Gonarthrosis of the knee joint 2 degrees: symptoms and treatment

Gonarthrosis (arthrosis of the knee) - a chronic degenerative-dystrophic disease of the knee joint - affects 20% of the world's people. Patients aged 40 years and older have the greatest predisposition to progressive disease, while women suffer from it somewhat more often than men. The high incidence rate is explained by the complex structure and high mobility of the knee joint. According to the configuration, the knee joint is of the block type, and according to the biomechanical features, it is of the rotational type.

Simplified image of the disease.

The complex mechanism of the musculoskeletal system mostly undergoes serious degenerative-dystrophic changes due to previous local injuries and inflammations, prolonged excessive physical activity, autoimmune and hormonal disorders in the body. The disease is characterized by the destruction of the most important articular structure - hyaline cartilage.

Cartilaginous degenerations bring a lot of suffering to patients, because it is because of them that people cannot fully use the problematic lower limb, experiencing excruciating pain along with its stiffness and instability. Within the framework of domestic orthopedics, the disease is usually classified into three stages. The first is the easiest and most tractable in terms of treatment, but it is not always possible to recognize it on time, since it does not have pronounced symptoms. Usually people go to the hospital at stage 2 of the disease, when the disease begins to progress and pain and musculoskeletal dysfunction begin to be clearly felt. Therefore, in this article we will focus on the principles of treatment of gonarthrosis of the 2nd degree.

And this is a real image of gonarthrosis of the knee joint, this is how surgeons see it during surgery.

Brief description of the disease

Cartilage tissue, which is affected by severe chronic pathogenesis, is an elastic, fairly strong, elastic and smooth formation. Cartilage covers all surfaces of articulating bones: femur, tibia, patella. Thanks to the unique coating, unhindered, smooth, silent interaction of the ends of the articular bones occurs, causing the joint to move. Hyaline cartilage also serves as a shock absorber and stabilizer of movement. Due to lack of nutrition caused by negative pathological external or internal causes, it begins to gradually break down and, as a result, thin out and die.

As gonarthrosis progresses, the bone surfaces forming the knee joint become exposed and the space (articular space) between them narrows. As a result, spiky bone growths and cystic formations grow at the ends of the interacting bones, and critical deformation of the joint develops, which entails serious movement disorders. The flexion-extension potential of the lower limb in this section becomes limited, and with each stage the amplitude of movements progressively decreases. As a result, a person is unable to move normally and perform various types of physical activity, even the simplest. Stiffness of the knee is always accompanied by painful sensations, which at the initial stage of the pathology are not very disturbing, but starting from stage 2, they rapidly gain momentum in intensity.

Since hyaline cartilage does not have its own blood-vascular network, the destroyed areas are no longer restored. In a word, degenerative-dystrophic pathogenesis is irreversible in nature, and therefore it is impossible to completely cure it. But it can still be stopped in the early stages or significantly slowed down using conservative methods, preventing gonarthrosis from completely ruining a person’s quality of life. Advanced pathogenesis is treated exclusively through surgery to replace the joint with an endoprosthesis. That is why experts urge people to contact them in a timely manner: at the earliest manifestation of discomfort in the form of morning stiffness or local pain after long physical activity.

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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.

Types of gonarthrosis of the knee joint 2 degrees and aspects of treatment

Pathology of 2nd degree of severity can be secondary or primary. More often, a secondary form of the disease is detected, that is, when gonarthrosis becomes a consequence of certain knee injuries, advanced arthritis and certain pathological conditions of the body, for example, of an endocrine nature (diabetes mellitus, thyroid disease, etc.). The primary form is characterized by the causeless occurrence of degenerative processes in the cartilage of the knee, which is rarely observed.

Symmetrical damage to the joints, the joint space is completely absent.

In turn, the primary and secondary disease can be concentrated either in only one knee or simultaneously in both the right and left joints. In orthopedics, damage to one side is usually called unilateral, and damage to two joints of the same type is called bilateral. Bilateral degenerative joint damage at stage 2 or more is much more difficult to tolerate, since two legs suffer from serious articular deformities at once. Bilateral arthrosis, according to its etiology, predominantly belongs to the idiopathic (primary) form, while the unilateral lesion is almost always secondary.

