Diseases related to gonarthrosis of the knee joint

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Malykhin

Sergey Aleksandrovich

11 years of experience

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Gonarthrosis is arthrosis of the knee joint of a deforming type. The disease affects the hyaline cartilage in the surface of the joints of the tibia and femur. The pathology occurs in a chronic progressive form.

Clinical symptoms of joint gonarthrosis include the presence of pain that intensifies during movement, accumulation of fluid in the joint and limited movement. Late stages of gonarthosis are characterized by a lack of support on the leg. Diagnosis is based on the collection of complaints and anamnestic data, radiography and physical examination data. Treatment of knee joint gonarthrosis involves prosthetics if there is no effect from conservative treatment.

Gonarthrosis literally means knee joint. The pathology occurs in the form of deforming arthrosis. This means that the cartilage inside the joint is damaged in a physiologically dystrophic way, and not through an inflammatory process. The pathology occurs in a progressive form. This pathology is the most common type of arthrosis. The risk group most likely includes middle-aged and elderly women. At a young age, pathology occurs as a post-traumatic complication. Prevention is of great importance within the framework of preventive therapy.

Foci of deposited calcium salts in tendons and the apparatus of ligaments and tendons have a secondary role in the formation of gonarthrosis of the knee joint.

Symptoms and signs

Gonarthrosis of the joints develops gradually. The first stages of the disease practically do not bother patients, except for minor pain when going down or going up stairs. More sensitive patients report a feeling of stiffness in the joints or popliteal area.

A distinctive symptom of grade 1 gonarthrosis is the starting threshold of pain - this is the pain that accompanies the first steps after a sitting position. Further, in the process of walking, the pain disappears or is significantly dulled. Her reappearance will be marked by some kind of physical activity of significant severity.

External symptoms of gonarthrosis rarely appear. These mainly include swelling. Accompanying the pathology with fluid accumulation leads to synovitis. In this case, the joint swells to a spherical appearance and movements become constrained, and the patient feels heaviness.

Each degree of gonarthrosis has its own distinctive features. Grade 2 gonarthrosis is characterized by intense pain when walking and moderate physical activity. The progression of gonarthrosis leads to gradual immobilization of the joint. In this case, flexion and extension of the knee joint leads to crunching and sharp pain.

Grade 3 gonarthrosis is accompanied by constant pain. In this case, the movement of the joint is practically paralyzed and the patient cannot straighten his leg. The joint increases in size and becomes deformed. External signs of pathology appear - instability of gait, waddling nature of movements or inability to walk without additional support.

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In its development, arthrosis of the knee joint goes through the following stages:

• First stage of gonarthrosis

  – does not cause significant suffering to the patient, is characterized by intermittent aching or tightening pain, especially after heavy physical exercise or direct load on the knee joint. The so-called “starting pain” symptom appears, when the patient stands up abruptly, painful sensations arise that gradually pass, but if increased stress is placed on the limb, the pain resumes. May manifest as slight swelling, which goes away on its own. Rarely, but it occurs, synovitis - fluid accumulates in the joint capsule of the knee, due to which the knee area becomes spherical and swollen, movements in the limb are limited. At this stage there is no deformation of the joint yet.

• Second stage

  – the patient begins to be bothered by prolonged and quite severe pain on the front and inside of the joint, even with light loads, but after a long rest they usually go away. When the joint moves, a crunching sound is heard; if the patient tries to bend the limb as much as possible, sharp pain appears. A limited amplitude in the movement of the joint is revealed, and deformation begins to appear. Synovitis occurs frequently, lasts longer, and occurs with a large accumulation of fluid in the joint.

• Third stage

  – causes significant suffering to the patient, the painful sensations are constant and disturb not only while walking, but also during rest and even at night, preventing sleep. The joint is already significantly deformed, the position of the limb becomes X or O-shaped. A waddling gait appears, and often, due to significant deformation, a person cannot not only bend, but completely straighten his leg, as a result of which he has to use a cane or even crutches to walk.

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Causes of occurrence and development

Almost always, pathology develops against the background of the complex influence of a number of factors:

• injuries - tibia fractures, damaged menisci, tears or ruptures of ligaments. The disease occurs between 2 months and 5 years after injury;
• physical activity – playing sports is useful if the set of exercises and their intensity correspond to the age of the patient;
• excess weight - obesity leads to excessive stress on the joints and their premature wear; patients with varicose veins are especially at risk.

