Gonartroz (deforming arthrosis of a knee joint) – a degenerate and dystrophic disease at which the hyaline cartilage covering condyles of tibial and femoral bones is surprised. At late stages of a gonartroz all joint is involved in process; the subject part of a bone is condensed and expands. Gonartroz wins first place on prevalence among all arthroses. The disease usually arises at patients 40 years are aged more senior and it is more often observed at women. In certain cases (after injuries, at athletes) can develop at young age. The main manifestation of a gonartroz are the pains amplifying at the movements restriction of movements and sinovit (liquid accumulation) in a joint. Gonartroz develops gradually, for many years. Treatment of a gonartroz conservative. An essential role is played by timely prevention.
Gonartroz (Latin articulatio genus – a knee joint) or the deforming arthrosis of a knee joint – the progressing degenerate and dystrophic damage of an intra articulate cartilage of not inflammatory character. Gonartroz – the most widespread arthrosis. Usually strikes people of middle and advanced age, women suffer more often. After a trauma or constant intensive loadings (for example, at professional works by sport) can arise at younger age. The major role in the prevention of emergence and development of a gonartroz is played by prevention.
Contrary to popular belief, the reason of development of a disease – at all not in adjournment of salts, and in violation of food and change of structure of an intra articulate cartilage. At a gonartroza in the place of an attachment of sinews and the copular device the centers of adjournment of salts of calcium can meet, however they are secondary and are not the reason of emergence of painful symptoms.
Taking into account pathogenesis in traumatology and orthopedics allocate two types of a gonartroz: primary (idiopathic) and secondary . Primary arises without the previous injuries at patients of advanced age and usually happens bilateral. Secondary develops against the background of pathological changes (diseases, development violations) or injuries of a knee joint. Can arise at any age, usually unilateral.
Taking into account expressiveness of pathological changes allocate three stages of a gonartroz:
- The first stage – initial manifestations of a gonartroz. Periodic dull aches, usually – after considerable load of a joint are characteristic. Small, independently disappearing puffiness of a joint is possible. Deformation is absent.
- The second stage – increase of symptomatology of a gonartroz. Pains become more long and intensive. Often there is a crunch. Insignificant or moderate restriction of movements and small deformation of a joint is noted.
- The third stage – clinical manifestations of a gonartroz reach a maximum. Pains practically constants, gait it is broken. The expressed restriction of mobility and noticeable deformation of a joint is noted.
The knee joint is created by the articulate surfaces of two bones: femoral and tibial. On the forward surface of a joint the patella which at the movements slides on deepening between femur condyles settles down. The low-tibial bone does not participate in formation of a knee joint. Its top part is located sideways and is slightly lower than a knee joint and is connected to a tibial bone by means of an inactive joint.
Articulate surfaces tibial and a femur, and also the back surface of a patella are covered with smooth, very strong and elastic plotnoelastichny hyaline cartilage 5-6 mm thick. The cartilage reduces friction forces at the movements and performs shock-absorbing function at shock loadings.
At the first stage of a gonartroz blood circulation in the small intra bone vessels feeding a hyaline cartilage is broken. The surface of a cartilage becomes dry and gradually loses the smoothness. On its surface cracks appear. Instead of soft free sliding cartilages "cling" the friend to the friend. Because of constant microinjuries cartilaginous tissue becomes thinner and loses the depreciation properties.
At the second stage of a gonartroz there are compensatory changes from bone structures. The articulate platform is flattened out, adapting to the increased loadings. The subkhondralny zone (the part of a bone located at once under a cartilage) is condensed. At the edges of articulate surfaces there are bone growths – osteofita which by the form on the roentgenogram remind thorns.
The Sinovialny cover and the capsule of a joint at a gonartroza also regenerate, become "wrinkled". Character of articulate liquid changes – it gets thick, its viscosity increases that leads to deterioration in the greasing and feeding properties. Because of a lack of nutrients the degeneration of a cartilage accelerates. The cartilage becomes thinner even more and on certain sites absolutely disappears. After disappearance of a cartilage friction between articulate surfaces sharply increases, degenerate changes quickly progress, there comes the third stage of a gonartroz.
At the third stage of a gonartroz of a bone are considerably deformed and as if are pressed each other, significantly limiting the movements in a joint. Cartilaginous tissue is practically absent.
In most cases it is impossible to allocate any one reason of development of a gonartroz. As a rule, emergence of a gonartroz is caused by a combination of several factors. About 20-30% of cases of a gonartnoz are connected with the previous injuries: shin fractures (especially intra articulate), injuries of meniscuses, anguishes or ruptures of sheaves. Usually arises in 3-5 years after traumatic damage though also earlier development of a disease – in 2-3 months after a trauma is possible.
Quite often the demonstration of a gonartroz is connected with excessive loads of a joint. Age after 40 years – the period when many people understand that regular physical activities are necessary for maintenance of an organism in good shape. Beginning to be engaged, they do not consider age changes and excessively load joints that leads to bystry development of degenerate and dystrophic changes and emergence of symptoms of a gonartroz. Run and intensive bystry squats are especially dangerous to knee joints.
One more contributing factor of development of a gonartroz – excess weight. At excess body weight load of joints increases, there are both microinjuries, and serious damages (ruptures of meniscuses or anguishes of sheaves) more often. Especially hard proceeds at full patients with the expressed varicosity.
