Gonarthrosis what is it

Often patients ask the question: what is the difference between arthrosis and gonarthrosis? Translated from Greek, “arthrosis” is a joint. A degenerative-dystrophic change in the cartilage tissue in it, regardless of the location, is called arthrosis, specifying the location. For example – arthrosis of the shoulder, hip joint. “Gono” is the knee and the term “gonarthrosis” means the defeat of the knee joint, therefore, these names are considered synonymous.


According to the international classification of pathology, M10 code is assigned according to MBK 17. With the disease, the first changes occur at the cellular level. A lack of nutrients alters the structure of cartilage. During compression, fluid is released from the synovial bag onto the cartilage, which washes it, helps to slip, delivers the necessary vitamins and minerals. When unloading, it goes back.

Long loads or lack of movement cause a lack of synovial fluid inflow, cartilage nutrition is disrupted, its smooth structure is gradually destroyed and elasticity is lost. Gradually, the cartilage tissue becomes loose, with movement small fragments begin to separate, exposing the bones at the joints. They begin to come into contact with each other, the body responds to pathological deformation by the formation of bone growths (osteophytes). Increased friction causes pain and restricts human movement.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Classification

In medical practice, arthrosis of the knee joint is classified in several directions. Allocate primary and secondary gonarthrosis. In the first case, it is often diagnosed in an age category older than 50 years.

According to the localization of the lesion, gonarthrosis is allocated to:

    left-s >
    Primary pathology is characterized by damage to 2 limbs at once. Post-traumatic gonarthrosis is often diagnosed as unilateral.

On a note. Sometimes tissue degeneration processes occur on 2 joints at different times and progress at different speeds.

At the initial stage, the process of gonarthrosis is divided at the place of occurrence into the following varieties:

    medial – the inner s >

Causes of pathology

The causes of primary gonarthrosis remain unclear. It is believed that the development of the disease is associated with heredity or prolonged use of hormonal drugs. Secondary – include injuries, diseases and impaired body functions.

The main causes of gonarthrosis:

  • vascular pathology;
  • circulatory disturbance;
  • excess weight;
  • endocrine dysfunction;
  • trauma;
  • metabolic disease;
  • lack of vitamins;
  • infectious diseases;
  • reactive arthritis.

On a note. The risk of developing gonarthrosis increases after arthritis, weakening of the ligamentous apparatus, craniocerebral and vertebral injuries.

Degrees of disease

According to the nature of joint damage and symptoms, gonarthrosis is divided into 3 main degrees. Each is characterized by specific signs.

  1. Osteoarthritis of the knee of the 1st degree is expressed in a slight discomfort in the joint during prolonged exertion (playing sports, running, active walking, cycling, a long climb uphill). Pathological changes are minimal. Cartilage is thinning and slightly stratified. Depreciation abilities are fully preserved, sometimes a person can hear a small crunch in the knee without painful signs.
  2. At 2 degrees of the disease, partial cartilage destruction occurs. Its particles fall into the periarticular fluid, irritating the joint. The synovial bag gradually “dries out” and produces less “lubricant”. The joint gap decreases, causing slight friction of the bone structures with additional loads. A person begins to feel “starting” pains, which decrease in the process of movements. With joint overload, the pain syndrome becomes stable and is stopped by medications.
  3. Grade 3 is characterized by complete exposure of bone joints, their friction, proliferation of numerous bone “spikes” (osteophytes), limitation of knee mobility, lameness, persistent and sharp pains.

Symptoms

The development of gonarthrosis begins gradually. At first, a person experiences slight discomfort when climbing or descending stairs. Stiffness is felt in the joint, a slight crunch is heard. A characteristic symptom is the “starting” pain, which appears during the first steps. It passes quickly after a small load on the joint.

Further, the pain syndrome becomes more intense, the range of motion is significantly reduced, the appearance of synovitis (inflammation of the synovial fluid), joint swelling is possible.


At 3 degrees of the disease, difficulties arise not only with flexion, but also with leg extension. There is varus or hallux valgus deformity – deforming gonarthrosis. The gait is completely changing, the person rests on a cane or crutch.

The main symptoms are:

  • “Starting” pain;
  • crunch in the joint;
  • pain during exertion;
  • muscle weakness;
  • blockade (jamming of the leg);
  • limb instability.

Post-traumatic arthrosis can develop rapidly – 2-3 months after a fracture, bruise, dislocation. Even minor injuries can be a source of problems.

Diagnostics

Based on the patient’s complaints and objective examination data, the doctor presumably makes a diagnosis. Confirmation are laboratory blood tests and radiography of the knee joint.

Increased ESR in the blood indicates signs of inflammation. The cause may be joined infections, synovitis, arthritis. In this case, the doctor prescribes an additional examination.

At the initial stage on an x-ray, changes in the joint may be absent. The diagnosis is established on the basis of radiological and clinical signs of the disease.

