The knee joint is formed from the articular surfaces of the tibia and femur. In its anterior part there is a patella, which during movements glides smoothly along the recess located between the condyles of the femoral joint.
The femur and tibia along with the knee pad are covered with elastic glial cartilage, which is 5-6 mm thick. It helps to reduce friction during a person’s physical exertion, and when falling performs a shock-absorbing function.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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- Pathological changes in the joints: phased disorders
- Causes and predisposing factors
- Clinical manifestations
- The first stage
- The second stage
- Stage Three
- Which doctor treats knee gonarthrosis?
- Diagnostic measures
- Methodology of Evdokimenko
- The technique of Dr. Bubnovsky
- Gitt treatment
- Surgical intervention
- Therapeutic exercise
- Is gonarthrosis completely treated?
Pathological changes in the joints: phased disorders
At the first stage of the development of gonarthrosis of the knee joint, blood circulation first of all suffers. Small intraosseous vessels that supply blood to the hyaline joint are disrupted, which leads to the gradual drying of its surface. It becomes less elastic, and cracks begin to form on its surface.
As a result of this, instead of soft sliding, these cartilages touch each other. Inflammation begins to develop gradually, and diseased cartilage, shifting slightly, interfere with each other to fully perform their functions. Due to the formation of a large number of microcracks in the tissue region of which the cartilage consists, they gradually lose their cushioning properties.
In the second phase of the progression of gonarthrosis, compensatory changes in the bone area begin to occur. Under the influence of increased loads, the articular site begins to gradually flatten, this leads to compaction of the subchondral zone (the area of the bone that is under the cartilage).
The articular surfaces around the edges begin to grow with bone processes, which in the x-ray look like sharp spikes.
As the lubricating fluid in the joints becomes thicker, it loses most of its functions. This leads to accelerated cartilage degeneration. For this reason, it appears on the roentgenogram as a thin thread, or becomes generally invisible.
If this has been noticed, this means that the disease smoothly (or rapidly – it all depends on the situation) flows into the 3rd phase of development.
In the third stage of gonarthrosis of the knee, a marked deformation of the bones occurs. They seem to squeeze into each other, which leads to a decrease in joint mobility. Cartilage tissue is almost completely dry.
Causes and predisposing factors
The causes of arthrosis of the knee joint are not isolated – often the doctor determines several factors at once that entailed the development of the disease.
The most common and common causes are:
- previously suffered joint injuries (moderate or high severity);
- leg fractures, especially if there was an intraarticular injury;
- violation of the integrity of the structure of the menisci;
- tears or complete tears of the ligaments;
- excessively intense loads on the knee joints, etc.
Acute arthrosis of the knee is directly related to the age of the person. So, it was found that people older than 40 are most exposed to it, since during this period the flexibility of the cartilage begins to decrease, and the lubricating joint fluid gradually “dries out”.
To delay this moment, patients are recommended to exercise, but physical activity should be moderate and not lead to general discomfort.
Excess weight is also one of the factors predisposing to the development of gonarthrosis. The fact is that overweight creates an additional load on the bones and joints, which cannot but affect their health.
An important role is played by the fact which foot has the most stress. For example, if your “support” is the left leg, then there is a high probability that you may develop left-sided gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels. Ruptures of menisci or ligaments, which are considered a difficult way of manifesting joint injuries, are not excluded.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins. In this case, the patient is shown a consultation with a phlebologist.
A great risk of developing this pathology also exists in people who:
- previously suffered various types of arthritis;
- have an unfavorable heredity;
- have problems with the ligamentous apparatus;
- suffer from metabolic disorders;
- suffered craniocerebral injuries;
- suffered in an accident;
- had spinal injuries.
Many of these factors are often closely interconnected. An accurate determination of the cause helps to establish an accurate diagnosis and prescribe the patient the correct and effective treatment for arthrosis of the knee joint.
Symptoms of gonarthrosis manifest themselves far from immediately – they begin to occur gradually, depending on the stage of the disease. For this reason, the clinical picture should be considered in stages.
