Gonarthrosis of the knee joint: degrees, types, methods of treatment

What is gonarthrosis?

Gonarthrosis is a degenerative-dystrophic disease of the knee joint. The second name of the disease is osteoarthritis of the knees. The disease is non-inflammatory in nature and often leads to disability.

According to statistics, he is given one of the leading places among all types of arthrosis. In numbers, this is more than 20%. Of all the diseases that affect the knee joint, the incidence of gonarthrosis is 53%.

Gonarthrosis has been known to doctors for more than 100 years, in everyday life it is called “salt deposition”. Indeed, with arthrosis, calcification occurs (deposition of calcifications). However, such calcifications are limited and have no independent clinical significance. The pathological process occurs against the background of circulatory disorders in small bone vessels, after which destructive changes begin in the cartilaginous cover of the joint.

At the initial stages of gonarthrosis, cartilage tissue is destroyed at the molecular level, followed by degeneration of hyaline cartilage: in some places it becomes cloudy, thinner, stratified and cracked in different directions. The pathogenesis ends with the complete disappearance of the cartilage and the exposure of the underlying bone. In turn, the bone reacts to the death of cartilage by sealing, i.e. excessive growth of the bone along the periphery, as a result of which spikes are formed, the leg is deformed and bent. For this reason, the disease is additionally called “deforming arthrosis of the knee joint.”

The pathogenesis of gonarthrosis can be briefly described as follows:

• Metabolic processes in cartilage tissue are carried out due to osmotic pressure. When squeezed, the lubricant is released, and when unloaded, it is absorbed. In this way, when moving, the cartilage is constantly nourished. With incomplete recovery, dictated by increased mechanical stress, metabolic processes are disrupted. In the place of greatest pressure, the cartilage begins to thin;

• There is a violation of the structure of collagen fibers, which leads to a loss of depreciation properties, chondromalacia (softening of the cartilage of the patella) and a violation of the metabolic function of chondrocytes. Cartilage loses its stability and elasticity;

• There is a violation of congruence in the joint. The process is aggravated by increased synthesis of bone substance in the form of osteophytes (bone growths). The synovial membrane is irritated and inflammation begins in it. This leads to limited mobility of the joint;

• The most common arthrosis of the inner part of the knee joint between the surface of the femur and the patella. The disease is more susceptible to people of mature and old age, as well as professional athletes.

Causes of gonarthrosis

The main causes of osteoarthritis of the knee include:

• Violation of metabolic processes;

• Pathological changes in blood circulation and increased fragility of capillaries;

• Excessive body weight, which leads to an increase in axial load on the joint;

• Traumatization of the knee joints (torn ligaments, menisci, fractures, cracks);

• Past inflammatory diseases (rheumatism, arthritis);

• Excessive stress on the joints that athletes are subject to. Most often, tennis players, football players, athletes, gymnasts suffer from gonarthrosis;

• Hormonal and endocrine disorders;

• Old injuries that have not been adequately treated or have not been completed;

• Congenital anomalies in the structure of articular tissues;

• Hereditary factors.

Symptoms of gonarthrosis

The danger of gonarthrosis, like most arthrosis, lies in the severe consequences of late diagnosis. At stage 1, the disease almost does not manifest itself in any way, except for a slight pulling pain, which the patient attributes to fatigue.

A common symptom of gonarthrosis is a feeling of stiffness in the joint, “tightening” under the knee and aching pain in the knee after a long walk. Many patients with gonarthrosis (arthritis of the knee joint) complain of difficulty walking, mainly in the morning, after sleeping or after sitting for a long time. A person needs to “disperse” in order to feel better. With the development of gonarthrosis, pain in the knee, especially on its inner side, becomes more persistent and persistent. Often, patients with gonarthrosis feel a crunch when moving the knee joint. Further, restrictions on flexion and extension of the leg develop. As the disease progresses, lameness occurs. In more advanced cases, a person cannot move without the help of strangers or without crutches. Often the pain subsides when lying down, but it happens that at night a person suffers from pain.

When examining the knees at the initial stage of gonarthrosis, external changes are usually not detected. With the course of the disease, the deformation of the knee joint is very noticeable: the contours of the bones that form the joint are rough, contracture (incomplete flexion or extension), and curvature of the lower leg are detected. Putting the palm on the front surface of the knee, with a flexion or extension movement, you can feel a crunch in the knee joint of varying intensity and duration. A similar sensation can be obtained if the patella is moved outward in the transverse direction (positive patello-condylar symptom).