For controversial issues, the diagnosis is confirmed by magnetic resonance imaging, which allows you to study not only bone structures, but also blood vessels, soft tissues, ligaments, meniscus. Based on the diagnosis, the doctor selects the appropriate treatment or recommends arthroscopy. With exacerbation, non-steroidal drugs are prescribed. They relieve pain and inflammation of tissues. Further treatment is carried out using chondroprotectors (Arthra, Teraflex, Don). Additionally, vitamins and exercise therapy are prescribed.

Diet for gonarthrosis

In addition to complex treatment for gonarthrosis, doctors recommend adhering to a special diet. Proper nutrition can improve metabolism, metabolic processes and accelerate tissue regeneration. The disease causes instability of the joints, so patients need to lose extra pounds.

Basic principles of nutrition:

  • fractional meal;
  • limited calories (2000 for women and 3000 for men);
  • the inclusion of products necessary to strengthen cartilage;
  • last meal 3 hours before bedtime;
  • the exclusion of fatty, fried and salty foods;
  • heavy drinking (1,5 liters).

The daily diet should include fermented milk products, boiled meat, quail eggs, nuts, fruits and vegetables. Jelly and jelly should become your favorite dish. They contain a lot of collagen and chondroitin, which help restore cartilage. Flour products should be limited. Loose porridge should be present on the menu: buckwheat, rice, oatmeal.

  • coffee;
  • fast foods
  • sausages;
  • tomatoes and cabbage;
  • alcohol;
  • sauces and mayonnaise;
  • sweet soda;
  • muffin


In order to get rid of gonarthrosis, it is necessary not only to eat right, but also to reconsider the usual way of life. Doctors recommend taking leisurely walks and doing special gymnastics. Walking should not be active and stress the joint. When exacerbation is necessary to wear knee pads. They relieve stress and swelling, help normalize blood circulation.

Can I steam with gonarthrosis? Bath, rubbing and warming the joint improves blood circulation. Cartilage receives the necessary vitamins and minerals. Procedures help relieve muscle cramps and improve ligament structure. When gonarthrosis is useful to swim. In water, the load on the knee joint is reduced. Movements help strengthen muscles and improve blood flow.


Timely access to a doctor, treatment and prevention will help stop destructive processes, restore the elasticity of the cartilage and return it to depreciation functions. It must be remembered that gonarthrosis is a chronic disease that can cause disability.

Gonarthrosis

Gonarthrosis is a pathological condition that is characterized by degenerative processes occurring in the knee joint.

Gonarthrosis of the knee joint is characterized by cartilage destruction, as well as joint deformation, accompanied by a violation of its functions. Most often, this disease affects elderly women.

You can take a course of treatment for gonarthrosis in the multidisciplinary clinic of CELT! Anyone can become our patient – metropolitan registration for this is not required.

  • Initial consultation – 2
  • Repeated consultation – 1 800

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Causes

In accordance with the causes of appearance, it is customary to distinguish two main types of gonarthrosis:

  • primary – the reason for its appearance has not yet been established; as a rule, this is bilateral gonarthrosis, which occurs in elderly patients;
  • secondary – occurs against the background of an existing injury or pathology of the knee joint at any age; as a rule, this is unilateral gonarthrosis.

In more than 20% of cases, pathology develops after intraarticular fractures of the lower leg, tearing of ligaments or deformation of menisci. Often gonarthrosis develops 5 years after the appearance of the pathology, but in rare cases, it appears after 3 months.

The appearance of the disease can provoke a high load on the joint. People over the age of 40 who regularly work out in the gym are at risk. Excessive load when performing heavy exercises can lead to degenerative-dystrophic changes. Not only training, but also the load on the joints due to excess weight can lead to similar consequences. Therefore, you need to follow a diet and control body weight. Genetic predisposition often causes gonarthrosis. If a person has a weakened ligamentous apparatus and is prone to arthritis, then he is at risk and should avoid excessive stress on the joints.

Symptoms

The development of pathology is slow and at the initial stage, people notice a slight pain in the joints while walking or climbing stairs. In the knee zone, contraction and stiffness are observed. The main symptom is a sharp pain while getting out of bed or at the beginning of walking after a long journey. After warming up the joint, the pain syndrome disappears. The disease does not manifest itself externally except for swelling, as fluid accumulates. This leads to the formation of slight swelling and a change in shape.

The second stage is characterized by severe pain during moderate physical exertion and when walking. In a calm state, the pain disappears, after which it reappears during exertion in the anterior-inner part of the joint. With sudden movements, a crunch may appear. The shape of the joint changes and becomes spherical due to the accumulation of fluid.

The third stage leads to acute pain syndrome during exertion and in a calm state. A person can not only fall asleep due to severe pain, but also wakes up at night and cannot fall asleep.

Due to impaired mobility of the knee, a person cannot bend the leg normally. The size of the joint increases, the shape of the legs changes (becomes O-shaped or X-shaped). This leads to impaired gait, and in the most severe cases, the need for support (a person moves with support on a cane).

Inspection of a specialist in the first stage often does not lead to the detection of gonarthrosis due to the absence of external manifestations. At the second and third stages, there is a decrease in mobility, curvature of the limbs, and joint deformation. With the development of synovitis, the form becomes rounded and smooth, and during palpation, the specialist detects fluctuation.

