Symptoms, diagnosis and treatment of gonarthrosis of the knee joint 1,2,3 degree

Osteoarthritis of the knee is a fairly common disease, the leader of all arthritis. His active study of physicians from different countries began more than a century ago, which causes a significant progress in the fight against disease. At the household level this pathology is persistently called the deposition of salts, although the primary role of the process of calcification is not important. The disease is dangerous and can lead to limited mobility and disability.

Osteoarthritis of the knee joint requires long-term treatment, which is not always able to help without surgery. Is not to be on the surgical table, it is essential to identify pathological changes and begin treatment at an early stage. just Like the majority of articular diseases, osteoarthritis is easier to avoid by taking preventive measures than to treat pain after strenuous.

What happens in this disease?

Gonarthrosis or osteoarthritis of the knee joint, is a degenerative joint disease caused by degeneration of the cartilage, until its complete destruction, resulting in deformation of the joint; thus, less severe inflammatory reactions are secondary phenomena also arise from processes of degeneration.

The Beginning of the pathology is usually associated with structural changes in cartilage tissue at the molecular level, including as a result of violations of blood circulation in the small vessels. Then the process involves the hyaline cartilage, which becomes cloudy, is reduced in thickness, is covered with stratified and mixed microscopic cracks. The pathological process resulting in the ultimate destruction of small and large cartilage, and at the same time exposing the bone joint.

The Body instinctively reacts to the disappearance of cartilage by bone growth in the peripheral areas, resulting in growth of osteophytes. As a result of abnormal changes in the deformed joint, bent the lower limb. This outcome provided the name of the destructive pathology – deforming arthrosis.

Violations in gonarthrosis

The disease comes with the growing following of pathological disorders in the joint:

1. disruption of metabolic process in the cartilage: constant nourishment of the cartilage occurs due to separation and absorption of the lubricant in the movement of the joint, but the disease leads to changes in osmotic pressure and disturbance of the recharge. Areas of increased pressure there is thinning of the cartilage.
2. Structural changes of the collagen fibers: starts the softening of the knee cartilage, broken cushioning function of the cartilage and metabolic ability of chondrocytes – the cartilage loses its elasticity and appears its instability.
3. Violation of articular congruence: activates the synthesis of bone substance, leading to the growth of osteophytes. As a result irritated synovium, which creates an inflammatory process in it, begins the loss of articular mobility.
4. Most actively destructive process flows in the internal area of the joint between the patella and the femur.

Classification pathology

Classification of gonarthrosis is conducted in accordance with the international system ICD 10 code 17.0 – 17.9. The characteristics of the etiology are distinguished 2 main types: primary and secondary osteoarthritis.

Primary (idiopathic) style is a development of the degenerative process on the cartilage healthy, not previously exposed to pathologic influences. The process becomes the result of mechanical and physiological overload. The secondary form of the disease develops on the joints previously subjected to pathological effects (injury, illness), and the beginning of the process due to the decrease of the resistance of cartilage to normal loads. The most common type – post-traumatic gonarthrosis.

Taking into account the localization of lesions differs between unilateral and bilateral gonarthrosis. In turn, one-sided view characterized by damage to the joint only on one limb: right-hand and left knee osteoarthritis. The most difficult and dangerous is the two-way type, when subjected to the destruction of knee joints of both legs. The main reason for this form is the age factor.

Cause and stage of the disease

To initiate a degenerative process of cartilage destruction, need triggers.

Identify the following causes of disease:

• metabolic disorders, especially hormonal imbalance;
• poor circulation and capillaryfragility;
• excessive body weight;
• knee injury (fracture, cracked bones, torn ligaments or meniscus);
• inflammatory diseases (rheumatism, arthritis)
• frequent and prolonged physical overload (especially in athletes – gymnasts, soccer players, athletes, tennis players)
• endocrine disruption
• genetic abnormalities of the structure of tissues;
• genetic predisposition, violation of statics of the body;
• age factor.

The Severity of gonarthrosis is determined by the type of lesion and complications.

It is divided into 3 stages and, respectively, 4 the degree of development:

1. stage 1 (stage 1): initial phase, characterized by a slight narrowing of the joint cavity, visible on the radiograph. There is a feeling of discomfort in the joints, fatigue in the evening, slight limitation of joint mobility.
2. stage 2 (stage 2): on the radiograph there is a significant narrowing of the gap and the appearance of osteophytes, the bony growths. There is a pain syndrome with increased with prolonged standing or walking, crunching in the joint, complicated with flexion and extension of knee, restricts the angle of extension of the leg, the appearance of signs of atrophy of the quadriceps femoral muscle.
3. stage 3 (3rd degree): deformation joint with a violation of the axis of the leg, kneecap instability. There is a sharp increase in pain even at rest, swelling, local temperature, impaired mobility of the joint.
4. in 3 stage 4 severity: severe deformity of joints, complete disappearance of the cartilage, impaired mobility of the limb, the pain is of a permanent nature.

