Knee Gonarthrosis 1, 2, 3 Degrees - Types, Symptoms, Modern Methods Of Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Knee gonarthrosis: 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 knee osteoarthritis. The disease is non-inflammatory in nature and often leads to disability.

According to statistics, he is assigned 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 frequency of manifestations 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 (calcification) occurs. However, such calcifications are limited and do not have independent clinical significance. The pathological process occurs against the background of circulatory disorders in small bone vessels, after which destructive changes begin in the cartilage of the joint.

At the initial stages of gonarthrosis, the destruction of cartilaginous tissue occurs at the molecular level, followed by degeneration of the hyaline cartilage: in places it becomes cloudy, becomes thinner, stratifies and cracks 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 the cartilage by compaction, i.e. excessive growth of bone along the periphery, as a result of which thorns are formed, the leg is deformed and bent. For this reason, the disease has an additional name "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, grease is released and absorbed when unloaded. 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 shock-absorbing properties, chondromalacia (softening of the patellar cartilage) 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 the increased synthesis of bone substance in the form of osteophytes (bone growths). The synovium is irritated and inflammation begins in it. This leads to limitation of joint mobility;
• 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.

Content:

• Causes of gonarthrosis
• Symptoms of gonarthrosis
• The degree of development of gonarthrosis
• Types of gonarthrosis
• Diagnosis of gonarthrosis
• How to treat gonarthrosis?
• Author's and innovative treatment methods
• Operative treatment
• Physical education for gonarthrosis
• Physiotherapy for gonarthrosis
• Massage and manual therapy
• Prevention of deforming gonarthrosis
• Useful Tips

Causes of gonarthrosis

The main causes of arthrosis of the knee joint include:

• Disruption of metabolic processes;
• Pathological changes in blood circulation and increased fragility of capillaries;
• Excessive body weight, which leads to an increase in the axial load on the joint;
• Injury of the knee joints (ruptures of ligaments, menisci, fractures, cracks);
• Postponed inflammatory diseases (rheumatism, arthritis);
• Excessive stress on joints that athletes are exposed 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 untimely 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, "constriction" under the knee, and aching knee pain after long walking. Many patients with gonarthrosis (arthrosis of the knee joint) complain of difficulty walking, mainly in the morning, after sleeping or after a long sitting. A person needs to "disperse" in order to become easier. 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 walk without the help of strangers or without crutches. Often in the supine position, the pain subsides, 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, deformation of the knee joint is very noticeable: the contours of the bones forming the joint are rough, contracture (incomplete flexion or extension), curvature of the lower leg are found. Putting your palm on the front of the knee, with flexion or extension movement, you can feel a crunch in the knee joint of varying intensity and duration. A similar sensation can be obtained by moving the patella laterally outward (positive patella-condylar symptom).

When palpating the knee of a patient with gonarthrosis, a painful area is found, usually on the inner side 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, i.e. synovitis is attached. A similar condition is determined by the smoothness of the contours of the knee joint due to the swelling of the tissues above the patella and to the side of it, as well as the feeling of fluctuation when feeling 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.

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The degree of development of gonarthrosis

1 degree of gonarthrosis

With 1 degree of gonarthrosis, there is rapid fatigue of the limb and slight discomfort. Moderate crepitus may be observed during movement. Sometimes there is a subtle limitation of movement in the joint.

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

2 degree of gonarthrosis

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

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. X-ray images clearly show a significant narrowing of the joint space and the growth of osteophytes. The edges of the bones are "flattened".

3 degree of gonarthrosis

At 3 stages, the nature of the pain changes - it intensifies and can manifest itself at rest. In the area of the joint, swelling and a local increase in temperature often occur. Due to the possible presence in the joint of an "articular mouse" (fragments of breakaway osteophytes), symptoms of joint blockage may occur. They are manifested by acute pain, accompanied by a feeling of wedging.

In this case, the patient 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-ray images. Joint instability may occur.