General information about the disease and pathogenesis

Gonarthrosis is a type of arthrosis, a joint lesion that occurs in older people or in young people who endure heavy physical activity.
When the joint capsule cannot cope with the increasing load on it, microdamages occur, in the place of which osteophytes grow, leading to a narrowing of the joint space. The disease most often affects large and mobile joints, which bear significant load while walking or running. Example – knee and hip joints, lower back. Gonarthrosis and a healthy joint, comparison

Arthrosis is a common pathology of the musculoskeletal system. More than half of the cases of the disease are associated with damage to the knee joints. Pathological processes in the articular cavity are associated with the following phenomena:

1. Due to the disruption of metabolic processes in the cartilage associated with the functioning of the circulatory system, a parallel disturbance of osmotic pressure occurs. An example is that when you squeeze the knee during movement, synovial lubricant is released, and when it relaxes, it is absorbed. When walking, the cartilage plate is constantly nourished, helping to maintain its integrity. If this process is disrupted for some reason, premature or age-related wear of the joint capsule occurs.
2. Next, the structure of collagen fibers is disrupted, which causes a loss of shock absorption properties. Against the background of this pathological process, the metabolic function of cartilage cells is disrupted, which significantly slows down the regeneration of cartilage tissue. As a result, the cartilage structure becomes thinner, loses stability and elasticity.
3. Against the background of emerging pathological processes, irritation of the synovial membrane subsequently occurs, which leads to the appearance of a chronic inflammatory process. Against the background of long-term inflammation, osteophytes begin to grow, which provokes a decrease in joint mobility.
4. Subsequently, there is a gradual destruction of the cartilage with its complete erasure, against the background of which there is a narrowing of the joint space and an increased growth of osteophytes.

Professional athletes and people who work mostly standing all day are more susceptible to this pathology.

Bilateral gonarthrosis can be primary or secondary due to its occurrence. The primary form is not associated with exposure to adverse external factors. In such a situation, bilateral gonarthrosis develops independently, as an age-related degenerative-dystrophic process. Secondary bilateral gonarthrosis of the knee joint is the result of previous bone injuries, substance disorders, cartilage injuries and infections.

Routes of infection and risk factors

Gonarthrosis of the 1st degree - impaired blood circulation inside small bone vessels leads to the loss of the ability of cartilage to slide.

Grade 2 gonarthrosis – a change in the viscosity and thickness of the joint fluid, cartilage degeneration begins due to lack of nutrition, friction between the bones increases and the disease progresses.

Gonarthrosis of the 3rd degree - the bones are practically pressed into each other, the movement of the joint is limited, and the cartilage as such no longer exists.

Risk factors for developing the disease include:

• arthritis of any nature;
• hereditary ligament weakness;
• impaired metabolism;
• impaired innervation in a number of neurological diseases;
• traumatic brain injuries;
• spinal injuries.

Why and how gonarthrosis develops

The main cause of gonarthrosis is the inability of the joint to resist high loads. Predisposition to the development of knee arthrosis is:

• hereditary features of the structure and functioning of articular tissues;
• age – the disease develops in the second half of life;
• excess body weight - the more it is, the greater the load on the knee;
• hormonal disorders;
• previous trauma - intra-articular fracture, sprain and rupture of ligaments, etc.;
• long-term chronic arthritis of any origin.

Under the influence of all these factors, blood circulation and the composition of the synovial fluid that nourishes cartilage are disrupted. This leads to disruption of intracellular metabolism in cartilage cells (chondrocytes) and the predominance of destructive processes (catobolism) over creative ones (anabolism).

Normally, chondrocytes produce enzymes that maintain the state of elastic formations of the intercellular substance (matrix). With arthrosis, chondrocytes gradually lose their functions, and the matrix loses its elasticity and shock-absorbing properties. The cartilage atrophies (dries out), then cracks. The bone becomes exposed and becomes denser, so protective mechanisms are activated and it begins to grow, forming osteophytes (bone growths), the joint loses its structure, and deforming arthrosis of the knee joint develops.

Metabolic disorders may be accompanied by periodically occurring aseptic inflammatory process of the synovial membrane. This further intensifies the pain and contributes to the progression of the pathological process. This disease is usually called osteoarthritis or osteoarthritis.