Stages and their clinical manifestations

It is customary to distinguish three stages of the development of this disease, which are manifested by different symptoms and disorders of the knee joint:

I stage of gonarthrosis

This stage includes clinical manifestations characteristic of the onset of the disease. As a rule, this is a pain of a dull nature, localized inside the knee joint and arising after a long walk.

From time to time, the knee joints swell, but any visual deformities are absent.

II stage of gonarthrosis

This stage is characterized by an increase in existing clinical manifestations:

  • pains become longer and brighter;
  • when moving with a knee, a crunch in the joint is clearly audible;
  • stiffness in the joints in the morning;
  • there is a slight restriction of extension and flexion of the joint;
  • the size of the joint is increasing.

III stage of gonarthrosis

At this stage, all the symptoms are fully manifested:

  • pains bother constantly – both during exertion and at rest;
  • the limitations of joint extension and flexion are pronounced;
  • gait is disturbed;
  • the knee joint is noticeably enlarged and deformed.

Gonarthrosis 3 degrees

IV stage of gonarthrosis

Gonarthrosis of the 4th degree is one of the stages of the disease, which is characterized by the development of degenerative-dystrophic processes in the knee joint.

Anatomy and pathological changes in the joint with gonarthrosis

The knee joint consists of the surfaces of the tibia and femur. In the anterior zone there is a patella gliding along a depression between the condyles of the femur. At the same time, the tibia does not affect the functionality of the knee joint. The surfaces of the femur and tibia have a cartilaginous layer, the thickness of which is 5 mm. It absorbs shock and reduces friction during movements.

The disease begins to form with a deterioration in blood supply in the small intraosseous vessels through which blood enters the cartilage. Because of this, the cartilage becomes dry and thin, which leads to a loss of cushioning function. The second stage of the pathology develops against the background of compensatory changes in bone tissue. Compaction of the subchondral part occurs, and osteophytes are formed along the edges of the joint (bone growths in the form of spikes).

The joint capsule and synovial membrane become dry and deformed, and the joint fluid thickens (lubrication of the joints worsens). Due to the lack of transport of nutrients to cartilage, destruction occurs. After the destruction of the cartilage, degenerative changes are accelerated, which provokes the development of the third stage of the disease. At a severe stage, indentation and change in the shape of the bones occurs, which causes a decrease in mobility and acute pain in the knee joint.

Diagnostics

Before proceeding with the treatment of gonarthrosis of the knee joint, the CELT doctors carry out a diagnosis that allows you to identify the cause and degree of the disease, as well as determine the subsequent treatment. For this, an examination is carried out by a specialist, an anamnesis is collected, an X-ray examination, computed and magnetic resonance imaging are performed. An integrated approach allows us to study pathological changes in bone structures in detail, as well as to determine changes in soft tissues.

Gonarthrosis of the knee: causes, symptoms, diagnosis, treatment and prevention

Gonarthrosis of the knee joint, or osteoarthritis of the knee is a disease of the knee joint in which its deformation and dysfunction are characteristic (as a result of the destruction of cartilage tissue).

At risk are elderly and middle-aged people, as well as professional athletes. Of all the pathologies affecting the knee joint, gonarthrosis occurs most often (in every second patient).

Our clinic has long and successfully been engaged in the diagnosis and treatment of orthopedic diseases. Remember that most of them do not have symptoms at the initial stage, but quickly progress to severe forms, which can lead to irreversible consequences. If you have gonarthrosis, treatment should be selected by a qualified specialist, taking into account the characteristics of your case.

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Causes of knee gonarthrosis and types of pathology

Osteoarthritis of the knee joint can develop for a number of reasons:

  • heredity or congenital pathologies of the knee joint
  • heavy load on the joints (both in athletes and in people with excessive vest)
  • knee injuries
  • leg injuries previously treated incorrectly
  • metabolic disorders, endocrine diseases
  • circulatory problems

Depending on which side the joint is affected, distinguish between left-sided and right-sided gonarthrosis, as well as bilateral gonarthrosis of the knee joint, the treatment of which should be as complete as possible, in order to avoid differences between the limbs subsequently.

Gonarthrosis of the knee: symptoms and treatment

There are three degrees of knee osteoarthrosis. If a person develops gonarthrosis of the 1st degree, symptoms are usually absent. The patient may experience slight discomfort, which is manifested by a feeling of tightness in the area under the knee. Mistakenly, people think this is a symptom of leg fatigue.

For the further progression of the disease, the onset of pain is characteristic. The patient feels pain after prolonged walking or long standing. But signs of gonarthrosis of the 2nd degree are not limited to this. So, difficulties arise with the flexion-extensor reflex of the knee, a crunch appears during movements and the structure of the cartilage changes. In connection with the last factor, the prefix “deforming” is added to the diagnosis. Violation of blood flow can also provoke gonarthrosis of the hip joint, the symptoms and treatment of which are similar to knee gonarthrosis.

Gonarthrosis of the 3rd degree is characterized by an increase in pain, while knee pain is felt even in a state of absolute rest of the legs. Swelling may occur in the joint area. At this stage, the cartilage and joint are so deformed that it will be noticeable to the naked eye (curvature of the lower leg, etc.).