Regardless of the type of gonarthrosis in grade 2, treatment first involves the use of conservative methods, and in the absence of a therapeutic effect, surgical methods. Non-surgical technologies give positive results only with 1-2 degrees of arthrosis of the knee joint, and even then, unfortunately, not always. It is worth noting that the non-surgical approach does not involve curing the disease itself (all arthrosis is incurable), but:

competent prevention of further cartilage destruction using medications and physical means;
symptomatic action against painful symptoms through painkillers;
maintaining the muscular-ligamentous system with the help of exercise therapy, which will to a certain extent help improve movements.

From the complete absence of destruction to its last stage.

Conservative therapy is advisable at the initial stage; in the middle phase of development of gonarthrosis, the level of its productivity decreases significantly, but there is hope for improving well-being. In the last phase, non-surgical methods do not work at all. You must understand if you suddenly decide to fight an incurable illness of grade 2-3 in severe manifestations yourself using folk remedies or some vaunted unconventional method, the modified configuration of the joint and the destroyed areas have been and will remain. It is simply impossible to achieve this physiologically. If everything were so simple, then there would not be such a large number of disabled people, and such unimaginable numbers would not have to perform difficult operations such as endoprosthetics every day.

By the way, sometimes they give disability already at the 2nd stage of gonarthrosis with persistent and severe functional disorders, rapidly progressing processes of degeneration and dystrophy of articular cartilage. When the disease reaches its final stage, the patient is clearly declared incapacitated. In these cases, there can be no question of any gentle treatment tactics; here it is recommended to remove the non-viable joint with the subsequent installation of an artificial joint. Only prosthetics can, at advanced stages, restore the lost locomotor-support functionality of a limb for many years (15-30 years).

The disease is not life-threatening, but it can cause severe, constant pain.

Do you want to live with your joint and not experience painful symptoms associated with physical failure, endless terrible pain, and the inability to walk without the use of crutches and outside help? Then contact an orthopedic doctor or rheumatologist in a timely manner!

If stage 1-2 is diagnosed, you still have a chance to get by with supportive conservative therapy. Follow purely professional recommendations, expertly compiled by a specialist especially for you, taking into account your diagnosis and individual characteristics of the body.

Lifestyle, useful tips

If, when visiting a doctor, you are diagnosed with stage 2 gonarthrosis, you will have to follow these recommendations:

Maintain a positive mood. Although knee arthrosis cannot be cured, you should not despair. The degenerative-dystrophic process in the joint can be slowed down by using intra-articular injections (liquid endoprosthesis) with continued active lifestyle.
Move as much as possible, starting the day with light physical activity on your legs, which can be done right in bed. Throughout the day you need to regularly load your joints. If you lead a sedentary lifestyle, you need to get up and do a little warm-up. Prolonged stay in a stationary position is harmful to joint tissue.
Drink plenty of water. To maintain joints and metabolism in normal condition, the daily intake of clean water (in addition to tea, juices, coffee, soup) is 1 liter.
Control body weight. This is necessary to reduce the load on the affected joint. To this end, you need to switch to healthy food, excluding from the menu chips and sweets, semi-finished products, factory-made chicken, sausage products and store-bought pates, yoghurts. These products can be replaced with vegetables, beans, rose hips, sauerkraut, cottage cheese, and dried fruit compote.
Take chondroprotective drugs. Experts recommend regular treatment with chondroprotectors, and it is better to give preference to injectable agents.
Take calcium-containing medications. A course of vitamin D is also sometimes recommended. To select the correct remedy, you should consult your doctor.
Do not put too much stress on your knees when playing sports, as this causes the cartilage to wear out faster. This leads to the progression of the pathology. You need to properly combine activity and rest.
Workout. For gonarthrosis, it is better to choose swimming, skiing or cycling, since these sports are low-traumatic. Swimming helps to activate blood circulation, pump up the periarticular muscles, and restore tone.

Clinical picture at the middle stage

Pathological disorders of moderate severity are more intense than at an early onset. Painful sensations intensify and become more frequent; they can no longer go unnoticed. In addition to morning pain and discomfort after a long stay in a maximally immobilized state, pain syndrome naturally appears after walking and physical activity, and much more often begins to disturb for no apparent reason. When going up and down stairs, a person experiences difficulties, since the flexion/extension of the joint is already seriously limited.