The risk of emergence of a gonartroz also increases after the postponed arthritises (psoriatichesky arthritis, jet arthritis, rheumatoid arthritis, arthritis at gout or Bekhterev's disease). Besides, among risk factors of development of a gonartroz – genetically caused weakness of the copular device, a metabolic disorder and violation of an innervation at some neurologic diseases, craniocereberal injuries and spine injuries.
The disease begins gradually, gradually. At the first stage of a gonartroz of patients insignificant pains at the movements disturb, especially – during rise or descent on a ladder. The feeling of constraint in a joint and "tightening" in popliteal area is possible. A characteristic symptom of a gonartroz is "starting pain" - painful feelings which arise during the first steps after rise from a sitting position. When the patient with gonartrozy "disperses", pain decreases or disappears, and after considerable loading develops again.
Externally the knee is not changed. Sometimes patients gonartrozy note small puffiness of the struck area. In some cases at the first stage of a gonartroz in a joint liquid accumulates – develops sinovit which is characterized by increase in volume of a joint (it becomes inflated, spherical), heavy feeling and restriction of movements.
At the second stage of a gonartroz of pain become more intensive, arise even at small loadings and amplify at intensive or long walking. As a rule, pains are localized on the perednevnutrenny surface of a joint. After long rest painful feelings usually disappear, and at the movements arise again.
In process of progressing of a gonartroz the volume of movements in a joint gradually decreases, in attempt as much as possible to bend a leg sharp pain develops. The rough crunch at the movements is possible. The configuration of a joint changes, it as if extends. Sinovita appear more often than at the first stage of a gonartroz, are characterized by more persistent current and a congestion of bigger amount of liquid.
At the third stage of a gonartroz of pain become almost constant, disturb patients not only during walking, but also at rest. In the evenings patients long try to find a comfortable position to fall asleep. Quite often pains develop even at night.
Bending in a joint is considerably limited. In some cases not only bending, but also extension because of what the patient with gonartrozy cannot straighten a leg completely is limited. The joint is increased in volume, deformed. Some patients have a valgusny or varusny deformation – legs become H-shaped or Au-shaped. Because of restriction of movements and deformation of legs gait becomes unstable, rolling over. In hard cases patients gonartrozy can move only with a support on a cane or crutches.
At survey of the patient with the first stage of a gonartroz of external changes usually it is not possible to reveal. At the second and third stage of a gonartroz the posterization of contours of bones, deformation of a joint, restriction of movements and a curvature of an axis of an extremity is found. When moving a patella in the cross direction the crunch is heard. At a palpation the painful site of a knutra from a patella, at the level of an articulate crack, and also over it and under it comes to light.
At a sinovita the joint increases in volume, its contours become smoothed. The vybukhaniye on the perednebokovy surfaces of a joint and over a patella is found. At a palpation fluctuation is defined.
The diagnosis is exposed on the basis of complaints of the patient, data of objective survey and a radiological research. A X-ray analysis of a knee joint – the classical technique allowing to specify the diagnosis, to establish expressiveness of pathological changes at a gonartroza and to watch dynamics of process, doing repeated pictures after a while. Because of the availability and low cost it remains by the main method at diagnosis to this day. Besides, this way of a research allows to exclude other pathological processes (for example, tumors) in tibial and a femur.
At an initial stage of a gonartroz of change on roentgenograms can be absent. In the subsequent narrowing of an articulate crack and consolidation of a subkhondralny zone is defined. The articulate ends of femoral and especially tibial bone extend, edges of condyles become pointed.
When studying the roentgenogram it is necessary to consider that more or less expressed changes characteristic of a gonartroz are observed at most of elderly people and are not always followed by pathological symptoms. The diagnosis of a gonartroz is exposed only at a combination of radiological and clinical symptoms of a disease.
Now along with a traditional X-ray analysis for diagnostics of a gonartroz such modern techniques as the computer tomography of a knee joint allowing to study in detail pathological changes of bone structures and MRT of a knee joint, applied to identification of changes in soft fabrics are used.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Orthopedists are engaged in treatment of a gonartroz. Therapy of a gonartroz should be begun in the earliest terms. In the period of an aggravation recommend to the patient with gonartrozy rest for the maximum unloading of a joint. To the patient appoint remedial gymnastics, massage, physical therapy (UVCh, an electrophoresis with novocaine, with a hydrocortisone, diadynamic currents, magnito-and laser therapy) and mud cure.
Medicamentous therapy at a gonartroza includes hondroprotektor (the medicines improving exchange processes in a joint) and the medicines replacing sinovialny liquid. In some cases at a gonatroza intra articulate introduction of steroid hormones is shown. In the subsequent the patient can be directed to sanatorium treatment.
To the patient with gonartrozy can recommend to go with a cane for unloading of a joint. Sometimes use special orthoses or individual insoles. For delay of degenerate processes in a joint at a gonartroza it is very important to follow certain rules: to go in for physical culture, avoiding excessive loads of a joint, to choose convenient footwear, to watch weight, it is correct to organize a day regimen (alternation of loading and rest, performance of special exercises).
At the expressed destructive changes (at the third stage of a gonartroz) conservative treatment is ineffective. At the expressed pain syndrome, dysfunction of a joint and restriction of working capacity, especially – if gonartrozy the patient of young or middle age suffers resort to surgery (endoprosthesis replacement of a knee joint). In the subsequent rehabilitation events are held. The period of a complete recovery after operation on replacement of a joint at a gonartroza takes 3 months before half a year.