If gonarthrosis of the 1st degree is detected, treatment, as a rule, consists in massage, warming up this area, taking chondroprotectors (drugs to improve the functioning of bone tissue, joints and cartilage) and performing physical exercises. So, flexion-extension of the leg in the knee in a standing position, as well as circular movements of the knee cup with palms lying on it are effective. If bilateral gonarthrosis of the 1st degree of the knee joint is revealed, its treatment with the help of physical exercises is more successful. Springing exercises with sports tapes (shock absorbers) are recommended. The asana “cat pose” from yoga is useful: standing on all fours, the chest must be lowered to the floor, arms should be stretched forward, then the hips and buttocks should be moved to the heels. Squat should be done without lifting your chest from the floor and slightly arching your back.

When deforming gonarthrosis of the knee joint of the 2nd degree is diagnosed, treatment will require more serious. Since blood flow disorders and pain syndrome are characteristic of this stage, the specialist will prescribe vasodilator drugs, as well as antispasmodics. To increase blood flow activity and relieve inflammation, the patient will be recommended rubbing with ointments and gels and physiotherapeutic procedures.

At this stage, the treatment of gonarthrosis with platelet-rich blood plasma of the patient is actively used. For this, proteins and platelet cells are released from the patient’s blood. When mixed with its plasma, a unique serum is obtained, which is injected into the patient’s joint by injection and often under the supervision of ultrasound or CT. Oxygen therapy is also used, when the joint cavity is filled with medical oxygen, intra-articular injections of hyaluronic acid solutions are performed. Treatment of gonarthrosis of the 2nd degree can be carried out with the help of a helium-neon laser, which reduces pain and increases the motor ability of the knee joint, but this technique is expensive.

If bilateral gonarthrosis of the 2nd degree of the knee joint is diagnosed, the treatment of the limbs by the surgeon can be carried out both simultaneously and alternately with a break of several weeks.

The specialists of our clinic regularly improve their qualifications, which allows them to treat bilateral arthrosis at the most professional level. Modern equipment of the clinic guarantees the possibility of a complete and accurate diagnosis of orthopedic pathologies, as well as detecting deviations in the early stages. If you notice the symptoms described, do not hesitate to contact a specialist.

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When gonarthrosis of the 3rd degree of the knee joint is detected, the treatment will consist in surgical intervention. The most common is joint replacement (replacement of articular surfaces with artificial components) – this is a complex and responsible operation, but it returns the patient to a normal lifestyle and eliminates the need for painkillers and other drugs. Side effects during endoprosthetics (postoperative complications: vein thrombosis, secondary wound healing, etc.) were recorded in two percent of cases. The average “survival” period of an artificial joint is 15–25 years, depending on the type of prosthesis. If necessary, individual components of the prosthesis or the entire prosthesis can be replaced with a new one. The treatment regimen for grade 3 gonarthrosis includes hormonal drugs, NSAIDs, chondroprotectors and hyaluronic acid solutions.

If the patient has gonarthrosis of the knee joint of the 1st, 2nd degree, treatment with surgical intervention is possible. In the early stages, operations are performed using an arthroscope (debridement and diagnostic arthroscopy), when the joint is revised and, if necessary, the damage to the cartilage tissue is repaired. Periarticular corrective osteotomy is also performed when the bones are filed in a special way and fixed at an angle when the load on the joint is most optimal. Gonarthrosis 2, 3 degrees of the knee joint treatment in these ways also suggests. However, the effect of such interventions is temporary, about 3-5 years.

Gonarthrosis: diagnosis

Orthopedists are involved in the diagnosis and treatment of gonarthrosis.

In order to identify the disease, the following examination methods are used:

  • ultrasound examination (ultrasound) of the knee joint
  • magnetic resonance imaging (MRI)
  • roentgenography
  • biochemical blood and urine tests, as well as a blood test for erythrocyte sedimentation rate (ESR)
  • manual orthopedic examination (joints are felt, bones are linearly measured and joint mobility is determined at various bending angles)

The most accurate research method is considered to be MRI, since it allows you to examine each layer of the joint separately and determine the signs of gonarthrosis of the 1st degree of the knee joint. At this stage, the changes are minor and are expressed by a slight narrowing of the cartilage.

The degree of damage to the knee joint is perfectly determined by ultrasound, but it must be combined with an x-ray. Individually, these methods are ineffective.

At the second and third stages of the study, deformation of the knee joint, a significant narrowing of the cartilage, and accumulation of salts will be shown.

Prevention of gonarthrosis of the knee

Preventive measures to prevent the development of gonarthrosis are as follows:

  • it is necessary to balance the diet, focusing on foods with potassium and calcium, which bone tissue, joints and cartilage need
  • ensure adequate drinking regimen and physical activity, which is important for cartilage nutrition
  • the possibility of leg injuries should be minimized
  • if the injury is still received, it is necessary to deal with its treatment in a timely manner
  • existing endocrine abnormalities should be prevented or treated
  • need to monitor body mass index
  • upon reaching 35 years, an annual course of taking chondroprotective drugs is desirable

Remember that this pathology in the middle and severe stages leads not only to problems with leg health, but also to loss of motor ability, disability and forced change in the usual way of life. The specialists of our clinic will carry out a comprehensive and effective treatment of gonarthrosis of the knee joint and help you go through life easily and confidently!

