In medicine, the term "gonarthrosis" refers to the defeat of the intraarticular cartilage, which has a degenerative-dystrophic nature. The disease is non-inflammatory in nature. According to statistics, pathology is most often diagnosed in people over 40 years of age, but it also occurs in younger people. Patients with this disease must understand that gonarthrosis of the knee joint is such an ailment that progresses without timely treatment and can lead to serious consequences, including disability.
Development mechanism
The start of the pathological process occurs when there is a violation of the blood supply to the bone vessels, which occurs under the influence of various adverse factors. As a result, cartilage dystrophy is observed at the cellular level. The fabric becomes thinner, cracks form on it, its color changes. Gradually, the disease progresses: the cartilage disappears completely, bone exposure occurs. She, having lost protection from friction and external influences, begins to grow, bend and thicken.
The development of the disease occurs in several stages:
- Violation of metabolic processes. Metabolism in cartilage largely depends on the osmotic pressure index. With its increase, the synovial fluid is released, with a decrease - its absorption. Due to this, proper nutrition of cartilage is provided. Under the influence of adverse factors, metabolic disturbances occur, as a result of which the release of synovial fluid is reduced and the tissue thins under pressure.
- Degradation of collagen fibers. The cells that make up the cartilage tissue are softened, their functioning is disrupted. It loses firmness and elasticity, due to which its depreciation properties deteriorate.
- The formation of osteophytes. Due to impaired coherence of metabolic processes on the bone tissue, growths of a pathological nature are formed. They, in turn, contribute to the innervation of the synovial membrane, in which inflammation develops. A natural result is a significant limitation of joint mobility.
According to statistics, gonarthrosis most often affects the inside of the knee joint. As a rule, it is diagnosed in middle-aged and elderly people, as well as in athletes.
Causes
There are the following provoking factors, under the influence of which the process of the development of the disease starts:
- circulatory disturbance;
- failure of metabolic processes;
- overweight;
- hereditary predisposition;
- fragility of blood vessels ;
- knee injuries (fracture, crack, dislocation, rupture of ligaments, pinching of the menisci, etc.);
- inflammatory processes in the joints;
- high intensity of physical activity, including its mismatch with age;
- long-term damage that has not been completely cured;
- congenital malformations of the musculoskeletal system;
- violation of the sensitivity of the lower extremities.
In addition, the risk of developing the disease increases with psycho-emotional instability, prolonged exposure to stress, depression. Constant nervous tension provokes a spasm of muscle tissue, as a result of which gonarthrosis can occur.
Signs of pathology
The disease has several degrees of severity:
- the first;
- the second;
- the third.
Each of them has its own symptoms. The treatment of knee gonarthrosis also depends on the severity of the disease.
The initial stage of the development of pathology is characterized by mild symptoms or even their absence. In most cases, a person is not aware of the development of a serious disease, since minor pain sensations disturb extremely rarely. Meanwhile, treatment of gonarthrosis at this stage leads to the best results.
In order to prevent the progression of the disease, it is recommended to consult a doctor if the following warning signs appear (even if they are extremely weak):
- pain of aching nature;
- slight stiffness of the joint when trying to bend or unbend the knee;
- crunch;
- swelling.
As a rule, the treatment of gonarthrosis of the 1st degree is the use of non-drug methods of therapy.
At the next stage of the development of the disease, the symptoms become more pronounced. Both knee joints and one can be involved in the pathological process.
The second degree is characterized by the presence of the following symptoms:
- Pain In most cases, they periodically bother in the morning. The nature of the occurrence of pain is irregular, as a rule, it is short-lived and disappears on its own.
- Discomfort resulting from a long walk. For this reason, most people try to minimize the load on the joint, which is not the right decision. Lack of normal motor activity also negatively affects the course of the disease.
- Weather dependence. At low atmospheric pressure, the osmotic index increases, due to which there are pronounced pain sensations.
- Joint stiffness.
At this stage of the development of the disease, the structure of the cartilage changes, its deformation occurs, the joint gap narrows, osteophytes form.
Gonarthrosis of the 3rd degree is the most dangerous and complex stage of development. It is characterized by pronounced symptoms. The treatment of joint gonarthrosis at this stage is fraught with a number of difficulties, since the bone tissue has already grown enough.
