Arthrosis of the knee joints (gonarthrosis) - symptoms and treatment

Osteoarthritis of the knee joint (gonarthrosis) is a progressive chronic disease of the knee joint with damage, thinning and destruction of its cartilaginous part (the articular surfaces of the femur and tibia), as well as damage to the subchondral bone. Research (arthroscopy and MRI) has shown that, in addition to damage to the articular cartilage, the menisci and the synovial membrane are also involved in the process.Gonarthrosis is one of the most common orthopedic pathologies. There are synonyms - osteoarthritis (OA), deforming arthrosis.The disease is an important socio-economic problem, as it is widespread and significantly impairs the quality of life of patients due to constant pain and, in addition, becomes a cause of high disability.

Until the mid-1980s, there was no single definition of the disease.It was only in 1995 that the disease was characterized as the result of mechanical and biological factors leading to an imbalance between the processes of degradation and synthesis of the extracellular matrix of articular cartilage. As a result, fiber decay and degeneration occur, cracks, osteosclerosis and compaction of the cortical layer of the subchondral bone are formed, osteophytes grow and subchondral cysts are formed. 

Many factors lead to gonarthrosis, including:

1. chronic traumatization (violation of physical activity, excess weight);
2. endocrine, inflammatory, metabolic and ischemic diseases;
3. the presence of congenital or acquired disorders of the relationships, form or structural organization of the joint ends.

Symptoms of arthrosis of the knee joints

Knee osteoarthritis is characterized by:

• gradual onset;
• slight pain in the joint when moving, especially when going up and down stairs;
• "tightness", stiffness and "starting pain", which occurs with the first steps and decreases or disappears if the patient "drifts", after significant physical activity resumes.
• the appearance of the knee remains the same.Sometimes there is slight swelling or accumulation of fluid in the joint (synovitis develops).At the same time, the knee increases in volume, swells, becomes flattened, movement restriction and heaviness are felt.

As the disease progresses, the pain becomes more intense, it appears even with a slight load and prolonged walking.Localized on the front-inner surface of the joint. Prolonged rest usually helps the pain go away.The range of motion of the joints may decrease, crunching and sharp pain may occur when the leg is maximally flexed.The configuration of the joint changes as if it were expanding.Synovitis is more common, lasts longer, and involves a large amount of fluid.

The last stage of gonarthrosis is different in that the pain becomes almost constant, causing anxiety not only when walking, but also at rest and even at night, when patients have to look for a comfortable position to sleep.Movement is more limited: it is difficult to fully bend and straighten the leg.The joint deforms and increases in volume.A valgus (X-shaped) or varus (O-shaped) foot deformity is often observed. The gait becomes unsteady and jerky.In severe cases, a cane or crutches are needed.

According to the researchers, 76% of elderly people who complain of knee pain have X-rays showing gonarthrosis. According to statistics, women are more often affected by the disease, which is associated with hormonal changes after 45 years.

Pathogenesis of arthrosis of knee joints

There is primary and secondary osteoarthritis.

Primary arthrosis:

• Articular cartilage is constantly destroyed and renewed;usually these processes are balanced.With age, the renewal of cartilage slows down and destruction begins to prevail, which is called the process of degradation or degeneration. The weight of a person plays an important role, because with a mass of 70 kg in 20 steps we carry 700 kg on each leg (70 kg x 10 steps), and with a mass of 120 kg we already carry 1200 kg on each leg.Because of this, weak cartilage wears out much faster;
• you must remember: the joint receives nutrients and recovers while moving;A sedentary lifestyle reduces metabolic processes and the necessary elements do not reach the cartilage;
• There are conflicting data on the role of heredity in the onset of the disease.If the parents had arthrosis, then the probability of its appearance in children increases;
• occurs due to autoimmune synovial inflammation.

Secondary arthrosis is caused by:

• injuries (fractures, tears of the meniscus and anterior cruciate ligament). Unfortunately, in every person, regardless of age, these injuries lead to excessive stress on the cartilage.A fracture of any part of the bones covered with cartilage is accompanied by the formation of an unevenness - a "step". In this area, during movement, abrasion occurs and arthrosis is formed;
• rheumatoid arthritis, Koenig's disease (osteochondritis dissecans), consequences of purulent inflammation in the joint (gonitis), etc.;
• regional vascular disorders;
• chronic exudative-proliferative and cicatricial adhesive processes in the joint.

In arthrosis (osteoarthrosis), in addition to the progressive destruction of cartilage, the loss of its elasticity and shock-absorbing properties, the bones are gradually involved in the process. When loaded, sharp edges (exostoses) appear, which are mistakenly considered "salt deposits" - in classic arthrosis, salt deposition does not occur.As arthrosis progresses, it continues to "eat" the cartilage.Then the bone is deformed, cysts are formed there, all the structures of the joint are affected and the leg bends.

In addition to the inner or outer part of the knee, osteoarthritis can also affect the surfaces between the patella and the intercondylar groove of the femur.This option is called patellofemoral arthrosis.

 The cause is usually subluxation, fracture, or lateralization of the patella.