Gonarthrosis of the knee joint of the 1st degree: causes, symptoms and treatment

Characterization of the disease gonarthrosis of the knee joint 1 degree. Causes of pathology, characteristic symptoms, diagnostic methods and conservative treatment

Gonarthrosis is a disease of the musculoskeletal system, which is accompanied by destruction of the knee joint (mainly articular cartilage is destroyed) and leads to a deterioration in its function.

Pathology is more common in people over 50 due to age-related changes in the body. In young people, the disease occurs when adverse factors affect the metabolism in the tissues of the joint.

Gonarthrosis of the knee joint of the 1st degree is the initial stage of the disease (for a complete overview of the disease, see the link: Diagnosis and timely treatment at this stage stops the development of irreversible changes in cartilage and promotes complete recovery.

Further in the article: causal, signs, methods of diagnosis and therapy of the first degree of gonarthrosis.

Causes

With gonarthrosis, thinning occurs, destruction of articular cartilage; violation of nutrition and metabolism in the cartilage and bones that form the knee joint. The likelihood of pathology increases in old age as a result of a slowdown in metabolic processes and a deterioration in the microcirculation of blood, lymph, joint lubrication – which is associated with the natural aging of the body.

Factors contributing to the development of pathology in young people:

  1. overweight (obesity) increases the load on the knee joints;
  2. metabolic disorders (hyperparathyroidism, diabetes mellitus);
  3. injuries and operations on the knee joint;
  4. phlebeurysm;
  5. addictions (smoking, alcohol abuse).

According to statistics, adverse factors increase the risk of gonarthrosis by 5 times.

Symptoms

The initial stage of gonarthrosis is asymptomatic, progresses slowly and does not disrupt daily activity. Therefore, patients with 1 degree of the disease rarely consult a doctor.

At the same time, conducting therapy at this stage of the disease increases the chances of recovery and prevents the development of irreversible changes in the knee joints. Treatment of the 2nd – 3rd degree only slows the progression of the pathology, but does not restore the destroyed cartilage and bone tissue.

Symptoms of a disease of the 1st degree:

  • aching knees after physical overload (climbing stairs to the 7th floor and above, walking to a distance of more than 2 km, carrying heavy loads of more than 10 kg);
  • discomfort ceases after a short rest (10-15 minutes);
  • stiffness in the knee joints after a night’s sleep (persists for half an hour);
  • crunching in the knees while running, sharp squats – absent when walking;
  • fatigue of the muscles of the legs.

If these symptoms appear, you should consult a doctor (rheumatologist, arthrologist, orthopedist).

The increase in clinical signs – increased pain intensity, the occurrence of discomfort with slight physical exertion or during sleep, stiffness in the joints for more than an hour, crunch in the knees when walking, lameness – indicate a transition to the 2nd degree.

Diagnostics

To identify the degree of gonarthrosis, a rheumatologist (arthrologist, orthopedist) on the basis of patient complaints assesses the nature of the pain syndrome and the conditions for the appearance of discomfort in the knee joints.

To confirm the diagnosis, the doctor prescribes an X-ray examination, which shows a change in the joint space. At an early stage, pathological changes in the radiograph may be absent.

The diagnosis is also confirmed by computed tomography and magnetic resonance imaging (abbreviated as CT and MRI), which reveal cracks and irregularities in the cartilage layer of the knee joint.

Therapies

Therapeutic measures for grade 1 gonarthrosis lead to a complete restoration of the cartilage of the knee joint. To increase the effectiveness of therapy, it is necessary to normalize body weight, treat concomitant endocrine and vascular diseases, and abandon bad habits.

With 1 degree of gonarthrosis, conservative treatment is prescribed:

  1. Nonsteroidal anti-inflammatory drugs for 10-14 days (nimesil, movalis, ketorolac).
  2. Chondroprotectors for 4-6 months (don, chondrolone, rumalon). Chondroprotectors are prescribed in several courses, the total duration of therapy is usually 1,5-2,5 years.
  3. Physiotherapy (magnetotherapy, amplipulse, ozokerite).
  4. Foot massage.
  5. Physiotherapy. Therapeutic exercises must be performed regularly throughout life; It is also useful to visit the pool, ride a bike.

Avoid physical activities such as jumping, long-distance running, weight lifting. To prevent excessive stress on the knee joints, doctors recommend wearing orthopedic shoes and shock-absorbing sneakers.

There are contraindications. Specialist consultation required

Bilateral gonarthrosis – causes, symptoms, diagnosis, degrees, methods of treatment and prevention

Human joints are subject to constant load and mechanical stress. The development of bilateral gonarthrosis – a disease of the knee joint, which is characterized by deforming destruction of the cartilage plate, can be of 1, 2 and 3 degrees, as a rule, in the first stages it is reversible. With early diagnosis and adequate treatment, the prognosis is favorable.