The last stage is manifested by the following symptoms:
- severe pain that is regular in nature;
- visible changes in gait;
- severe knee deformity;
- meteorological dependence (pain intensifies with changing weather conditions);
- crunching when making movements, they become constrained.
At this stage, the damage to the cartilage tissue is maximum, the gap between the joints narrows, large spikes form on the bones, as a result of which the shape of the knee changes.
Diagnostics
It is necessary to consult a radiologist when the first alarming symptoms appear. This specialist is engaged in the treatment of gonarthrosis and further observation of the patient.
In the process of admission, the doctor conducts an initial diagnosis, including a survey and examination. The information received allows him to pre-establish a diagnosis. To confirm or exclude him, the doctor directs the patient to an X-ray examination. Using this method, it is possible to determine the stage of the disease, which is fundamentally important when drawing up a treatment regimen for gonarthrosis.
Along with radiography, modern methods are widely used: magnetic resonance imaging and computed tomography. In the process of their implementation, changes are detected not only in bone structures, but also in soft tissues, which allows timely detection of a number of complications.
Conservative Therapies
The choice of scheme depends on the degree of development of the disease. Based on the results of the diagnosis, the doctor determines which drugs and procedures will bring maximum efficiency in each case.
The treatment of gonarthrosis of the 1st degree involves the use of the following methods:
- Physiotherapy (iontophoresis, mud baths, UHF, etc.).
- Massage.
- Physiotherapy.
- Osteopathy.
- Sanatorium and resort treatment.
In addition, to achieve maximum effectiveness in the treatment of gonarthrosis, patients must follow a diet. Its task is to reduce body weight, which is one of the main reasons for the development of pathology. The diet should also be balanced, and the diet should be organized in such a way that it had 4-5 meals. At the same time, the serving size should not exceed 250 g. In addition, the menu must include products whose use helps to restore cartilage. These include: aspic, jelly, meat broth, jelly.
In most cases, for the treatment of gonarthrosis of the knee joint of the 1st degree, the use of the above methods is sufficient, but sometimes doctors consider it appropriate to prescribe chondroprotectors. These are drugs that positively affect the state of cartilage and contribute to its restoration. They can be taken orally or used externally.
For pain, a rheumatologist prescribes non-steroidal anti-inflammatory drugs (NSAIDs). They are also available in the form of tablets, and in the form of gels, ointments and creams.
In the treatment of gonarthrosis of the knee joint of the 2nd degree can not do without medications. At this stage, the treatment regimen, as a rule, is as follows:
- Reception or external use of drugs: chondroprotectors, hyaluronic acid, corticosteroids, non-steroidal anti-inflammatory drugs.
- Physiotherapy.
- Massage.
- Physiotherapy.
- Stay in sanatoriums and resorts.
NSAIDs have a complex effect: eliminate inflammation, relieve pain and help restore normal joint function. As a rule, the doctor prescribes the following drugs: Diclofenac, Ibuprofen, Indomethacin, Nimesulide.
The composition of chondroprotectors is represented by substances that are analogues of those that make up cartilage tissue. The course of treatment with such drugs is long, but they can significantly improve the course of the disease and stop its development.
Hyaluronic acid- containing products are analogues of synovial fluid. They accelerate the process of restoration of cartilage tissue, protecting it from damage, and also reduce the degree of friction of the bones.
Corticosteroids are sometimes prescribed to treat knee gonarthrosis. These hormonal drugs significantly improve the course of the disease. In most cases, they are used as an injection. Despite the high efficiency, this method is not very common. This is due to the high risk of serious side effects.
Thus, the treatment of gonarthrosis of the 2nd degree is reduced to the reception and external use of medications. The maximum effectiveness of therapy is achieved through auxiliary methods: massage, physiotherapy, etc. In exceptional cases, doctors recommend intra-articular injections of hormonal drugs.
Treatment of gonarthrosis of the knee joint of the 3rd degree is associated with a number of difficulties, which is due to the presence of severe deformation of bone tissue, which is almost impossible to return to its original form.
The main objectives of therapy at this stage are:
- elimination of the inflammatory process;
- deliverance of the patient from pain;
- restoration of joint mobility.