If the affected knee is left untreated, the joint will deteriorate, gradually leading to disability. The sooner such a patient seeks medical help, the faster he will get rid of pain.

Classification

Based on the ways the disease appears, there are:

• primary gonarthrosis - occurs on its own, often in the nature of bilateral gonarthrosis;
• secondary gonarthrosis of the knee - develops against the background of injuries or other pathologies of the knee joint, there are two types: right-sided gonarthrosis on the right leg and left-sided gonarthrosis on the left leg.

The severity of symptoms depends on the degree of gonarthrosis:

• Stage 1 – dull pain, slight swelling of the joint, no deformation;
• Stage 2 – increased symptoms and pain, the presence of a crunch, moderate limitation of movement and mild deformity;
• Stage 3 – maximum clinical symptoms, gait disturbance and severe constant pain, limited mobility and visible deformation of the joint.

Frequently asked questions about the disease

What is the difference between arthrosis and knee arthritis?

Arthritis is an inflammatory process, and arthrosis is degenerative-dystrophic.

Is it possible to walk with knee arthrosis?

It is not only possible, but also necessary, very gradually increasing the load.

Who treats arthrosis of the knee joint?

Traumatologist-orthopedist.

Is it possible to cure arthrosis of the knee joint without surgery?

This is a chronic process, it is impossible to completely cure it, but regular conservative treatment of arthrosis of the knee joint will relieve pain and improve the quality of life.

Osteoarthritis of the knee joint should under no circumstances be a death sentence. It can and should be treated, relieving a person of pain and increasing the quality of his life. At the Paramita clinic (Moscow), they know how to do this.

Literature:

1. Alekseeva L. I. Symptomatic slow-acting drugs in the treatment of osteoarthritis // Consilium med. 2009, 11, 100–104.
2. Kosareva M.A., Mikhailov I.N., Tishkov N.V. Modern principles and approaches to the treatment of gonarthrosis // Modern problems of science and education. – 2021. – No. 6.
3. Kuzucuoglu T., Yener T., Temize F. et al. Lornoxicam and Tramadol applications for postoperative pain management in lumbar disc surgery // Regional Anesth. and Pain Med. 2005, 30, Suppl 1, p. 81.
4. Koltka K., Talu GK, Cengiz M. et al. Comparison of the efficacy of intraarticular administration of lornoxicam, bupivacaine and placebo on postoperative analgesia after arthroscopic knee surgery // Regional Anesth. And Pain Med. 2004, 29, Suppl. 2, 89.

Themes

Arthrosis, Joints, Pain, Treatment without surgery Date of publication: 08/20/2021 Date of update: 01/11/2021

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Complications

Of course, the lack of competent and timely treatment of gonarthrosis leads to destruction and deformation of the knee joint, complete limitation of movement and disability. However, complications after neglected treatment of gonarthrosis can spread to other elements of the musculoskeletal system, the spinal column being considered the most significant.

Treatment of joint gonarthrosis is necessary to ensure adequate load on the spinal column, because restricting the movement of the knee joint increases the load on the spine by up to 75%. Therefore, among the consequences of pathology we will name the following:

• curvature of the spine;
• radiculitis;
• stenosis of the intervertebral canals;
• intervertebral hernias;
• osteochondrosis;
• vertebral instability.

Thus, the lack of relevant treatment for gonarthrosis of the joints leads to subsequent pathologies and their complications, growing like a snowball.

This development will lead to long-term treatment through a series of surgical operations not only on the knee joint. Other joints within the frame take on the load of the damaged knee joint, resulting in premature wear.

Another type of complication of the disease is the presence of an inflammatory process and large amounts of fluid that can leak outside the knee joint, causing new destruction and deformation, as well as the formation of a hernia or tumor.

When to see a doctor

If you have the slightest discomfort when moving or pain in the knee joint, you should contact a traumatologist or orthopedist; you can also seek an initial consultation with a surgeon.

JSC “Medicine” (academician Roitberg’s clinic) employs doctors from 66 medical specialties who have extensive work experience and are constantly improving their qualifications. You can make an appointment and choose a doctor on the website, by calling +7 (495) 775-73-60 or from the administrators at the clinic: Moscow 2nd Tverskoy-Yamskoy Lane, 10.