The first stage
At the initial stage of the development of the disease, patients complain of mild pain in the knee, which intensifies during physical exertion. They become especially intense during the descent and climb the stairs.
In addition to pain, the patient feels a certain stiffness of movements, “contraction” in the joint. It is felt in the popliteal part, and passes when the knee muscles relax.
Another characteristic feature is the so-called “starting pain syndrome”. It develops at the first steps of the patient. When the knees get used to the load, this anomaly disappears without a trace.
The second stage
At this time, the symptoms of knee arthrosis become more intense and noticeable. The pain intensifies, causing significant difficulties and discomfort when walking. The pain syndrome disappears after a long rest, but with intense exertion again makes itself felt.
Inflammation of the joint causes swelling of the knee, which is visible even with the naked eye. When walking, a strong, unpleasant crunch occurs. Movements become heavier and constrained.
The pain becomes very severe, and the patient can not do without painkillers. It’s hard for a person to bend his knee, he feels the stiffness of the movements of the joint. It becomes deformed, increases in size. In severe cases, the patient cannot move without additional support.
All of these signs of knee arthrosis should not be ignored by the patient. A disease can put a person in a hospital bed for a long time, and sometimes lead to disability.
Which doctor treats knee gonarthrosis?
To make a diagnosis and treat knee gonarthrosis, you need to see a traumatologist orthopedist. If necessary, surgical intervention may require the help of a surgeon.
To establish the cause of the ailment, an integrated approach to the examination of the patient is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination of an orthopedist and history taking. The doctor determines whether the patient has symptoms of acute arthrosis of the knee joint, palpates the affected area of the leg, measures the bone and performs angiometry – a test with which you can evaluate joint mobility at different angles.
- A clinical blood test to evaluate ESR.
- Blood biochemistry.
- The study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common methods of examination for arthrosis. However, in the initial stages, the image does not show any changes – they can be seen only in the later stages of development. The radiograph shows a narrowing of the joint gap, sclerotic changes in the cartilage, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, full-fledged examination results can be achieved if an ultrasound scan is performed along with radiography.
- MRI allows you to thoroughly examine all layers of articular, cartilage and bone tissues, and notice the first dystrophic changes in the early stages of arthrosis. However, MRI has one big minus – the procedure is quite expensive. But its high accuracy contributes to a 99,9% accurate diagnosis.
The treatment of acute knee arthrosis, as well as its diagnosis, requires an integrated approach. But, first of all, it is necessary to apply drug therapy, because a diseased joint can become inflamed at any time.
How to treat knee gonarthrosis with pharmacy drugs, and which drugs to choose? This will tell only a traumatologist. Often, the following groups of drugs are included in the treatment regimen:
- Non-steroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously damage the gastrointestinal tract, so they can not be used for a long time. This can not be said about the drugs of the COX-2 group, which are more sparing (Celecoxib, Nimesulide, etc.). They are administered intramuscularly or intravenously.
- The treatment of arthrosis of the knee also involves the use of hormonal drugs. They help relieve inflammation and get rid of swelling of the knee. Their use is advisable in the event that synovitis occurs (an inflammatory process in the synovial membrane).
- Treatment with chondroprotectors.
- The use of ointments, gels, creams (DIP Rilif, Finalgon, Finalgel, etc.). They improve blood circulation, warm, relieve swelling and inflammation.
Methodology of Evdokimenko
How to cure knee arthrosis using this technique? The main elements of the treatment regimen according to Evdokimenko are:
the use of medicines (NSA >
In addition, according to the famous rheumatologist Evdkominko, an important role is played by the diet for arthrosis. Due to a properly developed diet and the use of all of the above methods, you can achieve amazing results from therapy as soon as possible.
The technique of Dr. Bubnovsky
Often, treatment of arthrosis of the knee joint, as well as other articular pathologies, is carried out according to this technique.
