If a person ignores even the pronounced symptoms of gonarthrosis, then after a few months or years he is diagnosed with this pathology of the knee joint, grade 3 of severity. It is characterized by constant pain, aggravated by walking, and significant limitation of mobility. At the initial stage of therapy, conservative methods are used. As a rule, they are ineffective. Therefore, orthopedists immediately offer patients surgical treatment - endoprosthetics.
Features of grade 3 knee joint gonarthrosis
Gonarthrosis is a degenerative-dystrophic pathology that affects the knee joints. With grade 3 disease, clinical manifestations reach their maximum, including due to the development of complications. Most often, gonarthrosis is detected in women after the onset of natural menopause. But very young people often suffer from it, subjecting their knee joints to excessive stress. Stage 3 pathology is characterized by almost complete destruction of the cartilaginous layer of the knee, severe deformation of the femur and tibia.
What is gonarthrosis
Gonarthrosis of the knee joint is a chronic, constantly progressive degenerative-dystrophic disease of the knee joints of non-infectious origin, in which thinning, damage and destruction of its cartilaginous components, i.e., the articular surfaces of the tibia and femur, occur. Also, with gonarthrosis, the subchondral bone is affected, the synovial membrane and menisci are involved in the pathological process. As a result, the joint space decreases, the knee joint becomes deformed and loses mobility, and due to the fact that it is constantly subject to significant loads, pathological changes in its structures actively progress and are difficult to reverse.
The term gonarthrosis can only be used in relation to degenerative-dystrophic processes exclusively in the knee joints.
The knee joint has 2 surfaces formed by the tibia and femur. Its front part is protected by the patella (kneecap), which moves between the condyles (rounded protrusions) of the femur. All articular surfaces, including the tibia, femur and the inner surface of the patella, are covered with hyaline cartilage. Normally, it is a perfectly smooth, strong and at the same time elastic structure, and its thickness is 5-6 mm.
Thanks to these features, hyaline cartilage effectively absorbs movement, softens impacts when walking, jumping, etc., and also prevents bone surfaces from rubbing against each other. But when certain prerequisites arise, it becomes deformed, becomes thinner in places, and collapses, exposing bone structures, which is called gonarthrosis. As a result, hyaline cartilage is no longer able to fully perform the functions assigned to it, which provokes a decrease in motor capabilities due to the occurrence of pain in the affected knee or in both in a bilateral degenerative-dystrophic process.
The development of gonarthrosis leads to disruption of the entire musculoskeletal system, including the spine. Therefore, the lack of treatment or inadequate therapy can lead not only to tenosynovitis of the adductor muscle group of the thigh, contracture and synovitis, but also to the development of osteochondrosis, intervertebral hernias and associated neurological disorders, as well as the development of arthritis of other joints. With a unilateral pathological process, the load on the second, healthy knee joint increases sharply, as the patient tries to spare the affected leg, which seriously increases the risk of developing gonarthrosis of the second knee and, as a consequence, disability due to severe pain, loss of support function and serious limitation of mobility .
Development mechanism
Initially, gonarthrosis affects hyaline cartilage. It becomes thinner, thicker, and less smooth. When sliding, the cartilage lining the bone surfaces now “clings” to each other, which further accelerates their destruction. The joint capsule gradually degenerates, and the synovial fluid thickens. Due to lack of nutrients, cartilage disappears from a large surface of the bones. Increasing loads leads to their deformation and pressing into each other. Multiple bone growths (osteophytes) are formed, constantly injuring soft tissues and synovial membranes.
Causes of health problems
Grade 3 gonarthrosis can be primary or secondary. In the latter case, its development is provoked by previous injuries (intra-articular fractures, dislocations, ruptures of kneecaps, ligaments, tendons) or pathologies already present in the body:
- rheumatoid, reactive, gouty, psoriatic arthritis;
- scleroderma, systemic lupus erythematosus;
- endocrine, metabolic diseases, including diabetes mellitus, hypothyroidism.
Primary gonarthrosis usually occurs against the background of natural aging of the body as a result of a slowdown in recovery processes. The prerequisites for it are increased stress, obesity, and a sedentary lifestyle.
Symptoms of pathology
Grade 3 gonarthrosis is characterized by constant pain that occurs both during the day and at night. Often, not only flexion at the knee joint is limited, but also extension. A person cannot fully straighten his leg, which pathologically changes his gait and posture. He shifts his weight to the healthy limb, limps, and leans in the direction opposite to the affected joint. In some cases, the legs become bent and hallux valgus or varus deformity occurs. The patient's movement is often only possible with the help of a cane, walker, or crutches.
Disability
In order to determine whether a person needs to be given a disability, one must first diagnose what stage the disease is at.
A person is recognized as able to work in the following cases:
- if the changes are minor or moderate;
- the disease is accompanied by various disorders of static-dynamic functions, but the course of gonarthrosis is slowly progressive.
Disability of the third group is given to people in the following cases:
- if a moderate impairment of motor function is diagnosed;
- if a person performs work that involves significant physical activity;
- if a person is forced to constantly be on his feet;
- if there is a pronounced violation of the static-dynamic function.
There are certain situations in which patients with gonarthrosis will be sent to undergo a disability commission:
- if the progression of the disease lasts for three years or longer, with exacerbations occurring at least three times during the year;
- if the patient underwent surgery to treat arthrosis of the knee joint, as a result this significantly affected his ability to work;
- in case of violation of the musculoskeletal function of a limb, if this process is pronounced.