What is bilateral gonarthrosis

This is a degenerative-dystrophic pathology, which is characterized by the destruction of the knee joints of both legs. In medical practice, the disease is considered severe, which in a short period of time leads to disability of the patient. Bilateral lesion is diagnosed in the elderly. The nature of the pathology is idiopathic or age-related. The clinical picture is pronounced in the advanced stage, because both joints are subjected to axial load. According to ICD-10, primary bilateral gonarthrosis has a code of M17.0.

Causes

The knee joint in the human body is the largest, is responsible for the ability to make movement with the legs. He is constantly exposed to a heavy load from the whole body and is very prone to injuries. Over time, the joint wears out, so primary gonarthrosis is more often diagnosed in the elderly, whose cartilages are very worn out. There are other factors that affect premature joint wear and the development of bilateral pathology:

  1. Knee injury Damage to the knee leads to the development of post-traumatic arthrosis.
  2. The development of other pathologies that adversely affect cartilage, for example, arthrosis.
  3. Genetic predisposition.
  4. Varicose veins, overweight.
  5. The use of specific medications.

Symptoms

Earlier identification of signs of pathology and timely initiation of therapy will help to obtain a positive result without disabling the patient. The main clinical symptoms of the disease include the following clinical picture:

  • pain develops gradually, at first only when walking;
  • it becomes difficult for a person to climb and go down the stairs;
  • with prolonged standing in the knee joint, a pain symptom appears;
  • with complications of the synovitis pathology, blood outflow is disturbed due to knee edema, which leads to pain in the calf;
  • “turns” caviar at night;
  • it becomes difficult for the patient to bend his leg at the knee;
  • when you try “to stop” to straighten the knee joint there is a crunch and a sharp pain in the joint;
  • with gonarthrosis, the patient walks constantly on bent legs.

Stages of development of the disease

Gonarthrosis of the bilateral type in the absence of adequate therapy can be aggravated. Several degrees of pathology are distinguished, which are characterized by an aggravation of degenerative changes in the joint. The following stages of the development of the disease are distinguished:

  1. Bilateral gonarthrosis of the 1st degree. Appropriated in the first stages of development, when there are no vivid symptoms. Pain appears only after a dull physical exertion in a dull form (long walking, jogging). At this stage, a tumor may sometimes appear in the knee area, it passes by itself without additional intervention. At stage 1 of gonarthrosis, bone and joint deformities are not observed.
  2. Bilateral gonarthrosis of the 2nd degree. Appropriated if the signs are identified. The pain manifests itself more often, expressed more intensely. In the second stage, a crunch appears in the knee joint, which appears during movement. With a long absence of activity, there is some stiffness in the knee, especially after sleep. After charging, it passes completely. At this stage, there is a configuration and an increase in the joint.
  3. Bilateral gonarthrosis of the 3rd degree. The last and most difficult stage of pathology. The pain syndrome becomes constant, without reference to the load or knee position. Weather conditions affect the joint, causing pain, physical activity is reduced to a minimum. The last stage of gonarthrosis is manifested in X – and O-shaped deformation.

Complications

At the first stage of the pathology, there are no consequences for humans; timely therapy has a favorable prognosis. The consequences for the patient appear when moving to the 2nd stage. The following possible complications of the disease are distinguished:

  1. The development of total ankylosis. This is a local complication when there is a single fusion between the bones.
  2. Gangrene of the foot, lower leg takes place during fusion with compression of the artery, getting the vessel between the bones.
  3. There are a number of total complications, which include: scoliosis, osteochondrosis, muscle atrophy of the affected part of the body.
  4. A frequent consequence of the disease is the development of arthritis, a hernia of the intervertebral disc. Sometimes internal organs are involved.

Diagnostics

If you experience symptoms and suspected joint pathology, you must make an appointment with the doctor. He will conduct an examination, collect an anamnesis and, with the likelihood of developing gonarthrosis, will direct him to conduct the following studies:

  • X-ray of the knee joint, which will show the presence of deformation of the joint;
  • at the initial stage, magnetic resonance imaging will help determine the pathology;
  • additional laboratory tests may be prescribed to confirm the diagnosis.

Treatment

Bilateral gonarthrosis of the 2nd degree of the knee joints can be treated conservatively. If it was possible to diagnose the disease at the 1st stage, then there will be no health consequences. At the second stage, a comprehensive approach is needed to prevent deformation of the joint. A positive result is achieved using the following treatment methods6

  1. Drug therapy. This includes several groups of drugs: anti-inflammatory drugs, analgesics, chondroprotectors. Their action is aimed at reducing pain, relieving swelling and inflammation. It also requires funds that stimulate the replacement of synovial fluid.
  2. Physiotherapy. A whole range of procedures is prescribed that positively affect the condition of the knee joint: magnetotherapy, therapeutic massage, electrophoresis, gymnastics.
  3. Orthopedic therapy. Various orthopedic devices (orthoses, canes, etc.) are used in this direction. They help reduce the load, which is very important in the treatment of bilateral type gonarthrosis.
  4. Surgical intervention. It is used in advanced stages of the disease, provided that other methods do not give positive dynamics. The doctor must explain the essence of the procedure to the patient and obtain his consent. After the operation, a rehabilitation period follows. It is carried out, as a rule, at the 3rd stage of gonarthrosis.

