint: degrees, types, and methods of treatment

What is osteoarthritis?

Gonarthrosis is a degenerative disease of the knee joint. The second name of the disease – osteoarthritis of the knees. Illness is noninflammatory in nature and often leads to disability.

Statistically he is one of the leading places among all types of arthritis. In numbers, it is more than 20%. Of all the diseases that affect the knee joint, frequency of manifestations of osteoarthritis – 53%.

Gonarthrosis is known doctors for more than 100 years, at home it is called "calcination". And really, when osteoarthritis occurs calcification (deposition of calcification). However, this calcification are limited and do not have an independent clinical significance. The pathological process occurs in the background of violations of blood circulation in the small vessels of the bone, followed by destructive changes in the cartilage cover of the joint.

In the initial stages of osteoarthritis is the breakdown of cartilage at the molecular level, followed by degeneration of hyaline cartilage: sometimes it becomes cloudy, thinner, splits and cracks in different directions. Pathogenesis, resulting in the ultimate disappearance of the cartilage and exposure of bones to be. In turn, the bone reacts to the loss of cartilage seal, i.e. excessive growth of bone at the periphery, resulting in formation of the spikes, the foot is deformed and bent. For this reason, the disease has the additional title of "deforming arthrosis of the knee joint".

The pathogenesis of osteoarthritis can be briefly described as follows:

  • Metabolic processes in the cartilaginous tissue are due to the osmotic pressure. When squeezing the grease is secreted and absorbed while unloading. In this way the motion is ongoing nutrition of the cartilage. In case of incomplete recovery, is dictated by elevated mechanical load, metabolic processes are violated. The site of maximum pressure, the cartilage starts to thin;
  • There is a disruption of the structure of collagen fibers, resulting in loss of cushioning properties, chondromalacia (softening of the cartilage of the patella) and violation of the metabolic functions of chondrocytes. The cartilage loses resilience and elasticity;
  • It is a violation of congruence in the joint. The process is aggravated and enhanced synthesis of bone substance in the form of osteophytes (bone growths). Synovium is exposed to irritation and it starts inflammation. Itleads to limitation of joint mobility;
  • The most common arthrosis of the inner part of the knee joint surface between the femur and patella. The disease is more exposed to people of Mature and elderly, and professional athletes.

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Causes of osteoarthritis

The main causes of knee arthritis include:

  • A metabolic process;
  • Pathological changes of blood circulation and increased capillary fragility;
  • Excess body mass, which leads to increased axial loading on the joint;

  • Trauma of the knee (torn ligaments, meniscus, fractures, fissures);

  • Transferred inflammatory diseases (rheumatism, arthritis);

  • Excessive load on the joints, which affects athletes. Most often osteoarthritis affects tennis players, footballers, athletes, gymnasts;
  • Hormonal and endocrine disorders;
  • Old injuries that are inadequately treated or whose treatment was not completed;
  • Congenital malformations of the structure of joint tissues;
  • Hereditary factors.

The symptoms of osteoarthritis

The danger of osteoarthritis as well as most of the arthritis is severe the consequences of delayed diagnosis. At 1 stage, the disease almost does not manifest itself, except for a slight pulling pain that the patient withdraws to fatigue.

Common symptom of osteoarthritis is stiffness in the joint, "retraction"below the knee and aching knee pain aftertaking a long walk. Many patients with gonarthrosis (arthrosis of knee) complain of difficulties with walking mainly in the morning after sleeping or after sitting too long. A person needs to"go away" in order to feel better. With the development of osteoarthritis pain in the knee, particularly on inner side, becoming more persistent and permanent. Often patients with gonarthrosis feel the crunch when moving the knee joint. Develop further limit flexion and extension of legs. With the progression of the disease occurs claudication. In more severe cases people can't get around without assistance or without crutches. Often in the supine position, the pain subsides, but sometimes at night people suffering from pain.

During the inspection of the knees at the initial stage of gonarthrosis external changes are usually not detected. With the course of the disease is very noticeable deformity of the knee joint: the contours of the bones forming the joint, of coarse, found contracture (incomplete flexion or extension), the curvature of the lower leg. Resting your palm on the anterior surface of the knee when flexor or extensor movement you can feel the crunch in the knee joint of varying intensity and duration. A similar feeling can be obtained, if you move the patella laterally in the transverse direction (positive patello-contrary symptom).