Competencies

Development of gonarthrosis

Gonarthrosis is a disease belonging to the dystrophic-degenerative type.
The most common type of arthrosis, which is characterized by destruction of the knee cartilage, which is accompanied by deformation and dysfunction of the entire joint. This is a disease that occurs in old age, especially in women. Gonarthrosis is a pathology that manifests itself as frequent pain in the knees caused by dystrophic changes in the knee joint. The disease occurs more often in women, especially in old age - after 50 years.

Mechanism of disease development

It all starts with the fact that blood circulation in the knee joint changes. Cartilage, not receiving sufficient nutrition, becomes thinner and dies over time. This leads to bone being exposed on individual fragments of the intra-articular surfaces.

During physical activity, severe pain occurs due to strong friction of bone elements. At rest they are absent. As a result of the reaction to pain, osteophytes—growths or spines—appear on the bones. Because of them, deformation of the knee joint occurs, which leads to a change in the appearance of the entire leg.

Causes

At an early stage, it is difficult to determine the disease, since there is no pain. Therefore, patients with gonarthrosis seek help from doctors much later.

Primary gonarthrosis

The primary form of pathology develops independently and does not depend on concomitant diseases. The main reason is a disruption of normal metabolism in joint tissues, which occurs as the body ages. Predisposing factors are poor lifestyle and excess weight.

Genetic predisposition also plays a certain role in the development of the disease. Gonarthrosis does not belong to the group of pathologies transmitted from generation to generation, but hereditary factors are of great importance in its development. Many scientists associate the appearance of primary arthrosis of the knee joint with prolonged use of hormonal drugs and their side effects on the body.

The primary form of the disease usually affects both knee joints at once. Less commonly, the disease is only one-sided, but as it progresses it still spreads to the joint of the second leg.

Secondary gonarthrosis

The secondary form of the disease occurs as a complication of any pathology and has an easily identifiable cause.

Factors that lead to knee arthrosis:

• Traumatic damage to the joint and associated pathological changes (rupture of ligaments holding bone formations, trauma to the meniscus, bleeding inside the joint capsule, fractures).
• Surgery on the knee area.
• Arthritis is an inflammatory disease of the joint.
• Neoplasms.

Secondary gonarthrosis is characterized by damage to only one knee. The disease cannot be bilateral.

Symptoms

With gonarthrosis, characteristic symptoms appear. The patient complains of stiffness and limited active movements in the knee, as well as the appearance of pain during physical activity, prolonged walking, and running. The severity of pain usually increases in the morning, as soon as the patient gets out of bed.

Over time, the pain intensity increases and the disease progresses. The pain becomes almost constant. It is difficult for the patient to walk, go up and down the stairs, and even while sitting the patient experiences severe discomfort. The pain only goes away when lying down.

In severe cases of the disease, night “joint” pain appears, which prevents the patient from sleeping normally. The gait changes: the patient begins to limp, tries not to step on the sore leg so as not to experience pain. As the disease progresses, the patient cannot move independently; he needs to lean on someone or use crutches. Over time, mobility in the joint becomes less and less. It is difficult for the patient to bend and straighten his leg; every movement is accompanied by a crunching sound.

Deforming gonarthrosis is also characterized by the presence of local signs of the disease. Severe swelling is detected in the area of ​​the knee joint, the normal shape of the limb is disrupted, and the bones are deformed.

Stages of gonarthrosis

Depending on how severe the patient’s clinical symptoms are, there are 4 degrees of gonarthrosis:

• 1st degree.
  This is the initial stage of the disease, in which symptoms appear exclusively during intense physical exertion. The patient notes discomfort in the knees, which quickly disappears without any treatment. Sometimes swelling of the joints may appear, but there is no deformation of the bones.
• 2nd degree.
  At this stage, the pain intensifies and becomes more frequent. In the morning, there is limited movement in the joint and a crunching sensation. The swelling intensifies, and the first signs of deformation appear.
• 3rd degree.
  The disease is characterized by maximum severity of symptoms. The patient experiences severe pain when moving, his gait is impaired, he cannot move independently without the help of relatives or without the use of assistive devices. The deformation of the bone elements of the joint is clearly expressed, its volume is increased due to local swelling of the soft tissues.
• 4th degree.
  This stage is characterized by the same clinical picture as the third. The only difference is in the X-ray picture of the pathology. In the image, with the fourth degree of gonarthrosis, the joint space, which normally separates the bones of the thigh and lower leg, will be almost completely absent. Because of this, the patient experiences constant sharp pain that does not stop even at rest.

