Joint diseases currently occupy a huge niche among pathologies of the musculoskeletal system. Among them, gonarthrosis occupies an important place.
What it is?
Gonarthrosis is understood as an inflammatory disease of a degenerative-degenerative nature that affects the knee joint. This disease is widespread and develops mainly in middle-aged and elderly women. The frequency of occurrence of this pathology is higher in rural areas than in cities.
The disease is characterized by depletion of articular cartilage, a change in joint congruency, as well as the development of bone growths in the joint area (osteophytes). With gonarthrosis, the volume of active movements, the configuration of the articular surfaces changes.
The disease has a high risk of patient disability, a significant deterioration in their quality of life. With untimely diagnosis of the process, the prognosis for recovery and complete restoration of impaired joint function worsens.
Causes
Among the reasons that provoke the development of gonarthrosis, the following can be distinguished:
- Hereditary predisposition. According to statistics, the risk of developing gonarthrosis is quite high in patients whose parents suffered from this disease.
- Heavy static work. At the same time, there is prolonged stagnation of blood and lymph in the joint area, its overload, which contributes to a significant increase in the load on the articular cartilage. This factor most often serves as a prerequisite for the development of gonarthrosis of the 1st degree.
- Joint injuries. They are the most common cause of gonarthrosis as a long-term consequence or complication. They cause immediate damage to the cartilage, which subsequently undergoes resorption.
- Overweight and osteochondrosis. They are not the direct causes of the development of gonarthrosis, but worsen the course of the disease itself.
- Congenital malformations of the knee. Due to improper laying of embryonic tissues, the joint cannot develop fully, which is why gonarthrosis of the 1st degree of the knee joint develops.
Features of the course of the disease
Gonarthrosis has some specificity, which depends on the cause that causes it. If the cause is not exactly clarified or there are predisposing factors such as overweight or spinal diseases, then in this situation, bilateral grade 1 gonarthrosis most often develops. If the disease is based on trauma or some professional features, then in this situation there will be a unilateral lesion of the knee joint.
Damage to the joint on the one hand is more favorable with respect to treatment, however, such a condition progresses faster than with a bilateral process. Bilateral gonarthrosis of the 1st degree is more favorable in terms of prognosis, however, treatment takes longer.
Classification of Gonarthrosis
The disease can be divided by the volume of the lesion (bilateral or unilateral). Unilateral, in turn, is divided into right-sided gonarthrosis and gonarthrosis of the left knee joint.
In terms of severity, three stages of the disease are distinguished:
- Gonarthrosis of the 1st degree (or stage) has no clinical manifestations and is detected only during a routine examination or is an accidental find by diagnosticians. Deformation for this stage is not characteristic.
- The second stage of gonarthrosis already has some clinical signs (pain after a long walk or static load, some stiffness during movements). The volume of active movements is gradually limited due to initial changes and deformations in the joint.
- Gonarthrosis of the third stage is characterized by a constant pain syndrome, visible deformation and almost complete loss of active movements in the joint. Passive movements are difficult. Walking at this stage is not possible.
Gonarthrosis of the 1st degree
This stage of gonarthrosis is the most favorable for patients. The pathological process can stop at this stage and not progress further. Changes in the joint do not cause inconvenience to patients and do not limit their social activity. Bilateral gonarthrosis of the 1st degree develops less frequently than its unilateral form.
The main symptoms that may appear at this stage are a feeling of discomfort in the knee joint after a long physical work, non-intense aching pain that quickly passes after a period of rest. Depending on which joint is affected, left-side and right-sided forms are distinguished. Left-sided gonarthrosis of the 1st degree develops mainly in left-handed people and is characterized by pain in the left knee joint.
The right-sided form is much more common. Jockeys, wrestlers, weightlifters, gymnasts usually suffer from it. During prophylactic arthroscopy, right-sided gonarthrosis of the 1st degree is diagnosed in 40 percent of the population.
The pain usually appears in the morning and disappears after a few minutes (for example, when charging).
In some cases, patients may be disturbed by a crunch in the joint, or friction felt during palpation of the joint (just put your hand on your knee and bend it several times).
With a competent division of labor and rest, gonarthrosis of the 1st degree of the knee joint at this stage stops. It either proceeds, but rather slowly. Deterioration is usually observed only after a few years (depending on the mode and type of work).
In rare cases, deforming gonarthrosis of the 1st degree may develop. This phenomenon is extremely rare. The development of this form of the disease is prognostically much worse than the classical course.
If there is grade 1 gonarthrosis, treatment may not be required.
Stage 2 gonarthrosis
With the progression of the disease, gonarthrosis moves to a new stage. Stage 2 (or degree) of gonarthrosis is characterized by a more intense pain syndrome: if at the first stage only starting pains were noted (in the morning or after a long rest), then unpleasant sensations can appear at any time. The pain is more intense, it is more difficult to stop with anti-inflammatory drugs.
Due to the intensity of the pain syndrome, atrophy of the muscles of the affected limb can often be observed. It takes place due to the fact that patients, sparing a sore leg, are less and less trying to load it.
The main characteristic feature of stage 2 is the development of deformation in the joint. Most often, patients cannot fully extend their bent leg. Palpation can determine the mismatch of the articular surfaces (with unilateral gonarthrosis when compared with a healthy leg) or perceived formation on both sides (bilateral gonarthrosis).