When the feeling of the knee of a patient with osteoarthritis found a painful area, usually on the inner side of the joint, at the level of the condyles of the femur, the large tibia and the articular gap. Often in the cavity of the knee joint effusion accumulates, i.e. joins synovitis. Such a state is determined by the smoothness of the contours of the knee joint due to vbuhanie tissues above the kneecap and to the side of it and a sense of fluctuation when the feeling of the protrusion with both hands.

In the process of progression of osteoarthritis symptoms appear brighter, become more pronounced. Timely correct diagnosis plays an important role in the fight against the disease.

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The development of gonarthrosis

1 degree of gonarthrosis

With 1 degree of osteoarthritis there is fatigue of the limbs and slight discomfort. During movement there may be moderate crepitus. Sometimes there is a subtle limitation of motion in the joint.

Bones of the knee at this stage do not undergo significant changes. On x-ray you can see a slight narrowing of the joint space.

2 the degree of gonarthrosis

Second degree is characterized by the occurrence of pain, especially after youlong stand or walk. Characteristic crunch becomes more pronounced. There are problems with the extension and complete flexion of the limb. A so-called starting pain.

You may experience atrophy of the quadriceps. Significantly limit angle of total flexion and extension of the limb in the knee joint. The x-rays clearly shows a significant narrowing of the joint space and the growth of osteophytes. Edges of bones "flattened".

3 the degree of gonarthrosis

Stage 3 is changing the character of the pain – it is amplified and may manifest alone. In the joint there is often a swelling and local fever. Due to the possible presence of joint a "joint mouse" (fragments of splinter osteophytes) can occur symptoms the blockade of the joint. They manifest a sharp pain, accompanied by a sensation of jamming.

The patient in this case, can be deprived of all power of independent movement. Occurs deformity of the knee with change of the axis of the limb, which is clearly seen on x-rays. Can present with joint instability.


Types of osteoarthritis

Gonarthrosis divided into types according to etiology:

  • Primary gonarthrosis occurs against a background of comparative health. Mostly affects older people, more often women than men. At risk are people with excessive body weight, i.e. obese, they often acquire osteoarthritis of the knee;
  • Secondary gonarthrosis develops after suffering a knee injury or is a complication of infectious diseases. Subject to the timely treatment of injuries and inflammations of the knee joint the development of osteoarthritis can be avoided.

Localization gonarthrosis is divided into the following types:

  • Right-side gonarthrosis – striking the right knee joint. This form of arthritis are more typical for athletes and people whose professional activity is connected with excessive static and dynamic loads on the right leg;
  • Left-side gonarthrosis – striking left knee joint. The disease is characteristic of athletes and middle-aged people with excess body weight;
  • Bilateral gonarthrosis , destroys the joints of both feet. This kind of disease is the most severe, as it significantly increases the risk of disability. To him the most in the elderly becausethe nature of bilateral gonarthrosis in most cases, idiopathic (age-related).

The nature of the occurrence and course of disease all of these types of arthritis do not differ from each other. Bilateral gonarthrosis in the running form can flow more pronounced as the axial load simultaneously exposed to both patients joint.


Diagnosis of gonarthrosis

There are many diagnostic methods, but their effectiveness may be greatest only with an integrated approach.

Examination of orthopedic

Examination of orthopedic the first and very important diagnostic event. This includes:

  • Palpation of the joint;
  • Linear measurements of the bones;
  • Plomeria (definition of mobility in the affected joint at different angles).

Clinical studies

Tests for gonarthrosis include:

  • A study of blood counts and erythrocyte sedimentation rate (ESR);
  • Determination of the level of fibrinogen, urea and other biochemical parameters of blood and urine.

X-ray examination

The main method of diagnosis of osteoarthritis is the study of diseased hip using x-rays. At the initial stage of the disease x-ray examination may not show, and if they show only minor changes. In the later stages reveals a narrowing of the joint space, sclerosis of cartilage, damage to bone and deposition of salts.

Ultrasound

Ultrasound examination of the affected knee gives the best results, but it cannot completely replace x-rays. Therefore, all people suffering from degenerative-dystrophic diseases of the joints, have to make an x-ray.

MRI – magnetic resonance imaging

It is the most advanced method of diagnosis, which allows the layers to examine all the parts of the joint and to identify the earliest changes in cartilaginous tissue. Disadvantage of the method lies in the relatively high cost of survey of each segment. A definite plus – high accuracy: it often turns out that the gonarthrosis is not the only disease of the musculoskeletal system in a specific patient.