When feeling the knee of a patient with gonarthrosis, a painful zone is found, usually on the inside of the joint, at the level of the condyles of the thigh, tibia and joint space. Often, effusion accumulates in the cavity of the knee joint, that is, synovitis joins. A similar condition is determined by the smoothness of the contours of the knee joint due to the swelling of tissues above the patella and to the side of it, as well as the feeling of fluctuation when palpating the protrusion with both hands.

In the process of progression of gonarthrosis, the symptoms appear brighter, become more pronounced. Timely correct diagnosis plays an important role in the further fight against the disease.

Degrees of development of gonarthrosis

1 degree gonarthrosis

With grade 1 gonarthrosis, there is rapid fatigue of the limb and slight discomfort. During movement, moderate crepitus may be observed. Sometimes there is a barely noticeable restriction of movement in the joint.

The bones of the knee at this stage do not undergo significant changes. On x-ray, you can see a slight narrowing of the joint space.

2 degree gonarthrosis

The second degree is characterized by the occurrence of pain, especially after you stand or walk for a long time. The characteristic crunch becomes more pronounced. There are problems with extension and full flexion of the limb. There is a so-called starting pain.

There may be atrophy of the quadriceps femoris muscle. The angle of full flexion and extension of the limb in the knee joint is significantly limited. Significant narrowing of the joint space and growth of osteophytes are clearly visible on x-rays. The edges of the bones are “flattened”.

3 degree gonarthrosis

At stage 3, the nature of the pain changes – it intensifies and can manifest itself at rest. In the joint area, swelling and a local increase in temperature often occur. Due to the possible presence of an “articular mouse” (fragments of broken off osteophytes) in the joint, symptoms of blockade of the joint may occur. They are manifested by acute pain, accompanied by a feeling of jamming.

The patient in this case may be completely deprived of the possibility of independent movement. There is a deformation of the knee joints with a change in the axis of the limbs, which is clearly visible on x-rays. Joint instability may occur.

Types of gonarthrosis

Gonarthrosis is divided into types according to etiology:

• Primary gonarthrosis arises against the background of comparative health. Basically, older people are sick, more often women than men. At risk are people who are overweight, i.e., obese, they are the ones who most often acquire arthrosis of the knee joint;

• Secondary gonarthrosis develops after a knee injury or is a complication of infectious diseases. With timely treatment of injuries or inflammation of the knee joint, the development of arthrosis can be avoided.

By localization, gonarthrosis is divided into the following types:

• Right-sided gonarthrosis – Affects the right knee joint. This type of arthrosis is more inherent in athletes and people whose professional activities are associated with excessive static and dynamic loads on the right leg;

• Left-sided gonarthrosis – Affects the left knee joint. The disease is typical for athletes and middle-aged people with overweight;

• Double sided gonarthrosis – destroys the joints of both legs. This type of disease is the most severe, as it significantly increases the risk of disability. Elderly people are most susceptible to it, since the nature of bilateral gonarthrosis in most cases is idiopathic (age-related).

By the nature of the occurrence and course of the disease, all these types of arthrosis almost do not differ from each other. Bilateral gonarthrosis in advanced form can be more pronounced, since both diseased joints are simultaneously subjected to axial load.

Diagnosis of gonarthrosis

There are many diagnostic methods, but their effectiveness can be greatest only with an integrated approach.

Orthopedic examination

An orthopedic examination is the first and very important diagnostic event. This includes:

• Joint palpation;

• Linear bone measurements;

• Anglemetry (determination of mobility in the affected joint at various angles).

Clinical researches

Tests for gonarthrosis include:

• Study of the blood count and erythrocyte sedimentation rate (ESR);

• Determination of the level of fibrinogen, urea and other biochemical parameters of blood and urine.

X-ray studies

The main method for diagnosing gonarthrosis is the study of the diseased joint using x-rays. At the initial stage of the development of the disease, an x-ray examination may not show anything, and if it does, then only minor changes. In the later stages, narrowing of the joint space, cartilage sclerosis, bone damage, and salt deposition are found.

Ultrasound examination

Ultrasound examination of the knee joint affected by arthrosis gives the best results, but it cannot completely replace radiography. Therefore, all people suffering from degenerative-dystrophic diseases of the joints must definitely take an x-ray.

MRI – magnetic resonance imaging

This is the most advanced diagnostic method that allows you to examine all parts of the joint in layers and determine the earliest change in the cartilage tissue. The disadvantage of the method is the rather high cost of examining each segment. And a definite plus is high accuracy: it often turns out that gonarthrosis is far from the only disease of the musculoskeletal system in a particular patient.