Medication

When diagnosing left-sided gonarthrosis or right-sided gonarthrosis, the doctor prescribes the traditional course of treatment with the help of several groups of drugs. For treatment, the following types of medications are used:

  1. NSAIDs or non-steroidal anti-inflammatory drugs. Available in the form of gels, ointments, tablets, and in rare cases in the form of solutions for intramuscular injection. Popular options are Ibuprofen and Diclofenac.
  2. Hormonal drugs. Used for intraarticular injections to quickly relieve inflammation and stop soreness. Assign, as a rule, Diprospan, Kenalog, Hydrocortisone.
  3. Chondroprotectors. The action of drugs is aimed at restoring cartilage. Effective options among doctors are: Structum, Rumalon, Alflutop.
  4. Warming ointments. The action of medicines is aimed at improving blood circulation, eliminating inflammation (Dolobene, Fastum).
  5. Vasodilator medicines are used to reduce muscle tone (Actovegin, Trental).
  6. Antispasmodics are necessary for the relief of pain (Midokalm No-shpa).
  7. Vitamin complexes are needed to strengthen the immune system, the income necessary for the regeneration of trace elements.

Nonsteroidal anti-inflammatory drugs

This group of medicines is prescribed by a doctor to relieve the inflammatory process, pain in the knee. In the pharmacy you can find many drugs of this type in different dosage forms. The most popular means are:

  1. Celebrex. It has analgesic, antipyretic, anti-inflammatory effects. The drug effect is achieved by inhibition of COX-2. It is prescribed for gonarthritis, gonarthrosis 1-2 degrees of 100-200 mg / day. Long-term use is contraindicated due to the large list of side effects, contraindications. The duration of treatment is determined by the doctor.
  2. Ketanov. Provides short-term relief of moderate to severe pain. Adults drink 10 mg every 6 hours. Take longer than 2 days is contraindicated. You can not use the medication during lactation, pregnancy or in the presence of ulcerative lesions of the gastrointestinal tract.

Chondroprotectors

With bilateral knee damage, chondroprotectors, which are the main part of the treatment of the disease, are indicated for treatment. Effective remedies from this group are:

  1. Chondroitin Sulfate. Eliminates the negative effect of enzymes that corrode cartilage, improves saturation of articular cartilage with water, and stimulates growth. The standard dosage is 1-, 5 g 2 times a day. The duration of treatment should not exceed 60 days. The medicine is contraindicated during lactation, pregnancy, a tendency to bleeding.
  2. Glucosamine sulfate. Prevents the destruction and damage of cartilage, leads to normal production of intraarticular fluid. According to the instructions, you need to take 1 tablet twice a day. The therapeutic effect is achieved during treatment for 6 months. You can not take the medication for individual intolerance, during lactation, pregnancy, or with impaired renal function.

Gonarthrosis

Gonarthrosis (osteoarthrosis, deforming arthrosis of the knee joint) is a degenerative-dystrophic disease in which the hyaline cartilage is affected, covering the condyles of the tibia, femur and patella.

In the late stages of gonarthrosis, the entire joint is involved in the process; the joint gap narrows, the underlying part of the bone becomes denser, bone growths (spikes, osteophytes) appear. The disease usually occurs in patients over the age of 50 and is more likely to occur in women.

In some cases (after injuries, in athletes, as a result of certain diseases), gonarthrosis can develop at a young age. The main manifestation of gonarthrosis is pain, aggravated by movement, limitation of movement and synovitis (fluid accumulation) in the joint.

Gonarthrosis develops gradually over many years. If treatment is not started at the time, the pathological process will end with the destruction of cartilage, exposure of bones and complete destruction of the joint. A significant role is played by timely prevention.

Classification

Given etiopathogenesis, two types of gonarthrosis are distinguished:

primary (idiopathic);
secondary gonarotrosis.

The reason for the development of idiopathic gonarthrosis is not known and is usually bilateral. Secondary gonarthrosis develops against the background of previous (or as a result) pathological changes in the knee joint: diseases, developmental disorders, injuries, after infectious complications. It can occur at any age, usually one-sided.

Given the severity of pathological changes, three stages of gonarthrosis are distinguished:

• Stage I – the initial manifestations of gonarthrosis. Periodic dull pains are characteristic, usually after a significant load on the joint. A slight swelling of the joint is possible, which disappears after rest. There is no deformation.
• Stage II – an increase in the symptoms of gonarthrosis. The pains become longer and more intense. Often there is a crunch, swelling in the joint. Slight or moderate restriction of movements and slight deformation of the joint are noted. At this stage, analgesics (conservative treatment) help patients relieve pain.
• Stage III – the clinical manifestations of gonarthrosis reach a maximum. The pain is almost constant, the gait is broken. Marked restriction of mobility and marked deformation of the joint are noted. NSAIDs, physiotherapy, and other methods of conservative treatment are ineffective at this stage.