Gonarthrosis 3 severity
This stage is almost terminal during the course of the disease, and patients acquire a disability group (if they cannot be operated on).
The pain syndrome becomes permanent and does not stop with conventional analgesics. Perhaps the use of narcotic drugs (in the hospital).
Deformations become visible to the naked eye, and the volume of active and passive movements is significantly reduced, up to a complete loss. Perhaps the development of X-shaped and O-shaped deformations.
Ankylosis may develop in the affected joint, due to which surgical correction of the pathology is indicated.
The articular cartilage completely disappears from the joint cavity. Friction of the articular surfaces becomes more noticeable.
In some cases, the third stage of gonarthrosis is characterized by the development of blockade of the knee joint - a condition in which it is impossible to bend the leg or straighten it.
Such patients need joint prosthetics.
Diagnostics
The diagnosis is entirely dependent on the patient's complaints, his medical history (life, work), as well as information obtained during examination and using instrumental methods.
During a general examination, a pronounced mismatch of the articular surfaces can be detected. On palpation, local soreness can be felt (in the case when gonarthrosis of the 1st degree, synovitis and bursitis occur).
During movement, the joints are guided by the sound of cod or crunch when making a movement.
In addition to examination, it is necessary to determine the range of motion in the joints. The volume of active movements - those movements that the patient can make himself, and passive - with the help of a doctor.
Of the instrumental methods, radiography of the affected joint and endoscopic examination have spread. Radiography allows you to determine the condition of the joint space, as well as to identify developing areas of joint deformation. In order to determine gonarthrosis of the 1st degree, radiography should be performed first. Intra-articular endoscopy allows you to determine visual changes on the articular surfaces. It should be remembered that endoscopy is an abdominal intervention, and can harm the joint, and also provoke an exacerbation of the process.
Treatment of 1 and 2 degrees of gonarthrosis
Like any disease, gonarthrosis requires a certain approach to treatment. Properly selected therapy should organically combine non-drug methods, drug support and physiotherapy.
If there are gonarthrosis of the 1st, 2nd degree, they can be treated at home or in a hospital with a significant exacerbation. It all depends on the individual characteristics of the patient and the clinical picture. Usually, folk methods and drug support are used for this.
When a patient complains of gonarthrosis of the 1st degree, the treatment will be carried out on an outpatient basis and include symptomatic therapy - non-steroidal anti-inflammatory drugs (Nimesulide, Movalis) inside and general measures - diet, hardening, vitamin therapy.
At the second stage of the disease, injectable anti-inflammatory drugs and analgesics (Diclofenac, Tramadol medicines), as well as drugs for restoring synovial fluid synthesis (Hyaluronic acid drug) are added to the above drugs. The products containing the components of the articular cartilage, such as “Chondroitin Sulfate”, “Don”, will not interfere.
Treatment of severity 3
When the condition worsens and the diagnosis of gonarthrosis of 3 severity is diagnosed, conservative treatment becomes largely ineffective (it is also possible to use narcotic analgesics).
To correct joint disorders, surgical treatment should be resorted to, usually joint prosthetics.
This operation allows you to replace both affected articular surfaces (femoral and tibial) bones. Indications for such an operation are persistent impaired movement in the joint, as well as completely destroyed articular surfaces with a loss of walking ability.
In some cases (if the patient may not undergo such an operation or if the patient refuses prosthetics), it is possible to remove the formed bone growths using an arthroscope - a device inserted into the joint cavity. This intervention is less traumatic and can be performed under local anesthesia.
Complications of gonarthrosis
With untimely diagnosis of the disease, some complications may develop. Among them, we can distinguish those that directly affect the affected limb, and those that will have an effect on the body as a whole.
Gonarthrosis of the 1st degree does not lead to the development of complications and is the most favorable form.
Local complications include the development of total ankylosis (the formation of a single fusion between the bones), gangrene of the lower leg and foot (can occur when the vessel enters between the affected bones and their fusion with compression of the artery). Possible impairment of passing nerves with the development of intense pain and impaired limb function.
Total complications include the development of osteochondrosis, scoliosis (due to improper distribution of the load on the limbs), muscle atrophy of the affected half of the body. Often there is the development of arthritis (due to redistribution of load) and herniated discs. With the progression of total complications, involvement of internal organs is also possible.
In some cases, pain shock may develop .
Gonarthrosis Prevention
Like any disease, gonarthrosis of the 1st degree is easier to prevent than to cure.
The main preventive measures include a healthy lifestyle, proper nutrition (saturated with calcium, glucuronic acid, vitamin D), getting rid of excess weight, and giving up bad habits.
If possible, less time should be spent on the feet. The uniform distribution of the load and the work regime helps prevent overloading the joint and delays the development of the disease.
It is also necessary to consult a doctor more often in order to timely diagnose the disease and take early measures.
Of no less importance is the treatment of concomitant diseases of the musculoskeletal system and metabolism.
Subject to all the above measures, the likelihood of developing arthrosis of the knee joint is extremely small. A high risk, however, remains with a burdened family history (if there were cases of the development of the disease in close relatives).