Steps can be an insurmountable challenge.

As for the results of the X-ray examination, they usually contain the following content:

in direct and lateral projections, a significant narrowing of the joint space is clearly visible (2-3 times the required norm);
a change in the density of articular cartilage is detected;
there are large osteophytes at the ends of the articulating bones;
there is pronounced subchondral osteosclerosis of the surfaces;
the first deformations of the bones and the curvature of their axis are visualized.

Due to pathological transformations and acute pain, a person protects the problematic leg in every possible way, trying to transfer the main part of the load to the healthy limb. Due to the forced gentle regime, muscle structures weaken, lose their functional tone, decrease in volume, in other words, they gradually begin to atrophy. Muscle atrophy further complicates motor problems: along with inadequate range of motion during exercise, lameness appears. Due to the destruction of cartilage, non-physiological sounds are felt in the knee at the moment of movement - crunching, clicking. The contracture is moderately expressed.

Symptoms

Arthrosis is a slowly progressive disease that in itself never causes changes in blood counts (for example, ESR), an increase in body temperature or other clearly noticeable characteristic signs. It is noteworthy that the degree of pain and limitation of joint mobility does not directly depend on morphological changes. That is, one patient may have severe pain even with minor cartilage degeneration, while another may have virtually no pain even with pronounced changes, clearly visible on X-rays, MRI or CT, or ultrasound. The fact is that there are no nerve endings or blood vessels in cartilage. Therefore, symptoms appear only when changes begin in other tissues.

How to treat grade 2 gonarthrosis of the knee joint

To make any treatment decisions, up-to-date diagnostic data is needed. Conventional radiography can cope with the basic diagnosis; X-ray images quite informatively display morphological changes in the bone joint and periarticular structures.

The final diagnosis is made based on:

X-ray images obtained;
patient's anamnestic data;
screening tests to assess the symmetry and mobility of the knee joint;
results of clinical and biochemical blood tests;
conclusions of laboratory tests of urine.

In some cases, if the orthopedic traumatologist deems it necessary, the patient is referred to undergo a computed tomography or magnetic resonance imaging scan and consultation with other highly specialized specialists. After a comprehensive diagnosis, the most effective treatment tactics are recommended in accordance with the diagnosis. First of all, they try to improve the patient’s condition through conservative therapy. It is based on methods such as:

physical therapy under the supervision of a physical therapy instructor (a well-planned set of exercises can improve mobility);
restorative exercises in the aquatic environment - aqua gymnastics, swimming in the pool (without overloading the knee area, the muscular-ligamentous apparatus is effectively strengthened);
physiotherapy - electrophoresis, UHF therapy, magnetic therapy, electromyostimulation, paraffin treatment, etc. (physiotherapy promotes the production and delivery of nutrients to the cartilage by increasing blood flow and lymphatic drainage in the limb;
drug therapy using drugs in the form of intra-articular injections to stimulate metabolism and nutrition in joint tissues (preparations based on chondroitin and glucosamine sulfate, hyaluronic acid);
symptomatic treatment with the use of NSAIDs, in isolated cases hormonal steroids (for pain and swelling);
diet therapy, which allows you to lose weight if you have increased body weight, thereby reducing excess compression on the knee joint;
massage procedures to activate local blood circulation and regulate tissue trophism.

If complex therapy, including the above methods, does not give the desired results, that is, the disease continues to progress, one of the guaranteed effective types of orthopedic surgery is mainly used - total or partial endoprosthetics. In the absence of positive dynamics after qualified conservative care, is grade 2 gonarthrosis treated non-surgically? Unfortunately, no.

Attention! Any treatment using conservative methods at this stage of development does not get rid of the fundamental root of the problem, but only makes it possible to slow down degenerative generalization and smooth out symptoms that seriously depress the patient’s quality of life.

When to see a doctor?

It is important to consult a doctor if the first signs characteristic of knee arthrosis are detected:

prolonged and intense pain that increases with movement;
periodic crunching in the joint area;
restrictions in physical activity;
noticeable knee deformity;
swelling

If these symptoms occur, it is imperative to visit an orthopedic traumatologist for an examination and to undergo appropriate diagnostic procedures and prescribe therapy. You can also contact a rheumatologist or surgeon with similar complaints.

