Knee gonarthrosis of the 2nd degree: symptoms, diagnosis, treatment, prevention
The content of the article:
- Causes of occurrence
- Symptoms of knee gonarthrosis of the 2nd degree
-
Diagnosis of the disease
- X-ray
- Arthroscopy
- MRI
- Ultrasound
- Ultrasonography
- Scintigraphy
-
Treatment of gonarthrosis of the knee joint of the 2nd degree
- Drug treatment
- Surgery
- Massage and manual therapy
- Physiotherapy
- Physiotherapy
- Prevention of gonarthrosis
- Video
Knee gonarthrosis of the 2nd degree is a complex complex of degenerative and dystrophic processes, in which all joint structures are affected: cartilage, synovial membrane, subchondral bone, periarticular tissues. The development and progression of the disease can be associated with age, hormonal, genetic and environmental factors.
Gonarthrosis is a degenerative-dystrophic disease that affects the knee joints
According to statistics, the prevalence of gonarthrosis among men is 14.1 / 100 thousand, among women - 22.8 / 100 thousand. It occupies one of the leading places among all types of arthrosis (more than 20%). Of all the pathologies of the knee joints, gonarthrosis manifests itself in more than 50% of cases.
Osteoarthritis of the knee joint is a multicomponent process, which is based on a congenital or acquired imbalance in the shape or structural organization of the articular ends, their chronic trauma due to a violation of the exercise regime, excess weight. It can also occur due to inflammatory, metabolic, endocrine and ischemic diseases.
In the absence of adequate treatment, the disease progresses, up to disability
Gonarthrosis is common among people over 45. If this disease is not cured, progression is possible, which can cause limitation of the work of the musculoskeletal system, as well as the patient's disability. The disease is a medical and social problem, as it leads to an increase in disability and a decrease in living standards.
Causes of occurrence
The main reasons for the development of gonarthrosis are the following disorders of physiological processes in the cartilage tissue:
- insufficient synthesis of proteoglycans;
- strengthening of catabolic processes;
- generation of reactive oxygen species;
- reduction of the synthesis of hyaluronic acid;
- hyperproduction of interleukin 1 and tumor necrosis factor α;
- hyperproduction of prostaglandin E2.
The factors involved in the development and progression of knee osteoarthritis are divided into mechanical, biochemical and genetic:
| Factors | ||
| Mechanical | Biochemical | Genetic |
|
Being overweight that puts more stress on the joint Injury to the knee joints (tears of ligaments, menisci, fractures, cracks) Increased stress on joints to which athletes (tennis players, football players, athletes, gymnasts) are exposed Old, inadequately treated injuries or injuries that have not been completed |
Disruption of metabolic processes Hormonal and endocrine disorders Violation of blood circulation and increased fragility of capillaries Past inflammatory diseases (rheumatism, arthritis) |
Congenital anomalies in the structure of articular tissues |
In addition, risk factors for the development of osteoarthritis of the knee joint can be:
- elderly age;
- female;
- high physical activity;
- high bone mineral density;
- the use of hormone replacement therapy;
- lack of antioxidants, vitamins C and D;
- muscle weakness;
- smoking.
Excess weight acts as an independent trigger for the development of gonarthrosis, especially in women with bilateral localization of the disease.
Symptoms of knee gonarthrosis of the 2nd degree
Depending on the location, gonarthrosis is divided into the following types: left-sided, right-sided and bilateral. With bilateral gonarthrosis of the 2nd degree, the joints of both legs are deformed, the elderly are most susceptible to it.
Gonarthrosis is characterized by constant or intermittent pain
The classification of the disease by type and form has become widespread among doctors: compensatory, subcompensatory, decompensatory, which correspond to 1, 2 and 3 radiological stages of osteoarthritis of the knee joint. Patients with advanced stages (2 and 3) who first sought medical help account for up to 75% of patients with this disease.
At the heart of gonarthrosis is the pathological process of destruction of the articular cartilage, which is associated with clinical and radiological manifestations of the disease, namely pain, limited mobility in the joint, narrowing of the joint space, osteophytes.
These diagnostic signs appear at later stages of the disease, and pathological changes in the cartilage tissue occur before they can be noticed at the macro- and microscopic levels.
Grade 2 gonarthrosis is characterized by:
- intermittent or persistent pain syndrome with relative drug dependence;
- slight instability of the joint without disrupting biomechanics;
- partial loss of articulation functions within the functional requirements;
- atrophy of the quadriceps femoris muscle (possible, but not required);
- significant narrowing of the joint space and proliferation of osteophytes.
With gonarthrosis, restriction of movement develops gradually and increases during periods of exacerbation. With prolonged pain syndrome, signs of synovitis may appear - inflammation of the synovial membrane of the knee joint. Osteoarthritis of the knee joint is a slowly progressive chronic disease with increasing symptoms, characterized by periods of exacerbation and remission.
Diagnosis of the disease
There are several approaches to the diagnosis of gonarthrosis, but the most effective is their complex application. Methods for diagnosing pathology:
- radiography;
- arthroscopy;
- magnetic resonance imaging (MRI);
- ultrasound examination (ultrasound);
- ultrasonography;
- scintigraphy.
X-ray
The X-ray method remains generally accepted in the diagnosis of the disease. However, the degree of destructive lesion of the articular cartilage does not correlate with the radiological stage of gonarthrosis, although the correlation between them increases in the presence of synovitis.
Therefore, in the early stages of degenerative lesions of the joints, when the changes in the bone tissue are still insignificant, the X-ray method of investigation is not very informative.