How to treat osteoarthritis?

The method of treatment of gonarthrosis is not very different from the methods of treatment of arthrosis of other joints.

Step 1 – remove inflammation

This is traditionally used:

  • NSAIDs – nonsteroidal anti-inflammatory drugs, which are prescribed intramuscularly or intravenously. Medicines in the form of injections give a more lasting and strong analgesic effect. These include drugs such as diclofenac, olfen, diklak, ibuprofen, indomethacin, Ketoprofen;

Prolonged oral use of these drugs may have a negative effect on the stomach, liver, kidneys and the entire gastrointestinal tract, especially in chronic diseases.

  • NSAIDs COX-2, are the most effective and gentle compared to the NPRC COX-1. They can be used for a long time, for several months. Is meloxicam, celecoxib and nimesulide;
  • Hormonal drugs. This group of medications used for intraarticular injections in the presence of synovitis of the knee (inflammation of the synovial membrane). The goal of therapy – the removal of inflammation and pain in the shortest possible time. Minus application, the damage to cartilage tissue, a large number of contraindications and side effects. The most commonly used in gonarthrosis synthetic hormones: hydrocortisone, kenalog, diprospan;
  • Antifermental preparations. They neutralize the synthesis of some enzymes and prevent further degeneration of joints. The most well-known drugs in this group: contrical, Owain, gordox. For gonarthrosis they are administered intra-articular.

Step 2. Provide anabolic and anti-catabolic effect

For this purpose medicines that replace the necessary for the synthesis of cartilage substance, rendering the cartilage narrowly-specific protective effect. They are also called chondroprotectors. These drugs contain substances included in the matrix of cartilage. These medicines are natural, well-perceived by the body and actively stimulate collagen synthesis.

To justified used in the knee drugs include structum, DON, asked, rumalon, mucosal. They are all slow drugs that need to take long courses. Some of them are available in the form of solutions for injection. This form of application is most effective.

Step 3. Smear, heat, rubs

You can use various kinds of gels, ointments and creams. For the most part, they are warming and anti-inflammatory. The purpose of their application is to enhance local blood circulation and relieve inflammation. Most well known products of this group: we, finalgon, dolobene, ointment, Fastum gel, nikofleks.

Step 4. Improve blood circulation

Vasodilator drugs are used to reduce intravascular tone muscles. These drugs enhance the internal blood flow and improve tissue trophism, located around joint. For gonarthrosis recommended Cavinton, trental and Actovegin. For strengthening vascular walls apply upsavit or askorutin.

Step 5. Remove unnecessary tone

Such antispasmodics as mydocalm, sirdalud, chiseled and drotaverine (no-Spa) allow you to remove excessive muscle tension in the damaged segment. It often occurs as a compensatory reaction of the body.

Step 6. Enter the prosthetic synovial fluid

The most progressive method of treatment of gonarthrosis in recent years was the inclusion in the Protocol therapy of drugs based on hyaluronic acid. It is a natural component of cartilage and synovial fluid. Therefore, its introduction into the knee joint does not cause inflammation, rejection and other negative reactions.

At the same time, the use of such drugs as otherwisc, sinokor or "hyalual"., reduce movement and to relieve pain caused by friction of the articular surfaces. In gonarthrosis the most recommended drug in this group is permatron.

The sequence of treatment determined by the physician according to current protocols. At the same time can be administered anti-inflammatory therapy, the rate of chondroprotectors and physiotherapy. The hyaluronic acid is allowed to enter into the joint when completely removed inflammation. Otherwise, instead of the therapeutic effect can be the contrary to aggravate the disease.


More and innovative methods of treatment of gonarthrosis

To the author's methods of treatment of osteoarthritis of the knee include:

They have different principles of exposure, but all without exception proved to be efficient ways to maintain knee joints affected by osteoarthritis. Unfortunately, full recovery.

Oxygen therapy is a method of filling the joint cavity with medical oxygen. Helps to eliminate puffiness and reduce pain. Can be used as an alternative to hormonal therapy.

The stem cell treatment. The method consists in the transplantation of stem cells of the patient in the joint. The method, developed in Germany, allows you to defer a conservative treatment for many years. Used only in major medical centers in Germany.