If there are no doctors of this specialization in the nearest clinic, it is recommended to contact your local physician - he will be able to advise where specialized medical care of this type is provided.

Bilateral gonarthrosis of the knee joint 2 degrees

Bilateral gonarthrosis is a degenerative-dystrophic pathology that affects the knee joints of both lower extremities. Experts recognize such a crisis as particularly difficult because it can lead to disability in a short period of time. The disease predominantly occurs in old age, although there are exceptions. The genesis of the disease is mainly idiopathic: arthrosis begins to develop spontaneously against the background of the patient’s good health status. As a rule, the severity of defects in the structures of the right and left knee joints is different, that is, one of the knees is slightly more damaged. Features of the stages of deforming osteoarthritis of bilateral localization are the same as those of unilateral localization:

Stage 1 is the initial stage of the onset of unfavorable pathogenesis at the molecular level, when there are no deformations yet, the cartilage is just beginning to experience a nutritional deficiency, there are single small osteophytes, barely noticeable bone compactions appear, the joint gap is usually within normal limits;
Stage 2 is a moderately severe gonarthrosis, characterized by a sharp deterioration in the condition of the joint, namely, a significant enlargement of bone spines, a significant narrowing of the interarticular space (by 50% or more), a discrepancy in the correct ratio of the articular surfaces, distortion of the shape of the epiphyses of the articular bones;
Stage 3 is the final formation, accompanied by the complete disappearance of the gap between the articular surfaces, the formation of fluid cysts, large-scale osteophytic growths, critical bone deformations, the complete absence of viable tissues of hyaline cartilage, and, as a consequence, fatal blocking of the knee.

Stages of the disease on X-ray images.

If in phase 2 it is not possible to stop the progressive disease, as you understand, the knee joint will completely stop functioning. The problem is complicated by the fact that both joints are sick, so treatment cannot be delayed even for a moment! After all, the knee that hurts more will simply force you to put more stress on the opposite leg. The stronger limb will rapidly lose ground from irrationally increased loads, and limited work of the other leg will lead to critical dystonus of the periarticular muscles and continued destruction of the corresponding joint.

The probability of losing two vital joints at the same time is very high. The sooner you start treatment, the better for you. We emphasize that bilateral arthrosis of the knee joints is a serious problem that requires adequate multi-complex treatment. Conservative treatment measures are selected by purely professional doctors, strictly on an individual basis. They are based on techniques such as:

Exercise therapy and physiotherapy;
massage treatments;
intra-articular administration of drugs;
diet for losing weight and providing the body with important microelements and vitamins;
wearing special orthopedic products;
sanatorium treatment.

Unfortunately, as practice shows, intra-articular injections do not produce any effect.

The treatment process is long and lifelong. Unfortunately, no doctor will give you a 100% guarantee that the disease will respond to non-traumatic therapy. But at least you will do everything correctly, as required by orthopedic standards, and, perhaps, you will be able to achieve stable remission of the disease for several years. By not seeking qualified help and acting on your own, you are consciously signing your own death sentence to bilateral endoprosthetics, which will need to be performed very soon.

There are, of course, other surgical methods, for example, osteotomy (correction of the curved axis of the knee) and arthrodesis (artificial creation of ankylosis of the joint). But it is worth recognizing that these are already relics of the past; they are practically not used due to significant surgical aggression towards anatomical structures and the body as a whole, as well as due to low effectiveness and a high percentage of severe complications. In terms of manufacturability and effect, neither athrodesis nor osteotomy can come close to replacing knee joints with an endoprosthesis.

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Gymnastics Popova

Gymnastic exercises were developed by the famous chiropractor and traumatologist Peter Popov. The training is perfect for patients suffering from left- or right-sided arthrosis of the knee joints, as well as bilateral gonarthrosis.

Let's look at some exercises from Popov's gymnastic complex:

We sit on a chair and imitate walking, raising and lowering our heels.
We lie down on the floor and turn to our side. Raise your leg up and lower it. Then we turn over to the other side and repeat the exercise with the other leg.
We stand near the chair. Leaning against the back, we move one leg back a little and rotate the foot. Then we change the leg and perform the exercise with the second leg.