How to treat gonarthrosis?

The method of treatment of gonarthrosis differs little from the methods of treatment of arthrosis of other joints.

Step 1 – Relieve Inflammation

For this, traditionally used:

• NSAIDs – non-steroidal anti-inflammatory drugs, which are administered intramuscularly or intravenously. Medicines in the form of injections give a longer and stronger analgesic effect. These include drugs such as diclofenac, olfen, diclak, ibuprofen, indomethacin, ketoprofen.

• NPVS COG-2 – are the most effective and sparing in comparison with NVPS COX-1. They can be used for a long time, for several months. These are meloxicam, celecoxib, nimesulide and etoricoxib.

• Hormonal drugs. This group of medicines is used for intra-articular injections in the presence of synovitis of the knee joint (inflammation of the synovial membrane). The goal of therapy is to relieve inflammation and pain in the shortest possible time. The disadvantage of the application is a damaging effect on cartilage tissue, a large number of contraindications and side effects. The most commonly used synthetic hormones for gonarthrosis are: hydrocortisone, kenalog, diprospan;

• antienzymatic drugs. They neutralize the synthesis of certain enzymes and prevent further joint degeneration. The most well-known drugs of this group are contrykal, ovomin, gordox. With gonarthrosis, they are administered intraarticularly.

Step 2. We provide anabolic and anti-catabolic effect

To do this, drugs are used that replace the substances necessary for the synthesis of cartilage, providing a highly specific protective effect on the cartilage tissue. They are also called chondroprotectors. Such preparations contain substances that are part of the cartilage matrix. These medicines are natural, well accepted by the body and actively stimulate collagen synthesis.

The drugs justifiably used for arthrosis of the knee joint include structum, DONA, alflutop, rumalon, mucosat. They are all slow-acting drugs that need to be taken in long courses. Some of them are available in the form of solutions for injection. This form of application is the most effective.

Step 3. We smear, warm, rub

To do this, you can use various kinds of gels, ointments and creams. For the most part, they are warming and anti-inflammatory. The purpose of their use is to activate local blood circulation and relieve inflammation. The most famous drugs of this group are: apizartron, finalgon, dolobene, feloran, fastum gel, nikoflex.

Step 4. Improve blood circulation

Vasodilator drugs are used to reduce the tone of intravascular muscles. Such drugs can increase internal blood flow and improve the trophism of tissues located around the joint. With gonarthrosis, Cavinton, Trental and Actovegin are recommended. To strengthen the vascular walls, upsavit or ascorutin are used.

Step 5. Remove excess tone

Antispasmodics such as midokalm, sirdalud, tisalud and drotaverine (no-shpa) allow you to remove excessive muscle tension in the damaged segment. Often it occurs as a compensatory reaction of the body.

Step 6. Introducing Synovial Fluid Prostheses

The most progressive method of treating gonarthrosis in recent years has been the inclusion of drugs based on hyaluronic acid in the therapy protocol. It is a natural component of articular cartilage and synovial fluid. Therefore, its introduction into the knee joint does not cause inflammation, rejection and other negative reactions.

At the same time, the use of drugs such as otrovisk, sinokorm or hyalual can soften movements and relieve pain caused by friction of the articular surfaces. With gonarthrosis, the most recommended drug in this group is Fermatron.

The sequence of treatment is determined by the doctor according to the current protocols. At the same time, anti-inflammatory therapy, a course of chondroprotectors and physiotherapy can be prescribed at the same time. Hyaluronic acid preparations are allowed to be injected into the joint only when the inflammation is completely removed. Otherwise, instead of a therapeutic effect, you can, on the contrary, aggravate the course of the disease.

Author’s and innovative methods of treatment of gonarthrosis

The author’s methods of treatment of arthrosis of the knee joint include:

• Evdokimov’s technique;

• Bubnovsky’s technique;

• Gita’s methodology.

They have different principles of action, but all, without exception, have proven themselves as effective ways to maintain knee joints affected by gonarthrosis. Unfortunately, we are not talking about a complete recovery.

Oxygen therapy – a method of filling the joint cavity with medical oxygen. Allows you to eliminate swelling and reduce pain. Can be used as an alternative to hormone therapy.

Treatment with stem cells. The essence of the method is to transplant the patient’s stem cells into the joint. The method was developed in Germany and allows postponing conservative treatment for many years. Used only in large medical centers in Germany.