After receiving complete information about the disease, treatment is prescribed.

Diagnostics

It is quite easy for a doctor with extensive experience to determine the diagnosis of “gonarthrosis of the knee joint”. First, the doctor interviews the patient. The patient must tell in detail when the symptoms of the disease first appeared, how they developed over time, and whether new signs of the disease appeared.

The pathology is characterized by slow, gradual progression - the patient may feel symptoms for several years. If severe pain occurs suddenly, then it is worth suspecting the presence of another disease.

During a local examination at stages 2 and 3 of the disease, the doctor notices swelling in the joint area. For stage 1 gonarthrosis, swelling is not typical. Palpation allows you to identify the incorrect position of bone elements in relation to each other.

To accurately confirm the diagnosis, it is necessary to conduct instrumental diagnostics. First of all, the patient is sent for radiography. In the resulting image, you can examine the pathologically changed joint in all details. Magnetic resonance imaging is also prescribed according to indications. It helps to visualize the soft tissues surrounding the joint, as well as to examine its structure layer by layer and confirm the presence of gonarthrosis.

Treatment of gonarthrosis

Many methods, both conservative and surgical, have been developed for the treatment of gonarthrosis of the knee joints. The specific set of therapeutic procedures depends on the stage of the disease.

Conservative treatment

Conservative treatment includes medicinal and orthopedic treatment of gonarthrosis of the knee joint.
Drug therapy includes 4 groups of drugs:

1. Analgesics (pain relief);
2. Anti-inflammatory;
3. Glucocorticoids;
4. Chondroprotectors (substances that improve the condition of cartilage tissue).

Conservative treatment is used for grade 1 gonarthrosis.

Orthopedic treatment involves the use of tools and devices that fix the leg in one position and prevent heavy loads on the joint.

The main orthopedic devices are:

• A special cane designed for the patient to lean on when walking;
• Orthopedic insoles;
• Orthoses are knee braces that rigidly fix the knee joint in one position.

Most often, these devices are used in the treatment of bilateral gonarthrosis of the knee joint, grade 2.

Surgery

Grade 3 and 4 gonarthrosis cannot be cured conservatively, you can only relieve the pain. The cause of the disease, a pathologically altered joint, can only be eliminated through surgical treatment.

In the later stages of arthrosis of the knee joint, the arthroplasty technique is most often used. Either individual bone elements, or the entire joint at once, are replaced with artificially created analogues - prostheses. The only contraindication to surgical intervention of this type is the presence of osteoporosis in the patient - pathological fragility of bone tissue. In this case, the installed dentures will not adhere to the elements on which they are attached, and gonarthrosis will only intensify. That is why, before the operation, a complete examination of the patient is carried out to exclude contraindications.

Additional treatment

To restore the patient’s normal activity during the rehabilitation period, the following methods are widely used:

• Massage;
• Acupuncture;
• Physiotherapy;
• Manual therapy.

Physiotherapy is also effective:

• Mud therapy;
• Treatment with magnets;
• Ultraviolet;
• UHF irradiation;
• Diatoki;
• Joint electrophoresis;
• Cryotherapy – treatment by applying cold;
• Laser exposure.

These procedures help speed up tissue regeneration in the knee joint. However, only on condition that the patient follows a special diet for gonarthrosis of the knee joint, which compensates for the deficiency of vitamins and calcium in the body.

Physiotherapy

Despite the fact that physical therapy is an auxiliary method of treating knee gonarthrosis, its use is of great importance in restoring the patient’s mobility after surgical treatment. Its main goal is to strengthen muscles and improve blood circulation in the knee joint. As a result, leg mobility improves and pain decreases.

It is necessary to perform gymnastics for gonarthrosis while lying on the floor; the patient should not make active sudden movements. At first, the training should not last longer than 10 minutes, then gradually its duration should be increased to 30 minutes. It is important to perform the exercises smoothly and carefully so as not to overstrain the knee joint.

A set of exercises is developed by the doctor conducting the patient’s rehabilitation.
When compiling it, the stage of gonarthrosis and the presence of concomitant diseases are taken into account. For gonarthrosis the following are contraindicated:

• Run;
• Long walking;
• Squats.