Methodintra-articular laser therapy. The procedure is performed using low-intensity helium-neon laser, which penetrates into the joint through a needle introduced into the waveguide. Helps to reduce pain and increase range of motion in the joints. The method was developed in Russia, clinically tested, but due to the high cost is not widely used.

Ortokin – biological method of treatment of gonarthrosis, practiced in Europe since 2003. Ortokin is autologous serum obtained due to the selection of specific proteins from the patient's own blood. These proteins have anti-inflammatory effect. After the selection of blood and production of serum the drug is administered intra-articular person under ultrasound or computed tomography.

Ortokin allows you to:

  • To slow down the process of destruction of cartilage;
  • To reduce pain;
  • To stop the inflammation;
  • To increase the mobility of the knee joint.

The course of treatment is 1-2 injections. About 70% of the patients cease to suffer pain after the first injection.

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Surgical treatment

At different stages of gonarthrosis conservative therapy may not yield positive dynamics. In such cases, you begin to consider the need for surgical intervention.

There are several types of surgery for gonarthrosis:

  • Arthrodesis. With the help of this technique, remove the deformed cartilage along with joints. The method does not allow to maintain the physiological mobility of the limb. Resort to it rarely;
  • Arthroscopic, debridement. The technique is to release the joint from the deformed cartilage with arthroscope. Used in the early stages of the disease. Thanks to arthroscopy eliminates pain. The operation is simple. The effect of the procedure is temporary, 2-3 years;
  • Periarticular osteotomy. It is technically complex and rare surgery. Is to pre-filing and securing a different angle of the bones of the joint. This is done to redistribute the load. Rehabilitation is long enough, the effect of 3 to 5 years. Rarely used in the early and middle stages of osteoarthritis.

Arthroplasty

In our timearthroplasty is the most common and effective type of surgery for gonarthrosis. The technique allows to maintain the mobility of the limb, which provides the patient the opportunity to lead a full life. Replacement is a complex operation. It lasts only about an hour, but after it is necessary to undergo a long rehabilitation and development of the joint. This is one of the main features of knee replacement. The effect lasts for about 20 years, depending on the modification of the material. After that, the joint will again have to change because of the loosening of the prosthesis under the action of axial and mechanical loads.

We should not forget about possible complications, such as:

  • Regional necrosis of the skin;

  • Paresis of the peroneal nerve;
  • Thrombosis of the saphenous femoral vein;
  • Rejection of the prosthesis.

Such troubles are extremely rare and represent about 1% of the total number of operations. Therefore, it is necessary to consider that the effect of the replacement is sometimes the only way to improve the quality of life of patients with osteoarthritis of the knee joint.


Exercise for gonarthrosis treatment and not only

The goal of exercise for gonarthrosis lies in several factors:

  • Maintenance and increase of joint mobility;
  • The formation of a compensation mechanism due to the strengthening of muscular-ligamentous apparatus.
  • Increasing blood circulation and improving the trophism of adjacent tissues and the joint;
  • The maintenance of physiological muscle tone.

Exercise and the method of their execution selected depending on surviving active movements.

Banned for gonarthrosis include the following types of classes:

  • Movement of a violent nature, accompanied by pain;
  • Abrupt and high-amplitude leg swings;
  • Exercises with full axial load on the affected joint.

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A set of exercises for gonarthrosis

  1. Standing, try to relax completely, hands down. Follow podrachivaya movement of the whole body. Keep the knees was shaken with a small amplitude.

  2. Adhering to for support, bend your leg at the knee, point the heel to the buttock, then straighten forward leg, put it on the heelin front of him. Perform 15-20 times. Then do with other leg.

  3. While standing, place palms on knees. Perform small circular movements of the knee joint in one or other way. Adjust the amplitude of the feelings. Make at least 20 times.

  4. Exercise performed on the folded blanket. The surface should not be too hard. Kneel down and make the shaking in 1 exercise.

  5. Out, as in the previous exercise, walk on the knees, making a few steps in different directions.

  6. Stand in the emphasis lying on the knees (the floor should touch her hands and knees). Get down with his chest on the floor, stretching his arms forward, then move thighs and buttocks to the heels, by performing the gray on the heel, without lifting the chest off the floor. Climb back into focus and repeat the exercise several times.

  7. Lying on your left side, take the right leg up, bend the knee, straighten and maximally stretch the heel to the wall. Perform 12 times and change legs.