Anatomy and pathological changes in the joint with gonarthrosis

The knee joint is formed by the articular surfaces of the femur, tibia and patella. The patella is located on the front surface of the joint, which during movements glides along the groove between the condyles of the femur.

The fibula is not involved in the formation of the knee joint. Its upper part is located on the side and just below the knee joint and is connected to the tibia through a sedentary joint.

The articular surfaces of the tibia and femur, as well as the posterior surface of the patella, are covered with a smooth, very strong and resilient, densely elastic hyaline cartilage. Cartilage reduces the frictional forces during movements and performs a shock-absorbing function during shock loads.

Lateral and medial menisci, which are located between the articular surfaces of the tibia and femur, also perform a large shock-absorbing function. Of great importance in the development of gonarthrosis is the preservation of the cruciform and lateral collateral ligaments.

At the first stage of gonarthrosis, blood circulation is disturbed in small intraosseous vessels that feed hyaline cartilage. The surface of the cartilage becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of soft unobstructed glide, the cartilage “clings” to each other.

Due to permanent microtraumas, the cartilage tissue becomes thinner and loses its cushioning properties. Degenerative changes also develop in the menisci, the latter losing their elasticity.

At the second stage of gonarthrosis, compensatory changes occur on the part of bone structures. The joint area is flattened, adapting to increased loads. The subchondral zone is compacted (part of the bone located immediately below the cartilage). Bone growths – osteophytes – appear on the edges of the articular surfaces.

The qualitative and quantitative characteristics of the synovial fluid of the joint change – it thickens, its viscosity increases, which leads to a deterioration in lubricating and nourishing properties.

The synovial membrane and joint capsule during gonarthrosis also degenerate and become “wrinkled”. Due to a lack of nutrients, cartilage degeneration is accelerated. The cartilage is even thinner and completely disappears in some areas.

After the thinning (disappearance) of cartilage, the friction between the articular surfaces increases sharply, degenerative changes progress rapidly, the third stage of gonarthrosis occurs.

At the third stage of gonarthrosis, the bones are significantly deformed, the joint gap sharply narrows, significantly restricting movement in the joint. Joint surfaces of bones are completely exposed in places.

Causes of

In most cases, it is impossible to single out one single cause of gonarthrosis. As a rule, the occurrence of gonarthrosis is due to a combination of several factors.
Often the development of gonarthrosis is associated with previous injuries: fractures of the joint-forming bones, torn menisci, tears or torn ligaments. Gonarthrosis usually occurs years after the injury, although an earlier development of the disease is possible.

In the development of gonarthrosis an important place is occupied by excessive loads on the joint, which leads to the rapid development of degenerative-dystrophic changes and the appearance of symptoms of gonarthrosis. Especially dangerous for the knee joints are running and intense quick squats.

Another predisposing factor for the development of gonarthrosis is overweight. With overweight, the load on the joints increases, more often both microtrauma and serious damage (torn menisci or tears of the ligaments). More often gonarthrosis develops against the background of arthritis (psoriatic, gouty arthritis, reactive arthritis, rheumatoid arthritis, arthritis in ankylosing spondylitis).

In addition, among the risk factors for the development of gonarthrosis are weakness of the musculo-ligamentous apparatus (with congenital diseases), metabolic disorders and impaired innervation in certain neurological diseases, spinal cord and brain injuries.

Symptoms

The disease begins gradually. At the first stage of gonarthrosis, patients are concerned about minor pain during movements, especially during the ascent or descent of stairs. Perhaps a feeling of stiffness in the joint and “tightening” in the popliteal region.

A characteristic symptom of gonarthrosis is the “starting pain” – painful sensations that occur during the first steps after rising from a sitting position. When a patient with gonarthrosis “diverges”, the pain decreases or disappears, and after a significant load appears again.

Externally, the knee is not changed. Sometimes patients with gonarthrosis note a slight swelling of the affected area. In some cases, at the first stage of gonarthrosis, fluid accumulates in the joint – synovitis develops, which is characterized by an increase in the volume of the joint (it becomes swollen, spherical), a feeling of heaviness and limitation of movements.

In the second stage of gonarthrosis, the pain becomes more intense, occurs even with small loads and intensifies with intensive or prolonged walking. After a long rest, painful sensations usually disappear, and with movements arise again. As gonarthrosis progresses, the range of movements in the joint gradually decreases, and crunching during movements is possible.

In the third stage of gonarthrosis, the pain becomes almost constant, patients are worried not only while walking, but also at rest. Joint movements are significantly limited. In some cases, a patient with gonarthrosis cannot fully straighten his leg.

The joint is enlarged, deformed. In some patients, valgus or varus deformity occurs. Due to limitation of movement and deformation of the legs, the gait becomes unstable. In severe cases, patients with gonarthrosis can only move with the support of a cane or crutches.

Do not waste time and money! Do not risk your health!

Contact a qualified orthopedist at the first symptom of the disease. In our clinic, we will help you quickly get rid of your ailment.

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.

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