Knee osteoarthritis (gonorrhea) is a chronic progressive disease of the knee joint with damage, thinning and destruction of its cartilage (articular surfaces of the femur and tibia), as well as damage to the subchondral bone. Studies (arthroscopy and MRI) have demonstrated that in addition to damage to the articular cartilage, the meniscus and synovial membrane are also involved in this process.Gonorrhea is one of the most common orthopedic conditions. There are its synonyms - osteoarthritis (OA), deforming arthritis.This disease is an important socio-economic problem because it is widespread and significantly reduces the patient's quality of life due to constant pain and, moreover, becomes the cause of high disability.
Until the mid-eighties of the last century, there was no unified definition of this disease.It was not until 1995 that the disease was described as a result of mechanical and biological factors leading to an imbalance between the degradation and synthesis of the extracellular matrix of articular cartilage. As a result, fibrous breakdown and degeneration occur, cracks, bone sclerosis and compaction of the shell of the subchondral bone are formed, osteophytes develop and subchondral cysts are formed.
Many factors lead to gonorrhea, including:
- chronic injuries (violation of physical activity, overweight);
- endocrine, inflammatory, metabolic and ischemic diseases;
- the presence of congenital or acquired disorders of the relationship, shape or structural organization of the joint ends.
Symptoms of knee osteoarthritis
Knee osteoarthritis is characterized by:
- gradual onset;
- mild pain in the joints when moving, especially when going up and down stairs;
- “Tightness”, stiffness and “pain onset” occur during the first steps and gradually decrease or disappear if the patient “changes direction”, after significant physical activity, the patient resumes.
- The appearance of the knee remains the same.Sometimes there is mild swelling or fluid accumulation in the joint (synovitis develops).At the same time, the knee increases in volume, swells, flattens, limits movement and feels heavy.
As the disease progresses, the pain becomes more intense, appearing even with light exertion and long walks.Localized along the anteromedial surface of the joint. Prolonged rest often helps the pain go away.The range of motion of the joint may decrease, a cracking sound may appear, and sharp pain may appear when the leg is bent to its maximum extent.The shape of the joint changes, as if it is expanding.Synovitis is more common, lasts longer, and involves large amounts of fluid.
The final stage of gonorrhea differs in that the pain is almost constant, causing anxiety not only when walking, but also when resting, and even at night, when the patient has to find a comfortable position to sleep.Movement is more limited: it is difficult to bend and straighten the legs completely.Joints become deformed and increase in volume.Valgus (X-shaped) or varus (O-shaped) deformity of the leg is commonly observed. Gait becomes unstable and waddling.In severe cases, a cane or crutches must be used.
According to researchers, 76% of older adults complaining of knee pain had X-rays showing gonorrhea. According to statistics, women are more likely to suffer from this disease, which is related to hormonal changes after age 45.
Pathogenesis of knee osteoarthritis
There are primary and secondary osteoarthritis.
Primary arthritis:
- Articular cartilage is continuously destroyed and regenerated;Normally, these processes are balanced.With age, cartilage regeneration slows down and destruction begins to prevail, this is called degeneration or degeneration. A person's weight plays an important role, since with a mass of 70 kg in 20 steps we carry 700 kg on each leg (70 kg x 10 steps), and with a mass of 120 kg we already carry 1200 kg on each leg.Therefore, weak cartilage will wear out much faster;
- Remember: joints receive nutrients and are restored when moving;A sedentary lifestyle reduces metabolism and the necessary elements do not reach the cartilage;
- There is controversial evidence about the role of genetics in the occurrence of the disease.If parents have joint disease, the likelihood of this disease occurring in the child increases;
- occurs due to autoimmune arthritis.
Secondary arthritis is caused by:
- injuries (fractures, torn meniscus and anterior cruciate ligaments). Unfortunately, in any person, regardless of age, these injuries lead to excessive pressure on the cartilage.Fracture of any bone covered with cartilage is accompanied by an uneven formation - a “step”. In this area, when moving, abrasion will occur and arthritis will form;
- rheumatoid arthritis, Koenig's disease (osteochondritis dissecans), consequences of purulent inflammation of the joints (gonaditis), etc.;
- regional vascular disorders;
- Proliferative adhesion and chronic fluid secretion in the joints.
With osteoarthritis, in addition to the gradual destruction of cartilage, losing its elasticity and ability to absorb shock, bones also gradually participate in this process. Under load, sharp edges (exostoses) appear, which are mistakenly considered "salt deposits" - with classic arthritis, salt deposition does not occur.As arthritis progresses, it continues to “eat” the cartilage.Then the bones are deformed, cysts form there, all structures of the joints are affected, and the leg becomes bent.
In addition to the inner or outer part of the knee, arthritis can also affect the surface between the patella and the intercondylar groove of the femur.This option is called patellofemoral arthritis.
Its cause is usually a mild dislocation, fracture, or shifting of the kneecap to one side.
Classification and stages of development of knee osteoarthritis
Regardless of the cause, the disease has three stages:
- Stage I - initial manifestations.It is characterized by primary changes in hyaline cartilage. Bone structure is not affected.The blood supply in blood vessels and capillaries is interrupted.The cartilage surface becomes dry and loses its smoothness.If the disease is accompanied by continuous intense synovitis, a cyst will develop. After significant stress in the joint, dull pain occurs.There may be mild swelling that goes away after rest.There is no distortion.