  8. Sit, bent leg is put in front of him. Stretch the knee of the right leg to the left, then straighten, straightening knee bend and return to the starting position. After 12 repetitions, change legs.

  9. From the same starting position straighten your legs alternately, keeping the heels off the floor, then bend again at the same time, also without lifting from the floor. Repeat 12-14 times.

  10. Lie on your back, pull your bent leg to your chest, grab hold of the waist band and smooth motions try as hard as possible to straighten the leg. Do the exercise without jerks.

  11. Also lying on your back, attach the rubber isolator to the ankles, and the other end attach to the battery. Smoothly bend and unbend legs, pulling his knees to his chest.

  12. Get on all fours. One edge of the rubber damper attach to the ankle, the other fix for the battery. Slowly (slowly) bend and unbend the leg at least 10-15 times. The attenuator should not be too hard.


Physical therapy in gonarthrosis

All types of physiotherapy can be assigned in remission or slight disease exacerbation, but not in the acute phase of inflammation.

The most effective are:

  • Electrophoresis with drugs such asbischofite or calpain. Deeper penetration of the drug in such cases shall be with Dimexidum;
  • Magnetic therapy;
  • Ultrasound;
  • Microwave therapy;
  • Paraffin;
  • Radon and hydrogen sulfide baths;
  • Mud.

To maintain and prolong the phases of remission must undergo physical therapy 2-4 times per year, depending on the severity of the disease.

Electrophoresis with Caribana allows you to remove unnecessary tone, promotes the resorption of contractures and adhesions. You should perform at least 20 procedures, as the drug is cumulative. It acts only when the body is typed in the maximum concentration. A course of 10 treatments does not justify the money spent.

A mud treatment in gonarthrosis must be held 2 times per year, 10-15 procedures. You can hold it at home using drugstore dirt. Before application it must be heated to 38-40 degrees.

Massage and manual therapy for gonarthrosis

These types of effects on the knee joint is aimed at extending, warming and improving circulation in the joint. The massage is performed in the knee region, in the course of lymph flow from the periphery to the center, but without affecting the popliteal fossa. Manual therapy is carried out after a massage by an experienced technician. Its main task is the extension and stabilization of the joint.

You can perform the following exercise: stand in the healthy side to support, take up with a sick joint forward, then back, then sharp movement "throw" it to the side.

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Prophylaxis of deforming gonarthrosis

Gonarthrosis refers to a group of diseases that are better and easier to prevent than expensive and time consuming to treat.

As preventive measures we can recommend the following:

  • Engaged in dancing and sports, try to be wary of serious injuries (torn ligaments, fractures, severe injuries of the patella);
  • Maintain regular physical activity, as movement is the mechanical basis of nutrition of the cartilage;
  • Match diet with needs of bone and cartilage nutrients;
  • Follow the body weight;
  • When you receive an injury or discomfort in the kneejoints immediately seek qualified medical assistance;
  • Since 35 years, undergoing treatment with chondroprotectors;
  • Daily drink plenty of water.

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Useful tips

  • Start treatment of gonarthrosis with an accurate diagnosis. It is better to get advice from several leading experts.
  • Do not self-medicate. All medications, their dosage and duration of application should appoint and control the doctor.
  • Start each day with gymnastics.
  • If you want to play sports, talk with your doctor about the recommended for you kinds of loads. Even some of the yoga asanas can be disastrous for gonarthrosis.
  • Eliminate from your diet salty, spicy, fatty food. Prefer a healthy home-cooked meals. Milk products must have an average fat content or the calcium to be poorly absorbed. In the diet include low-fat jelly (cooked in the Turkey meat), natural jelly. Don't forget about eating saltwater fish and seafood.
  • If week application of an anti-inflammatory drug comes relief, consult your doctor to revise the treatment Protocol.
  • If I had a remission, and the disease does not bother you, do not exceed the permissible loads. No pain does not mean you are fully healed.
  • Try not to SuperCool the joints. Although osteoarthritis is not an inflammatory disease, the joint may respond to hypothermia a new relapse.

    • Most importantly, remember! You will not be able to help even the best doctor, if you don't want to put in the effort and help themselves. If necessary, surgical intervention do not give up, do not delay the date. However, it is very important that at the time of the operation, you were in good physical shape, then it will be easier postoperative rehabilitation. And it depends on you.


    andidate of medical Sciences Dmitry Volkov S., surgeon