Symptomatology

At the initial stage the symptoms of gonarthrosis are manifested by a feeling of tightening the muscles below the knee and a slight pain sensation after long Hiking trips. In the morning or after prolonged sitting takes a while for the "cycle" of the joint and the disappearance of discomfort in the knee. The development of pathology leads to the appearance of pain syndrome under knee. When walking is detected by the crunch in the joint. Further progression of the disease limits mobility of the joint, problems with the squat and the leg extension, you receive a limp. The pains grow stronger and longer.

A Visual inspection of the joint in the initial stages does not detect any changes. Gradually becomes noticeable joint deformation, and then the curvature of the leg. If you attach the arm to the knee, when bending the legs, you can distinguish a distinct crunch. Palpation indicates the presence of a painful area on the inner side of the knee joint.

Signs of gonarthrosis greatly increased if the disease is complicated by synovitis (inflammation of the inner lining). In this case, already at the first stage, noticeable swelling of the joint due to the fluid. At further stages it fills even the popliteal fossa posterior to the articular area (Baker's cyst). Pain is greatly enhanced.

The Primary diagnosis is made by inspection, palpation of the joint, change of direction of the bones, plomeria joint mobility. Laboratory investigations are carried out on common blood and urine tests: determination of erythrocyte sedimentation rate, fibrinogen, urea and other biochemical parameters. The ultrasound scan of the knee joint. Most informative have x-ray examinations and magnetic resonance imaging. Only after that the doctor treats the disease.

Tactics and methods of therapy

The Question of how to treat gonarthrosis of the knee joint, the doctor decides taking into account the stage and severity of the disease.

In General, the treatment is carried out comprehensively, but usually includes the following steps:

1. Elimination of the inflammatory response: assigned non-steroidal anti – inflammatory drug “Diclofenac”, “Olfen”, “Diclac”, “Ibuprofen”, “Indometacin”, “Ketoprofen”, “Meloxicam”, “Nimesulide”; in complicated stage apply injections with the introduction of hormones – drugs “Hydrocortisone”, “Kenalog”, “Diprospan”; to stop the degenerative processes are assigned antifermental means – “Contrycal”, “Owain”, “Gordox”.
2. Anabolic and anti-catabolic impacts, restoration of cartilaginous tissue: cartilage protectors – “Structum”, “DONA”, “Rumalon”, “Alflutop”, “Mucosal”.
3. Normalization of blood circulation, warming and soothing action: ointments, gels, creams – “Finalgon”, “Fastum gel”, “Nikofleks”, “Apizartron”, “Floran”.
4. Improve blood circulation, strengthen vascular tissues: vasodilator drugs – “Cavinton”, “Trental”, “Actovegin”, “Upsavit”, “Askorutin”.
5. Reduced muscle tension: antispasmodics – “no-Spa”, “Mydocalm”, “Chiseled”.
6. Restoration of synovial fluid: the replacements – “Trawick”, “ "Hyalual".”, “Permatron”.

The Complicated form of the disease can be treated with additional methods, such as: oxygen therapy (introduction of oxygen); the introduction of stem cells; laser therapy; introduction of a protein preparation “Ortokin” on the basis of blood serum.

In the final stages of gonarthrosis is the only effective methodbecomes surgical treatment. Made surgical operation on prosthetics of injured tissue. Depending on the severity of the disease are as follows:

• arthrodesis (removal of the destroyed cartilage along with joints);
• debridement arthroscopic (removal of the deformed cartilage through the arthroscope);
• osteotomy (fixing bones in a different position);
• replacement.

Preventive measures

The Treatment of gonarthrosis of the knee joint, particularly at the initial stage, is carried out by methods that do not involve drug therapy. Therapeutic physical exercises can improve blood circulation, strengthen the musculo-ligamentous system, raise the muscle tone, maintain joint mobility. Physical therapy is being developed by the attending podiatrist for the individual scheme.

Physiotherapy in osteoarthritis involves the use of the following methods: electrophoresis with bischofite, Kaipainen and increased with Dimexidum; magnetic therapy; ultrasound; microwave effect; paraffin bath; a radon and hydrogen sulfide baths; mud baths. Have proved to be effective therapeutic massage and manual therapy, if carried out by a specialist.

Prevention of a disease necessarily involves proper nutrition.

Diet for osteoarthritis excludes the use of pickles, spicy and oily food. The menu recommends an increased intake of low-fat jellied minced meat (e.g. Poultry meat), jelly, natural fruit. It is useful to eat sea fish and seafood.

disability and the disability group is not threatened if prevention is to carry out folk remedies. Effective use of infusion on the basis of garlic and lemon with the addition of celery. Recommended tea from herbs black beans. Particularly useful is the centipede grass, which should be added to salads. And of course, the extraction of beef tricks and hooves, it is better to use hot, fat uncured.