Types of gonarthrosis

Gonarthrosis is divided into types according to etiology:

• Primary gonarthrosis occurs against the background of comparative health. Basically, elderly people are sick, more often women than men. At risk are people with overweight, that is, obese, it is they who most often acquire arthrosis of the knee joint;
• Secondary gonarthrosis develops after a previous knee injury or is a complication of infectious diseases. If injuries or inflammations of the knee joint are treated promptly, 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;
• Bilateral gonarthrosis - destroys the joints of both legs. This type of disease is the most severe, as it significantly increases the risk of disability. It is most susceptible to the elderly, since the nature of bilateral gonarthrosis in most cases is idiopathic (age-related).

By the nature of the onset and course of the disease, all these types of arthrosis almost do not differ from each other. Bilateral gonarthrosis in an 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 measure. This includes:

• Palpation of the joint;
• Linear bone measurements;
• Angle measurement (determination of mobility in the affected joint at various angles).

Clinical researches

Analyzes for gonarthrosis include:

• Study of blood count and erythrocyte sedimentation rate (ESR);
• Determination of the level of fibrinogen, urea and other biochemical parameters of blood and urine.

X-ray examinations

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

Ultrasonography

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

MRI - Magnetic Resonance Imaging

This is the most advanced diagnostic method that allows you to study all parts of the joint layer by layer and determine the earliest change in the cartilage tissue. The disadvantage of the method is the rather high cost of examining each segment. And the undoubted 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 treating gonarthrosis differs little from the methods of treating arthrosis of other joints.

Step 1 - remove inflammation

For this, the following are traditionally used:

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

• 

  NSAID COX-2 - are the most effective and gentle compared to NSAID COX-1. They can be used for a long time, over several months. These are meloxicam, celecoxib, nimesulide, and etoricoxib. But the most effective agent is recognized as etoricoxib, which has high selectivity and safety. This remedy is represented by the Russian drug Etorelex, which, unlike foreign analogues, has a low cost, which is extremely important if long-term treatment is required.

• 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 syndrome as soon as possible. The disadvantage of using is a damaging effect on cartilage tissue, a large number of contraindications and side effects. The most commonly used synthetic hormones for gonarthrosis: hydrocortisone, kenalog, diprospan;
• Antienzyme drugs. They neutralize the synthesis of certain enzymes and prevent further joint degeneration. The most famous drugs in this group are: kontrikal, ovomin, gordox. With gonarthrosis, they are administered intraarticularly.

Step 2. Provide anabolic and anti-catabolic effects

For this, drugs are used that replace the substances necessary for the synthesis of cartilage, providing a narrowly specific protective effect on the cartilage tissue. They are also called chondroprotectors. Such preparations contain substances that make up 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. All of them are slow-acting medications that need to be taken over long periods. Some are available as injection solutions. This form of application is the most effective.

Step 3. We smear, warm, rub

For this, you can use various types 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 in this group: apizartron, finalgon, dolobene, feloran, fastum gel, nikoflex.

Step 4. Improving 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. For gonarthrosis, Cavinton, Trental and Actovegin are recommended. To strengthen the vascular walls, upsavit or askorutin are used.

Step 5. Remove excess tone

Antispasmodics such as midocalm, sirdalud, tizalud and drotaverine (no-shpa) allow you to remove excessive muscle tension in the damaged segment. It often occurs as a compensatory reaction of the body.

Step 6. Introducing synovial fluid prostheses

In recent years, the most progressive method of treating gonarthrosis has been the inclusion of hyaluronic acid-based drugs 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, synocorm or hyalual can soften movements and relieve pain caused by friction of the articular surfaces. For 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 treating gonarthrosis

The author's methods of treating arthrosis of the knee joint include:

• Evdokimov's methodology;
• Bubnovsky's technique;
• Gita's technique.

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

Oxygen therapy is a method of filling the joint cavity with medical oxygen. Allows you to eliminate puffiness and reduce pain. It can be used as an alternative to hormone therapy.

Stem cell therapy. The essence of the method is to transplant the patient's stem cells into the joint. The method was developed in Germany and allows you to postpone conservative treatment for many years. Used only in major medical centers in Germany.

Intra-articular laser therapy method. 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 its high cost it is not widely used.

Ortokine is a biological technique 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 anti-inflammatory effects. 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 destruction of cartilage tissue;
• Reduce pain syndrome;
• Stop inflammation;
• Increase knee mobility.