For the first two purposes, NSAIDs, corticosteroids, chondroprotectors, agents with hyaluronic acid are prescribed. However, with advanced cases, treatment of knee gonarthrosis with drugs is ineffective. In such situations, the doctor recommends a bone traction procedure in combination with physiotherapy, and the question of the advisability of surgery is also being addressed.
Surgical treatment
In extremely severe cases, conservative methods of therapy do not bring a positive result. In these situations, surgery is the only way to avoid disability and maintain mobility.
Currently, the following operations are underway to treat joint gonarthrosis:
- Endoprosthetics. This method involves the replacement of natural tissue with implants. They have an anatomical shape and perform all the functions of a joint.
- Arthrodesis. An operation in which a complete immobilization of the joint is carried out, which is not amenable to treatment.
- Arthrolysis. This method is characterized by excision of adhesions after opening the joint cavity.
- Arthroplasty. This is an operation in the process of which new surfaces are simulated, between which tissues taken from the patient are laid.
The choice of method is carried out by the doctor based on the diagnostic results. The rehabilitation period is approximately 6 months. At this time, it is necessary to strictly comply with all the doctor’s prescriptions and regularly perform physical exercises that strengthen muscles and provide the joint with optimal load.
Physiotherapy
It is an integral part of the therapeutic regimens used at all stages of the disease. In addition, with the help of gymnastics, the rehabilitation period after surgery is reduced and joint mobility is restored faster.
A set of exercises:
- Stand up straight, hands down. Make shaking with the body.
- Standing, pull the heel of the right leg to the buttock. Then the limb needs to be straightened. The number of approaches is 20. Repeat the exercise with the left foot.
- Put your palms on your knees in a standing position. Perform circular movements of the joints (alternately).
- Walking on all fours and forward and backward.
- Lie on your back. Pull the right leg bent at the knee to the chest. Hold the sock with your hands and try to straighten the limb. Repeat the exercise with the other leg.
- Tie an expander tape to your ankles. To fix its other end, for example, on the battery. Lie on your back and bend your legs, trying to pull them to your chest.
The regular implementation of these exercises improves the course of the disease and increases the effectiveness of drug therapy.
Unconventional methods
Treatment of gonarthrosis with folk remedies does not eliminate the need to visit a rheumatologist. In addition, they must be agreed with the doctor so as not to aggravate the situation.
The most effective recipes:
- Prepare dandelion flowers (it is allowed to use both freshly picked and pharmacy). Put them in a dark glass bottle. Pour the flowers with alcohol or classic vodka without additives. Clean in a cool place for 1 month. After this period, lubricate the joint twice a day.
- Grind 1.5 kg of leaves and stems of Jerusalem artichoke. Pour them with hot water. Fluids will need 8 liters. Allow the infusion to cool, and then lower the affected joint into it for 30 minutes. The course of treatment is 10 days.
- Mix 5 g of fat (preferably pork) and 1 g of table salt. Apply the resulting mass to the joint and wrap it with a warm scarf. The procedure must be done twice a day.
Forecast
It is important to understand that it is impossible to completely get rid of the disease. Patients with a similar diagnosis are forced to undergo regular treatment courses. Without timely medical attention, the disease will progress slowly, significantly worsening the quality of life. The natural result of ignoring pathology is disability.
In patients who promptly sought medical help, the prognosis in most cases is favorable, regardless of the degree of gonarthrosis of the knee joint. Treatment of pathology is carried out using modern methods that can stop the development of the disease and return the patient's quality of life to a normal level.
Finally
The term "gonarthrosis" refers to a disease in which there is a gradual destruction of cartilage tissue. As a result of its destruction, bones are exposed, friction arises between them. Then osteophytes begin to form, which significantly limits the patient's motor activity.
The disease has several stages of development. At the initial stage, a person, as a rule, does not suspect a serious ailment. In most cases, the pathology is detected during the examination, appointed for another reason. Many patients turn to a specialist only if pain in the knee joint occurs regularly.
The treatment regimen for gonarthrosis involves taking medications, invasive procedures (injections), physiotherapy, therapeutic exercises, osteopathy, massage, diet and staying in sanatoriums and resorts. In addition, positive dynamics can be achieved with alternative methods of therapy. With the failure of conservative treatment, surgical intervention is indicated.