Arthroscopy
The value of arthroscopic diagnostics is quite high, since the accuracy of this technique in examining the knee joint reaches 90-100%. Its main disadvantages are the invasiveness and high cost of equipment.
Arthroscopy is a reliable diagnostic method
In addition, the identification of degenerative changes in the cartilage tissue does not always mean that the patient has gonarthrosis. The detected changes can lead to osteoarthritis, however, bone-cartilaginous injuries up to 10 mm or more in the loaded zone of the condyles of the femur and tibia are regarded as prearthrosis.
MRI
Recently, for the purpose of early diagnosis of osteoarthritis and other diseases of the joints, along with arthroscopy, a non-invasive MRI method has been used, which provides the most complete and early diagnostic information and allows one to investigate changes in the bone, cartilaginous and soft tissue structures of the joint, as well as the subchondral bone in the X-ray negative period.
Despite its high diagnostic value, MRI is not considered readily available to a wide range of patients and medical institutions.
Ultrasound
The ultrasound method is more accessible and less expensive for diagnosing osteoarthritis of the joints. It allows you to identify the amount and localization of the articular fluid, changes in the periarticular tissues, the thickness and structure of the cartilage.
Ultrasonography
Examination of the knee joint with ultrasonography has many advantages:
- non-invasive surgical method, the study can be carried out repeatedly, since it is harmless;
- low cost.
The disadvantages include fuzzy visualization of changes in the cartilage tissue of the joint and intra-articular components.
Scintigraphy
Scintigraphy is an imaging method that allows you to assess the metabolic activity of the periarticular bone tissue, is highly sensitive in the early stages of cartilage changes in the knee joint.
Scintigraphy allows visualization and assessment of metabolic activity of periarticular bone tissue
Often the disease develops without pain, which complicates early diagnosis even with the availability of modern highly informative methods. Because of this, the search for diagnostic, prognostic markers, as well as markers for evaluating the effectiveness of treatment is relevant for persons with a high degree of risk of gonarthrosis.
Treatment of gonarthrosis of the knee joint of the 2nd degree
At the heart of the treatment of osteoarthritis 2 tbsp. are complex and conservative principles. The main goals of therapy are to reduce or completely relieve pain and restore the functions of the knee affected by gonarthrosis.
Drug treatment
The task of drug therapy is to reduce the intensity of pain through the use of simple and opioid analgesics, non-steroidal anti-inflammatory drugs. The use of glucocorticoids and hyaluronic acid preparations also helps to reduce pain.
The basis of drug treatment is chondroprotectors
Antiarthritic chondroprotective drugs with prolonged action suppress the main clinical manifestations of osteoarthritis, slow down its progression, stabilize structural changes in hyaline cartilage, and prevent changes in the unaffected joint.
It is advisable to combine these two drugs, they are synergistic and, when used together, complement and enhance the action of each other.
To restore internal blood flow and improve tissue trophism, vasodilators are used.
Surgery
Surgical intervention can be used in the absence of positive dynamics of conservative therapy. Types of operations for gonarthrosis:
- a rtrodesis (elimination of deformed cartilage tissue): allows you to maintain the physiological mobility of the limb;
- a rthroscopic debridement: like arthrodesis, it helps to eliminate pain;
- o coloarticular osteotomy (fixation of the bones of the articulation): used to redistribute the load;
- endoprosthetics (joint replacement): allows you to maintain the mobility of the limb.
With endoprosthetics, complications are possible: necrosis of the skin, paresis of the peroneal nerve, thrombosis of the femoral vein, rejection of the prosthesis, although they occur extremely rarely.
Massage and manual therapy
Massage is used to stretch, warm and improve blood circulation in the joint area. Requirements for implementation: performed in the knee area, along the lymph flow from the periphery to the center, without affecting the popliteal fossa.
Massage improves blood circulation and affects the muscles surrounding the joint
The task of manual therapy is to stretch and stabilize the joint, it is carried out exclusively after the massage.
Physiotherapy
Exercise therapy classes are aimed at achieving the following goals:
- reducing pain;
- an increase in the range of motion of the sore knee;
- restoring the strength of the muscles that stabilize the affected joint.
Exercise therapy includes exercises of a static and dynamic nature, which should be performed regularly in a standing or sitting position with the maximum reduction in the load on the affected joints.
Physiotherapy
Physiotherapy is prescribed in case of remission or mild exacerbation of the disease, but not in the most acute phase with inflammation. To prolong the remission phase, the course of physiotherapy must be completed several (2-4) times a year, which also depends on the degree of the disease.
As part of the complex treatment, physiotherapy is prescribed
Types of physiotherapy used for gonarthrosis:
- electrophoresis;
- ultrasound;
- magnetotherapy;
- paraffin treatment;
- hydrogen sulfide baths;
- microwave therapy;
- mud therapy.
Mud compresses are applied to the knee area; their temperature during the procedure should be 40–45 ° C.
Prevention of gonarthrosis
An important component of treatment is educational programs that disseminate information about the prevention of osteoarthritis among healthy people.
Physical therapy helps to increase range of motion and restore muscle strength
As a preventive measure for the occurrence of gonarthrosis, it is recommended:
- dance and sports, regularly maintain physical activity;
- avoid injuries (ligament ruptures, fractures, bruises of the patella);
- form a nutritious diet, taking into account the needs of cartilage and bone tissue;
- monitor weight;
- seek qualified medical help in case of injury or discomfort in the knee joints;
- take chondroprotective drugs once a year;
- drink enough water daily.
If symptoms of the disease appear, you should consult a doctor and follow his instructions.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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