The method of intra-articular laser therapy. The procedure is performed using a low-intensity helium-neon laser, which penetrates the joint through a waveguide inserted into the needle. Allows you to reduce pain and increase the range of motion in the joints. The method was developed in Russia, clinically studied, but due to the high cost it is not widely used.

Orthokin – a biological method for the treatment of gonarthrosis, which has been practiced in Europe since 2003. Orthokine is an autologous serum obtained by selecting specific proteins from the patient’s own blood. These proteins have an anti-inflammatory effect. After blood sampling and serum production, the drug is administered to a person intra-articularly under the control of ultrasound or computed tomography.

Orthokine allows:

• Slow down the process of cartilage destruction;

• Reduce pain syndrome;

• Stop inflammation;

• Increase the mobility of the knee joint.

1-2 injections are enough for a course of treatment. About 70% of patients stop experiencing pain after the first injection.

Operative therapy

At different stages of gonarthrosis, conservative therapy may not give positive dynamics. In such cases, begin to consider the need for surgical intervention.

There are several types of operations for gonarthrosis:

• Arthrodesis. Using this technique, the deformed cartilage tissue is removed along with the joint. The method does not allow maintaining the physiological mobility of the limb. They resort to it quite rarely;

• Arthroscopic debridement. The technique consists in freeing the joint from the deformed cartilage tissue using an arthroscope. It is used in the early stages of the disease. Arthroscopy relieves pain. The operation is simple. The effect of the procedure is temporary, 2-3 years;

• Periarticular osteotomy. This is a technically complex and rare type of surgical intervention. It consists in preliminary filing and fixing the bones of the joint at a different angle. This is done to redistribute the load. Rehabilitation is quite long, the effect is from 3 to 5 years. It is rarely used in the early and middle stages of gonarthrosis.

Endoprosthetics

Nowadays, arthroplasty is the most common and effective type of surgical intervention for gonarthrosis. The technique allows you to maintain the mobility of the limb, which provides the patient with the opportunity to lead a full life. Endoprosthetics is a complex operation. It lasts only about an hour, but after it it is necessary to undergo a long course of rehabilitation and development of the joint. This is one of the main features of knee arthroplasty. The effect lasts up to 20 years, depending on the modification of the material. After that, the joint will have to be changed again, as the prosthesis loosens under the action of axial and mechanical loads.

We must not forget about possible complications, such as:

• Regional necrosis of the skin;

• Paresis of the peroneal nerve;

• Thrombosis of the saphenous femoral vein;

• Denture rejection.

Such troubles are extremely rare and account for about 1% of the total number of operations. Therefore, it must be taken into account that the effect of arthroplasty is sometimes the only way to improve the quality of life of a patient with arthrosis of the knee joint.

Physical education with gonarthrosis – therapeutic and not only

The purpose of physical exercises for gonarthrosis is in several factors:

• Preservation and increase of joint mobility;

• Formation of a compensation mechanism by strengthening the musculoskeletal apparatus;

• Strengthening blood circulation and improving the trophism of adjacent tissues and the joint itself;

• Preservation of physiological muscle tone.

Exercises and methods of their implementation are selected depending on the remaining active movements.

The following types of activities are prohibited for gonarthrosis::

• Violent movements accompanied by pain;

• Sharp and high-amplitude leg swings;

• Exercises with full axial load on the affected joint.

A set of exercises for gonarthrosis

1. Standing, try to completely relax, lower your hands down. Perform shaking movements with the whole body. Make sure that the legs at the knees are shaken with a small amplitude.

2. Holding on to the support, bend the leg at the knee, point the heel to the buttock, then, straightening the leg forward, place it on the heel in front of you. Perform 15-20 times. Then do with the other leg.

3. Standing, place your palms on your knees. Perform small circular movements with the knee joint in one direction and the other. Adjust the amplitude according to your feelings. Do at least 20 times.

4. We perform the exercise on a folded blanket. The surface must not be too hard. Get on your knees and do the shaking as in exercise 1.

5. From the position, as in the previous exercise, walk on your knees, taking several steps in different directions.

6. Stand upright on your knees (hands and knees should touch the floor). Lower your chest to the floor with your arms extended forward, then move your hips and buttocks to your heels, doing a sit-up on your heels without lifting your chest from the floor. Rise up again and repeat the exercise several times.

7. Lying on your left side, take your right leg up, bend at the knee, straighten it and stretch your heel towards the wall as much as possible. Perform 12 times and change legs.