Before you begin performing such a gymnastic complex, you need to warm up the damaged joints by rubbing them with your palms. Any movements when performing such exercises should be performed measuredly.

Knee replacement for deforming gonarthrosis

Non-invasive or minimally invasive treatment that was not successful at stage 2 is pointless to use anymore. To effectively help the patient restore their quality of life, experts recommend undergoing high-tech arthroplasty. This surgical intervention allows in 95% of cases and above to achieve complete restoration of the limb’s functionality. Intraoperative and postoperative complications are minimal: negative phenomena practically do not occur with correctly performed intervention and impeccably organized rehabilitation.

Very often surgery is the only option.

The procedure for replacing a failed biological joint is the only real salvation for many patients with an incurable chronic pathogenesis. The productivity of such implantation has been reliably confirmed by multicenter clinical studies. According to many years of practical observations, with an artificial left-sided and/or right-sided analogue joint, the amplitude of movements is restored to full volume.

Simplified implant installation diagram.

A minimum of 15 years must pass before the next reinstallation of the prosthesis, although in most cases the non-native structure serves well on average for 20-25 years. We will once again emphasize that the main conditions for the long service life of a unique device that functions similarly to a healthy joint and a favorable prognosis are high-precision placement of an artificial prosthesis and high-quality postoperative rehabilitation of the patient.

Knee implant in mock-up.

The implanted product, which is placed instead of a destroyed knee joint, comes in various types, depending on the degenerative-dystrophic specifics. The most widely used types of endoprosthetic systems are:

unicondylar prosthesis – the lateral or medial condyle of the tibia is subject to prosthetics;
total implant with a movable platform - such models involve a complete replacement of articular surfaces (the most expensive, but considered the most physiological);
linked endoprosthesis - used in situations where the ligamentous apparatus of the knee is additionally damaged (mechanical stabilizers in this device will play the role of ligaments).

The structure of knee prostheses follows the natural configuration of the joint or its individual part, which needs to be replaced due to irreversible changes that have occurred. Modern endoprostheses are made from ultra-technological metal alloys based on titanium, chromium, cobalt, molybdenum or high-strength ceramics.

A unicondylar implant made of black ceramic is subject to longer wear.

The implant model and attachment method are selected by the operating surgeon at the preoperative stage of preparation. Based on the type of fixation, innovative designs are:

cement – bonded to the bone using medical cement;
cementless – fixed by hammering;
hybrid - one of the elements is placed on cement, the second is hammered into the bone using the “press fit” technique.

The surgery is performed under spinal (most often) or general anesthesia. The entire replacement process takes approximately 2 hours. The essence of the procedure is the resection of the deformed end elements of the articular bones, followed by the correct installation and rigid fixation of the endoprosthesis components. Immediately after prosthetics, they begin to implement a rehabilitation program, which provides for intensive prevention of all possible complications and high-quality development of the operated limb.

Pathogenesis

The pathology develops over a fairly long period of time. The whole process can be defined in the following sequence:

The emergence of causes of disruption of natural metabolic processes provokes the destruction of cartilage tissue.
Destructive processes destroy the structure of the fibers responsible for the shock-absorbing effect. Not only the elasticity of the tissues gradually decreases, but also the stability of the joint.
Due to the constant increased load on the joint membrane, an inflammatory process occurs, causing a decrease in mobility.

List of sources

Loginov S.I., Solodilov R.O. The influence of gonarthrosis on the kinematics of the knee joint. Bulletin of Siberian Medicine. 2016;15(3):70-78.
Kashevarova NG, Alekseeva LI, Anikin SG, et al. Osteoarthritis of the knee joints: risk factors for the progression of joint disease in a five-year prospective disease. Materials of the III Eurasian Congress of Rheumatologists, (Minsk, Republic of Belarus, May 26-27, 2021). Issues of organization and informatization of healthcare. 2021.
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.
Bagirova G.G. Osteoarthrosis: epidemiology, clinic, diagnosis, treatment / Bagirova G.G., Meiko O.Yu. - M., 2005. - 224 p.
Badokin V.V. Main symptom-modifying slow-acting drugs in the treatment of osteoarthritis // Breast Cancer. 2011. No. 12. pp. 72–79.