The development of Dr. Bubnovsky is based on the use of:
- surgical intervention;
- following a diet that removes excess fluid from the body;
Also, Dr. Bubnovsky recommends swimming more in the pool, visiting the sauna and going for a massage. This will help improve the patient’s health, especially if the disease has been ignored for a long time and has not been treated.
The treatment of knee gonarthrosis by the method of Vitaliy Gitt completely eliminates dynamic loads, since they can significantly accelerate the deformation process. Exercise should be slow, with low amplitude.
Example: to sit on a chair “on horseback”, that is, facing the back. The legs are wide apart, but do not allow them to touch the floor. Gently wave each foot in turn. Perform the exercise until you feel slightly tired. The number of approaches depends on the well-being of the patient.
How to treat advanced arthrosis of the knee joints? In this case, the only way out is operation. There are several types of surgical intervention performed for osteoarthritis of the knee joints:
- Removal of deformed cartilaginous tissue and diseased joint (arthrodesis). It is extremely rare.
- Removing damaged cartilage without removing the joint. Such an intervention is called arthroscopic debridement. It is carried out using a special device – an arthroscope. The procedure is simple, but the effect of it lasts no longer than 3 years.
- Sawing and fixing the diseased joint from a different angle. This method is called periarticular osteotomy. The technique is quite complicated, but it makes it possible to forget about the pathology for 3-5 years.
Surgical intervention is rarely used, and only in the absence of a method that cures the disease, at least for 1-2 years. In the initial stages of the disease, surgery is almost never performed.
Endoprosthetics is considered the most common treatment for gonarthrosis. This is a type of operation that allows you to fully maintain the mobility of the diseased knee. But, despite its effectiveness, such a technique requires a long rehabilitation. In addition, it can lead to rather serious consequences.
The place of the “real” patient is introduced an artificial joint, which can last for 20 years. Although, of course, it all depends on the material from which it was made. The procedure is not cheap, but quite effective, and therefore has gained particular popularity.
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease. However, the principles for performing exercises are the same for all cases:
- avoidance of intense loads on the knee joint;
- sharp and forced movements are prohibited;
- Do not perform exercises that require a full load on the sore joint.
Exercises that are allowed:
- light shaking of the legs in a kneeling position on a blanket spread on the floor;
- accurate movements on his knees in the same position;
- in the same position, straighten the legs one by one, trying not to tear off the heels from the floor, and then bend them again, avoiding sudden movements.
Such exercises in combination with medication and physiotherapy give excellent results.
All physiotherapeutic procedures are prescribed for gonarthrosis, which is in a state of remission. Among the most effective methods should be noted:
- electrophoresis with Dimexide or Caripain;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent a second outbreak of the disease, physiotherapy courses should be taken at least 2 times a year. This will help prolong the phase of remission.
Knee massage is performed to improve blood circulation. It is performed along the lymph flow in the direction from the peripheral site to the central zone. The popliteal fossa is not involved in this process.
Often along with massage sessions of manual therapy are carried out, aimed at the gradual extension of the diseased joint. Such procedures stabilize the patient’s condition, but can be carried out exclusively by a specialist.
Is gonarthrosis completely treated?
Is it possible to cure osteoarthritis of the knee joint completely? Perhaps no one, even the most experienced traumatologist, will be able to give a definite answer to this question. It all depends on the severity of the disease. If you take up therapy at the first stages of its development, then you can stop further joint deformation.
However, if pathology is detected in the last stages, then even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms. The operation helps to cure only for a few years, after which the disease can again remind itself.
To prevent gonarthrosis, you must:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, lifting and lowering legs, etc.);
- enrich the diet with products containing a lot of vitamins; more about diet for joints →
- limit the use of salt, hot spices, fried, smoked, sweet;
- maintaining normal fitness;
- immediate medical attention upon receipt of the slightest knee injury;
- prophylactic administration of chondroprotectors after reaching the age of 35;
- the use of the daily norm of water (2 l).
By following these simple recommendations, you will reliably protect yourself from arthrosis of the knee joint, as well as from other diseases that can reduce the quality of your life for a long time.