Classification and stages of development of arthrosis of the knee joints

Regardless of the cause, there are three stages of the disease:

• I stage - initial manifestations.It is characterized by primary changes in the hyaline cartilage. Bone structures are not affected.Blood supply in intraosseous vessels and capillaries is impaired.The cartilage surface dries out and loses its smoothness.If the disease is accompanied by constant intense synovitis, a cyst develops. After a significant load on the joint, a dull pain appears.There may be slight swelling, which disappears after rest.There is no deformation.
• Stage II - the cartilaginous layer thins sharply, and in some places it is completely absent. Osteophytes appear on the edges of the joint surfaces.The qualitative and quantitative characteristics of the synovial fluid of the joint change - it becomes thicker, more viscous, which leads to a deterioration of its nutritional and lubricating properties. The pain is more prolonged and intense, often there is a crunch when moving.There is mild or moderate limitation of movement and slight deformity of the joint.Taking analgesics helps relieve pain.
• Stage III - absence of cartilage in most affected areas, severe sclerosis (hardening) of the bone, numerous osteophytes, and sharp narrowing or absence of the joint space. The pain is almost constant, the gait is impaired.Mobility is sharply limited and deformation of the joint is noticeable.NSAIDs, physical therapy, and other standard treatments are ineffective. 

Depending on the number of affected joints, unilateral and bilateral gonarthrosis are distinguished.

Complications of arthrosis of knee joints

The most common complication of stage II and III is tenosynovitis of the adductor muscle group of the thigh. This is manifested by pain on the inner surface of the joint, which increases with movement.The reason is muscle imbalance and deformation.With a long-term reduction in range of motion, a contracture develops. In addition, synovitis often occurs.Gonarthrosis in an advanced stage affects the entire musculoskeletal system, disrupting the biomechanics of the spine and other large joints of the lower limbs.This can lead to a herniated disc and arthritis of other joints. The second knee joint is overloaded (if the disease is unilateral), as the patient spares the diseased leg, transferring the weight to the other, healthy one.

Diagnosis of arthrosis of the knee joints

The diagnosis is made by an orthopedist-traumatologist, and in the majority of cases, an examination and an X-ray of the knee joint in two projections (direct and lateral) are sufficient. Clinical data and imaging help to determine the stage of the disease.

In the early stages of the disease, with minor changes in bone tissue, X-ray examination is not so valuable. At this stage, gonarthrosis can be diagnosed by arthroscopy. The accuracy of the method is very high;only its invasive nature and cost can stop it.

Ultrasound does not allow a clear visualization of changes in the articular cartilage and intra-articular structures. With the help of MRI, you can detect changes in the bones, cartilage and soft tissue structures of the joint, as well as the subchondral bone with 85% accuracy. Scintigraphy can assess the metabolic activity of periarticular bone tissue.

The increased content of phosphorus and calcium in the dehydrated synovial fluid is evidence of the destruction of the osteochondral tissue of the joint and the accumulation of decay products.Blood is also examined - general analysis and erythrocyte sedimentation rate (ESR);determination of the level of fibrinogen, urea and other biochemical parameters of blood and urine.

Treatment of arthrosis of the knee joints

Conservative - anti-inflammatory drugs, pain relievers, muscle relaxants, vascular, chondroprotectors, compresses, kinesio taping, physical therapy, physical therapy, orthoses.

Minimally invasive - paraarticular blockades (novocaine + medicine relieves pain and inflammation), injection of artificial lubricant into the joint itself, plasmolifting.

Surgical - arthroscopy (a low-traumatic method for the treatment of intra-articular pathologies and removal of damaged structures), endoprosthetics.

Conservative methods are most effective in the initial stage of the disease. They help reduce pain and temporarily slow the breakdown of cartilage.In stage II, more effective methods are needed. The introduction of preparations with hyaluronic acid into the joint cavity is used to reduce friction and trauma to the cartilage.There is no clear evidence for cartilage repair, but it is good for lubricating surfaces."PRP therapy" (plasmolifting) is the injection of platelet-rich plasma into the knee joint, which is obtained from the patient's own blood by centrifugation. It nourishes the cartilage and promotes its recovery, as autoplasmic platelets contain numerous growth factors and cytokines that promote the regeneration of damaged tissue.

Endoprosthesis replacement is a common and effective surgical method for the treatment of severe gonarthrosis, which allows you to maintain limb mobility and the ability to lead a full life afterwards.It is a high-tech operation lasting about an hour and a half.In the postoperative period, long-term rehabilitation and development of the joint is necessary. After 25-30 years, when the artificial joint wears out, it must be replaced again.

Forecast.Prevention

You must understand that if arthrosis begins to develop, it must be treated immediately. If you are at risk of this disease, you can delay the start, for this it is recommended:

• reducing stress on the knee joint;
• swimming - water relieves stress;
• massage the lower leg and thigh muscles yourself;
• avoid hypothermia and overfatigue;
• maintain a normal weight;
• give up smoking and alcohol;
• women wear comfortable low-heeled shoes;
• do physical therapy

Before starting therapeutic exercises, you should definitely consult your doctor.Exercises are performed at a slow pace.If pain or discomfort occurs during gymnastics, the exercises should be stopped.

It is necessary to use only effective drugs.Rubbing, compresses and other folk methods are ineffective;they do not act on the cause of the disease, but only help to distract from the pain.Avoid injuries and overloads - jumping, carrying heavy objects, standing for long periods or sitting in an uncomfortable position. This accelerates the progression of the disease.

Also, timely diagnosis and treatment of rheumatoid arthritis, gout and systemic diseases is necessary.

The prognosis depends on the stage at which the patient went to the doctor and on the correct therapy. The sooner you start the right treatment, the better your chances of avoiding surgery.