- Stage II - the cartilage layer becomes much thinner and is completely absent in some places. Osteoporosis appears along the edges of joint surfaces.The qualitative and quantitative properties of the synovial fluid of the joints change - it becomes thicker, more viscous, which leads to a deterioration of its nutritional and lubricating properties. The pain lasts longer and is more intense, often making a cracking sound when moving.There is mild or moderate limitation of movement and mild deformity in the joints.Using pain relievers helps relieve pain.
- Stage III - lack of cartilage in most affected areas, severe sclerosis (hardening) of the bones, multiple bone spurs, and narrowing or no joint spaces. The pain is almost constant, gait is impaired.Mobility is significantly limited and joint deformities are noticeable.NSAIDs, physical therapy, and other standard treatments are ineffective.
Depending on the number of affected joints, unilateral and bilateral gonorrhea are distinguished.
Complications of knee osteoarthritis
The most common complication of stages II and III is tenosynovitis of the thigh adductor muscle group. This is manifested by pain along the inner surface of the joint, which increases with movement.The cause is muscle imbalance and deformation.With long-term reduction in range of motion, contractures develop. In addition, synovitis frequently occurs.Progressive gonorrhea affects the entire musculoskeletal system, disrupting the biomechanics of the spine and other large joints of the lower extremities.This can lead to herniated discs and arthritis in other joints. The second knee joint is overloaded (if the disease is on one side), because the patient forgives the painful leg and transfers weight to the other healthy leg.
Diagnosis of knee osteoarthritis
Diagnosis is made by an orthopedic traumatologist, and in the majority of cases, examination and X-rays of the knee joint in two projections (direct and lateral) are sufficient. Clinical data and images help determine the stage of the disease.
In the early stages of the disease, with minor changes in bone tissue, X-rays are no longer valuable. At this stage, gonorrhea can be diagnosed through arthroscopy. The accuracy of the method is very high;only its invasive nature and price can stop it.
Ultrasound does not allow clear visualization of changes in articular cartilage and intra-articular structures. Using MRI, you can detect changes in the bone structure, cartilage and soft tissue of joints as well as subchondral bone with 85% accuracy. Scanning can evaluate the metabolic activity of bone tissue around joints.
Increased levels of phosphorus and calcium in dehydrated synovial fluid are evidence of destruction of bone and cartilage tissue of the joint and accumulation of degenerative products.Blood is also examined - general analysis and erythrocyte sedimentation rate (ESR);Determine the concentration of fibrinogen, urea and other biochemical parameters of blood and urine.
Treatment of knee osteoarthritis
Conservative - anti-inflammatory drugs, analgesics, muscle relaxants, vascular agents, chondroprotectors, compression, mobilization, physiotherapy, physiotherapy, orthopedic devices.
Minimally invasive - para-articular blockade (Novocaine + drug reduces pain and inflammation), injection of artificial lubricants into the joint itself, lifting with plasma.
Surgery - arthroscopy (less traumatic method for treating pathologies in the joint and removing damaged structures), arthroscopy.
Conservative methods are most effective in the early stages of the disease. They help relieve pain and temporarily slow cartilage destruction.In phase II, more effective methods are needed. The introduction of hyaluronic acid preparations into the joint cavity is used to reduce friction and trauma to the cartilage.There is no clear evidence of cartilage recovery but it has a good lubricating effect on surfaces.“PRP therapy” (plasmolifting) is the injection of platelet-rich plasma into the knee joint, obtained from the patient's own blood by centrifugation. It nourishes cartilage and promotes its recovery, since platelets themselves contain many growth factors and cytokines that promote the regeneration of damaged tissues.
Endoscopic replacement is a popular and effective surgical method for treating severe gonorrhea, allowing you to maintain limb mobility and the ability to live a full life afterward.This is a high-tech operation that lasts about an hour and a half.In the postoperative period, long-term recovery and joint development are necessary. After 25-30 years, when the artificial joint wears out, it needs to be replaced.
Forecast.prevent
You need to understand that if arthritis begins to develop, it must be treated immediately. If you are at risk of this condition, you may be able to delay its onset as this is recommended:
- reduces stress on knee joints;
- swim - water relieves stress;
- personally massage the muscles of the legs and thighs;
- avoid hypothermia and overwork;
- maintain normal weight;
- quit smoking and alcohol;
- women wear comfortable low-heeled shoes;
- practice physical therapy
Before starting therapeutic exercises, you should definitely consult your doctor.Exercises are performed at a slow pace.If pain or discomfort occurs while exercising, the exercise should be stopped.
Just use effective medicine.Rubbing, compresses and other folk methods are ineffective;They do not affect the cause of the disease, but only help distract from the pain.Avoid injuries and overloads - jumping, carrying heavy objects, standing for long periods of time or sitting in uncomfortable positions. This accelerates the progression of the disease.
It is also necessary to promptly diagnose and treat rheumatoid arthritis, gout and systemic diseases.
Prognosis depends on the stage at which the patient sees the doctor and the exact treatment. The sooner you begin appropriate treatment, the better your chances of avoiding surgery.