8. Sit down, put your bent legs in front of you. Stretch your right knee to the left, then straighten it, straightening the knee, bend and return to the starting position. After 12 reps, change legs.

9. From the same starting position, straighten your legs one by one, without lifting your heels off the floor, then simultaneously bend again, also without lifting off the floor. Repeat 12-14 times.

10. Lie on your back, pull your bent leg to your chest, grab your toe with your hand and with smooth progressive movements try to straighten your leg as much as possible. Perform the exercise without jerking.

11. Also lying on your back, tie a rubber shock absorber to your ankles, and fasten the other end to the battery. Gently bend and unbend your legs, pulling your knees to your chest.

12. Get on all fours. Tie one end of the rubber shock absorber to the ankle, fix the other to the battery. Slowly (smoothly) bend and unbend your leg at least 10-15 times. The shock absorber should not be too hard.

Physiotherapy for gonarthrosis

All types of physiotherapy can be prescribed in the phase of remission or a slight exacerbation of the disease, but not in the most acute phase with inflammation.

The most effective are:

• Electrophoresis with drugs such as bischofite or caripain. Deeper penetration of the drug in such cases is provided with Dimexide;

• Magnetotherapy;

• Ultrasound;

• microwave therapy;

• Paraffin treatment;

• Radon and hydrogen sulfide baths;

• Mud therapy.

To maintain and prolong the remission phase, it is necessary to undergo a course of physiotherapy 2-4 times a year, depending on the degree of the disease.

Electrophoresis with caripain allows you to remove excess tone, promotes the resorption of contractures and adhesions. At least 20 procedures should be performed, since the drug is cumulative. It works only when the maximum concentration is gained in the body. A course of 10 procedures will not justify the money spent.

The course of mud therapy for gonarthrosis must be taken 2 times a year, 10-15 procedures each. You can carry it out at home using the mud bought at the pharmacy. Before use, it must be heated to 38-40 ° C.

Massage and manual therapy for gonarthrosis

These types of effects on the knee joint are aimed at stretching, warming and improving blood circulation in the joint area. Massage is carried out in the knee area, along the lymph flow from the periphery to the center, but without affecting the popliteal fossa. Manual therapy is carried out after massage by an experienced specialist. Its main task is traction and stabilization of the joint.

You can perform the following exercise on your own: stand with the healthy side to the support, move the leg with the diseased joint forward, then back, then “throw” it to the side with a sharp movement.

Prevention of deforming gonarthrosis

Gonarthrosis belongs to a group of diseases that are better and easier to prevent than expensive and long to treat.

The following can be recommended as preventive measures:

• While dancing and doing sports, try to avoid serious injuries (ligament ruptures, fractures, severe bruises of the patella);

• Maintain regular physical activity, as movement is the mechanical basis of cartilage nutrition;

• Make a diet taking into account the needs of bone and cartilage tissue in nutrients;

• Watch your body weight;

• In case of injury or discomfort in the area of ​​the knee joints, immediately seek qualified medical help;

• Starting from the age of 35, take preventive courses of treatment with chondroprotectors;

• Drink enough water daily.

Useful Tips

• Start the treatment of gonarthrosis with an accurate diagnosis. It is better to get advice from several leading experts.

• Do not self-medicate. All drugs, their dosage and duration of use should be prescribed and monitored by a doctor.

• Start every day with gymnastics.

• If you want to play sports, consult with your doctor about the type of exercise recommended for you. Even some yoga asanas can be fatal for gonarthrosis.

• Eliminate salty, spicy, fatty foods from your diet. Choose healthy homemade meals. Lactic acid products should have an average fat content, otherwise calcium will be poorly absorbed. Include in the diet low-fat jelly (cooked on turkey meat), natural jelly. Do not forget about the need to eat sea fish and seafood.

• If there is no relief after a week of anti-inflammatory drug use, consult a doctor to review the treatment protocol.

• If remission has come, and the disease does not bother you, do not exceed the permissible loads. The absence of pain does not mean that you are completely healed.

• Try not to overcool your joints. Although gonarthrosis is not an inflammatory disease, the joint may respond to hypothermia with a new relapse.

Most importantly, remember! Even the best doctor can’t help you if you’re not willing to make the effort to help yourself. If you need surgery, do not refuse and do not delay the date. However, it is very important that by the time of the operation you are in good physical shape, then postoperative rehabilitation will be easier. And it depends only on you.