Traditional treatment

The use of folk remedies will not replace full treatment from a doctor. With their help you can relieve symptoms, but you can stop the progression of gonarthrosis only after contacting a surgeon.

In the initial stages, the symptoms of the disease can be relieved using folk remedies:

• Clay compresses;
• Ficus tinctures;
• Baths with Jerusalem artichoke;
• Dandelion decoction;
• Apple cider vinegar.

Gonarthrosis

is a complex disease that actively progresses over many years. That is why, when the first symptoms appear, consult a doctor. Only specialized medical care will help stop the course of the disease and prevent the development of serious complications.

Diagnostics

Gonarthrosis is diagnosed by a traumatologist-orthopedist or surgeon. Initially, a detailed medical examination and x-ray are performed.

During the initial examination, signs can be detected only at stages 2 and 3 of the pathology due to deformation of bones and joints, curvature of the limbs of the bone and roughness of its contours. Palpation allows us to understand the presence and nature of pain.

Radiography is one of the classical examination methods. It makes it possible to clarify the diagnosis and differentiate it from other pathologies, gives an idea of ​​the depth of the lesions and the dynamics of the development of the process. In this case, the initial stage is usually difficult to see. In older people, changes are present due to age and, in the absence of clinical symptoms, do not lead to a diagnosis of gonarthrosis.

Modern research methods are CT and MRI, which are used extremely rarely.

Orthopedics and traumatology services at CELT

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Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

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• Highway of Enthusiasts or Perovo
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Driving directions

Treatment

How to treat gonarthrosis? There are two groups of treatment methods: conservative and surgical.

Conservative methods are used by traumatologists and orthopedists. Their success depends on the timely start of treatment - the earlier, the more successful. Periods of exacerbation must be spent in a state of complete rest. This therapy includes:

• gymnastics for gonarthrosis and physical therapy, which involves performing exercises for gonarthrosis;
• mud therapy;
• physiotherapy – electrophoresis with novocaine, magnetic and laser currents, diadynamic currents, UHF;
• medications – the following groups of drugs are administered through injections for gonarthrosis: chondoprotectors, steroid hormones;
• Spa treatment.

It is important to follow some rules - relieve the knee joint with a cane or orthoses, select comfortable shoes and insoles, control weight, and have a proper daily routine.

Surgical methods are used at the third stage of the disease, when standard therapy has not brought any visible effect or improvement. Surgical treatment is based on knee replacement. Prescribed to young and middle-aged people to compensate for limited physical activity. The period of rehabilitation and full recovery lasts from three months to six months.

How gonarthrosis is treated at the Paramita clinic

Our specialists have developed a special approach to the treatment of arthrosis of the knee joint. Each patient with suspected gonarthrosis is carefully examined. Based on the data obtained, specially selected therapy is prescribed, including:

• modern treatment methods - all the latest achievements of Western medicine, which make it possible to suppress the progression of the disease and relieve the patient of pain;
• traditional oriental methods - they have been successfully used for centuries by doctors of Ancient China and Tibet in the treatment of knee diseases and general improvement of the body.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthrosis

Our clinic uses the following effective methods for treating knee arthrosis:

• drug therapy – prescribing the most effective medications according to proven regimens developed in leading clinics in the world;
• plasma therapy (PRP therapy) – the use of patient’s blood platelets to stimulate the regeneration of cartilage tissue;
• various types of massage and therapeutic exercises, including kinesiotherapy;
• reflexology courses - influencing acupuncture points (AP) using acupuncture methods, warming with wormwood cigarettes (moxotherapy), etc.;
• osteopathy, manual therapy - various methods of influencing pathologically altered tissues with the hands of a doctor.

Patients of our clinic almost immediately forget about pain, and their quality of life after a course of treatment for arthrosis of the knee joint increases significantly.

Prevention

Preventive measures for gonarthrosis are of great importance as part of preventive therapy. Such events include:

• maintaining body weight at an average level;
• training the muscles of the lower extremities;
• avoiding joint injury;
• timely treatment of inflammation in the joints;
• moderation and strength of physical activity;
• compliance with the rules of a healthy lifestyle - proper nutrition, activity in accordance with the age limit, adherence to sleep and rest patterns;
• strengthening the immune system.