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

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Operative treatment

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

There are several types of operations for gonarthrosis:

• Arthrodesis. With 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 rarely resort to it;
• Arthroscopic debridement. The technique consists in freeing the joint from deformed cartilage tissue using an arthroscope. It is used in the early stages of the disease. Pain is eliminated through arthroscopy. The operation is simple. The effect of the procedure is temporary, 2-3 years;
• Periarticular osteotomy. This is a technically difficult and rare type of surgery. It consists in preliminary filing and securing 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

In our time, 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 you need to undergo a long course of rehabilitation and joint development. 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 looses 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 vein;
• Rejection of the prosthesis.

Such troubles are extremely rare and account for about 1% of the total number of operations. Therefore, it should be borne in mind 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 for gonarthrosis - medical and not only

The purpose of exercise for gonarthrosis is several factors:

• Maintaining and increasing joint mobility;
• Formation of a compensation mechanism by strengthening the musculo-ligamentous apparatus;
• Strengthening blood circulation and improving the trophism of adjacent tissues and the joint itself;
• Maintaining physiological muscle tone.

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

The following activities can be classified as prohibited for gonarthrosis:

• Violent movements accompanied by pain;
• Sharp and high-amplitude kicks;
• Exercises with full axial load on the affected joint.

On the subject: Exercise and gymnastics for gonarthrosis

A set of exercises for gonarthrosis

1. While standing, try to completely relax, lower your hands down. Perform shaking movements with your whole body. Make sure your knees are shaken with a small amplitude.
2. Holding on to the support, bend the knee, direct the heel to the buttock, then, straightening the leg forward, place it on the heel in front of you. Do it 15-20 times. Then do on the other leg.
3. While 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 sensations. Do it at least 20 times.
4. Perform the exercise on a folded blanket. The surface should not be too hard. Get on your knees and shake 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 in support lying on your knees (palms 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, performing a heel seat without lifting your chest off 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 and stretch your heel to the wall as much as possible. Perform 12 times and change leg.
8. Sit with bent legs in front of you. Stretch the knee of your right leg to the left, then straighten it, straightening the knee, bend and return to its starting position. After 12 reps, change your leg.
9. From the same starting position, straighten your legs alternately, without lifting your heels off the floor, then simultaneously bend again, also without lifting them 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 forward movements, try to straighten your leg as much as possible. Do the exercise without jerking.
11. Also lying on your back, tie the rubber shock absorber to the ankles, and fasten the other end to the battery. Smoothly 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 stiff.

Physiotherapy for gonarthrosis

All types of physiotherapy can be prescribed in remission or mild 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 the help of 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 resorption of contractures and adhesions. At least 20 procedures should be performed, since the drug is cumulative. It acts 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 completed 2 times a year, 10-15 procedures each. You can do it at home using mud bought at a 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. The 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 to stretch and stabilize the joint.

You can do the following exercise on your own: stand with the healthy side to the support, take the leg with the sore joint forward, then back, then with a sharp movement "throw" it to the side.

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Prevention of deforming gonarthrosis

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

The following can be recommended as preventive measures:

• Going in for dancing and sports, try to beware of serious injuries (ligament ruptures, fractures, severe bruises of the patella);
• Maintain regular physical activity, as movement is the mechanical basis for cartilage nutrition;
• Make a diet taking into account the needs of bone and cartilage tissue in nutrients;
• Monitor your body weight;
• If you are injured or have discomfort in the area of the knee joints, seek qualified medical help immediately;
• From 35 years of age, undergo preventive treatment with chondroprotectors;
• Drink plenty of water daily.

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Useful Tips

• Begin 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 exercise, consult 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 medium fat content, otherwise calcium will be poorly absorbed. Include in the diet low-fat jellied meat (cooked with turkey meat), natural jelly. Do not forget about the need to eat sea fish and seafood.
• If there is no relief after using an anti-inflammatory drug for a week, see your doctor to review the treatment protocol.
• If you are in remission, 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 can respond to hypothermia with a new relapse.

The main thing is to remember! Even the best doctor will not be able to help you if you do not want to make an effort and 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 only depends on you.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.