Most patients seek help in the early stages of malaise, since knee arthrosis is initially accompanied by pain. Often there is calcification of the joints, which in everyday life is called “salt deposition.”
Primary bilateral or idiopathic gonarthrosis occurs without apparent reason. The patient’s senile age, overweight, genetic predisposition, high physical activity or work in hazardous work can accelerate its appearance. More on gonarthrosis →
Unlike idiopathic, secondary knee gonarthrosis always has a cause. It could be:
- congenital dysplasia;
- autoimmune disorders;
- rheumatoid arthritis;
- purulent inflammation of the joints caused by staphylococcus;
- Koenig’s disease;
- chronic hemarthrosis;
- various specific infections (tick-borne encephalitis, syphilis, gonorrhea).
Post-traumatic bilateral gonarthrosis always develops against the background of injuries: fractures, bruises, dislocations, gunshot wounds, sprains of the knee joint or abnormal bone fusion.
A negative imprint on the appearance and development of bilateral gonarthrosis is also imposed by various risk factors:
- postmenopausal period;
- the presence of osteoporosis;
- exposure to industrial toxins;
All sorts of problems in the cervical or lumbosacral spine can cause gonarthrosis.
Symptoms and Degrees
The clinical picture of knee arthrosis is quite typical of articular pathologies. The disease is manifested by the following main symptoms:
- pain when walking;
- external deformation of joints;
- atrophy of adjacent muscles;
- curvature of limbs;
- crunching and creaking while moving.
The intensity of the signs of the disease depends on the severity of the destruction of the joints. On this basis, doctors distinguish three stages of damage:
- Bilateral gonarthrosis of the 1st degree. It develops with minor pain and mild swelling after exercise. The implicit symptoms of the first stage often mislead patients, resembling simple leg fatigue.
- Bilateral gonarthrosis of the 2nd degree. It manifests itself as persistent pain in the knee joints, which does not go away after rest. While walking, a creak and a crunch are heard, and swelling increases. Lameness and morning stiffness appear, and closer to the evening cramps in the calf muscles are noted.
- Bilateral gonarthrosis 3 degrees. The last stage of the disease. Destruction of the knee joint becomes irreversible, the legs are bent, movement is difficult or impossible. The pain increases with stress and changing weather.
The most favorable prognosis for treatment has bilateral gonarthrosis of the 1st degree. At this stage, the destruction of cartilage can still be stopped and even reversed by conservative therapy. The second stage of the disease rarely does without surgery. The third degree of damage requires a complete replacement of the joint.
Which doctor treats bilateral gonarthrosis?
An orthopedist or traumatologist is involved in the fight against knee gonarthrosis. These doctors diagnose the disease and select the optimal treatment regimen.
If such specialists are not available at the local clinic, you should contact your local GP or general practitioner.
Bilateral gonarthrosis can be identified on the basis of a visual examination and a number of instrumental studies. The more neglected the disease, the more pronounced are the external signs of deformation of the joints and limbs.
At all stages of malaise, the main diagnostic method is radiography in two projections. Today, Kellgren-Lawrence classification is used to confirm gonarthrosis:
- I – some narrowing of the joint space, the beginnings of osteophytes;
- II – obvious growths on the bone tissue, a marked narrowing of the joint space;
- III – osteophytes and narrowing of the articular gap are pronounced, bone deformation appears;
- IV — fusion of the articular ends is observed, ankylosis develops.
Such a diagnosis helps to determine the stage of destruction of the joints and to differentiate knee gonarthrosis from other osteo-diseases.
As additional activities, computed tomography and MRI are prescribed. From laboratory tests, they resort to the study of plasma for the level of fibrinogen, ESR and biochemical parameters.
The tactics of treating patients depends on the severity of the disease and the intensity of the manifestations. So, gonarthrosis of the 1st degree of the knee joint is well served with drug therapy, which cannot be said about stages 2 and 3 of the lesion. In these cases, surgery is indispensable.
The following medicines will help relieve inflammation and pain:
- drugs of the non-steroid group in injections and tablets – Ketoprofen, Ibuprofen, Diclofenac;
- corticosteroids for intraarticular administration – Kenalog, Hydrocortisone;
- chondroprotectors – Arthra, Chondroitin complex, Teraflex;
- warming and analgesic ointments – Capsicam, Diclofenac, Voltaren, Fastum-gel, Ibuprofen, Deep Relief.
The most modern and effective way to treat bilateral gonarthrosis is intra-articular injection of hyaluronate: Intraject, Fermatron. They are made once a week, combined with the introduction of ozone.
If possible, drug therapy is supplemented with physiotherapy and a visit to the spa zone. Exercise therapy for bilateral gonarthrosis includes elements aimed at strengthening the muscles of the legs.
Among the auxiliary methods of treatment can be noted massage, pharmacopuncture, therapy with leeches, acupuncture.
Surgical intervention is recommended for patients with bilateral grade 2 gonarthrosis with insufficient effectiveness of medication and physiotherapy. In this case, the most relevant and effective method of therapy will be arthroscopy or partial joint prosthetics.
With bilateral grade 3 gonarthrosis, surgery becomes mandatory. The patient is recommended to undergo knee arthrodesis or resection arthroplasty.
Any articular pathology is easier to prevent than then difficult and long to treat. Therefore, the prevention of bilateral gonarthrosis is better to do in advance, without waiting for the first symptoms of malaise:
- avoid knee injuries during sports, at work and at home;
- monitor nutrition and control weight;
- Do not supercool and timely treat all kinds of infectious diseases;
- periodically drink a course of chondroprotectors and hyaluronic acid;
- early correction of congenital or acquired skeletal disorders;
- drink enough purified water.
As a sports load, swimming, calm walks or Nordic walking are suitable. For running, it is better to choose a park area or other area with soft soil. This will help rule out minor knee injuries.
Bilateral gonarthrosis – a diagnosis for life. But this does not mean that the disease is not treatable. An integrated approach to the problem will slow down the destruction of joints and give many more years of active life.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
I have been treating joints for many years. I can say with confidence that the joints are always treatable, even in the very ripe old age.
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