During the commission, the patient's medical history is studied. The person’s complaints must be taken into account and the clinical picture is assessed. The patient must show how able he is to work. Disability of the second and third groups is confirmed once a year, and the first group must be confirmed once every two years.
Diagnosis of the disease
The diagnosis is made based on medical history, patient complaints, and external examination. With grade 3 gonarthrosis, the knee is deformed and enlarged. Synovitis often accompanying the pathology leads to its smoothing due to the formation of inflammatory edema. Of the instrumental studies, the most informative are radiography and MRI. According to indications, arthroscopy is performed - examination of the internal surfaces of the joint.
How to treat grade 3 knee gonarthrosis
Conservative treatment of grade 3 gonarthrosis is aimed at eliminating pain, muscle spasms, and stiffness. An integrated approach to therapy helps prevent the involvement of healthy tissues and joints in the destructive and degenerative process. Patients are recommended to reduce the load on the affected joint by using semi-rigid elastic knee pads. During the treatment period, you are allowed to move only with a cane or crutches.
Drug therapy
Despite the fact that it is impossible to eliminate severe deformations of bone and cartilage structures with the help of medications, they are necessarily used in the treatment of grade 3 gonarthrosis. The use of drugs can eliminate the symptoms of the disease and slow down its progression.
Glucocorticosteroids
Glucocorticosteroids are synthetic analogues of hormones produced by the adrenal glands. The drugs have a powerful analgesic and anti-inflammatory effect, therefore they are used to relieve acute pain. In the treatment of gonarthrosis, intra-articular or periarticular administration of glucocorticosteroids is practiced - Methylprednisolone, Dexamethasone, Triamcinolone, Diprospan. Hormonal agents are often combined with the anesthetics Novocaine and Lidocaine.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are the first choice drugs in the symptomatic treatment of grade 3 gonarthrosis. They quickly eliminate pain, reduce elevated local temperature, and relieve inflammation during relapses of synovitis. NSAIDs are used in the form of solutions for intramuscular administration (Movalis, Xefocam), tablets (Nimesulide, Diclofenac), ointments and gels (Voltaren, Fastum). Systemic drugs are combined with proton pump inhibitors to prevent ulceration of the gastric mucosa.
Chondroprotectors
This is the name of drugs in various dosage forms intended for the partial restoration of cartilage tissue. In case of grade 3 gonarthrosis, they are not used for this purpose due to the complete destruction of the cartilaginous layer of the knee. Chondroprotectors are used to improve metabolism in the joint and prevent further bone deformation. As they accumulate in articular structures, they also have a pronounced analgesic effect. Most often, Alflutop, Chondroguard, Structum, Teraflex, Artra, Dona are included in therapeutic regimens.
Muscle relaxants
In response to pain and pinched nerve endings, muscle spasms may occur. By restricting mobility, the body tries to solve problems. But more often, an increase in the tone of skeletal muscles leads to even greater compression of the nerves and increased pain. In such cases, patients are prescribed muscle relaxants Sirdalud, Baklosan, Mydocalm. First, the drugs are used in the form of injection solutions, and then the result is secured by taking tablets.
Surgical intervention
For grade 3 gonarthrosis, orthopedists immediately offer patients surgical treatment so as not to waste time on futile drug therapy. The most popular endoprosthetics is the replacement of the knee joint with an artificial implant. The operation is performed under general anesthesia or epidural anesthesia, after which long-term (3-4 months) rehabilitation begins. Endoprosthetics is the only treatment method for gonarthrosis that allows the patient to lead an active lifestyle.
Knee arthroscopy
Arthroscopy is an endoscopic operation using miniature surgical instruments. They are introduced into the cavity of the knee joint through several punctures of the skin and underlying soft tissue. The progress of the operation is monitored on the monitor screen, the image to which is transmitted from a video camera built into the endoscopic device. The surgeon performs partial resection of bone tissue, plastic surgery of ligaments and tendons, and removal of cartilage particles moving freely in the articular cavity. But arthroscopy can only improve knee function for a short time.
Corrective osteotomy
Corrective osteotomy is a surgical operation aimed at eliminating joint deformity through an artificial fracture. Dissection of the tibia and femur with further comparison of fragments at a certain angle contributes to the correct distribution of loads. To stabilize during movement, at the final stage of osteotomy, the leg is fixed with special metal structures.
Arthrodesis
Arthrodesis is artificial ankylosis, immobilization of a joint in a functionally advantageous position. The surgeon performs fusion of the kneecap, tibia and femur. After surgery, the knee loses the ability to bend and straighten. But the patient remains able to move independently using a cane or walker.
Arthroplasty
Arthroplasty is an operation aimed at restoring the size, shape and conformity of joint surfaces to each other. First, the surgeon disconnects the adhesive that immobilizes the knee. Then he excises the osteophytes, restores the shape of the articular surfaces, and installs an insulating autoplastic (from fascia, skin, adipose tissue) or alloplastic (from acrylate, stainless metals) spacer between them.
PRP therapy in orthopedics
PRP therapy is the introduction of autologous plasma with an increased concentration of platelets into the cavity of the knee joint. The therapeutic effect of the procedure is due to the presence of growth factors in the patient’s own plasma. These bioactive substances have a stimulating effect on cell division, intercellular metabolism, and hyaluronate synthesis, which promotes accelerated restoration of the soft tissue structures of the knee joint.
Physiotherapy
At the stage of exacerbation of grade 3 gonarthrosis, patients are shown electrophoresis or ultraphonophoresis with glucocorticosteroids, anesthetics, and B vitamins. After eliminating severe pain, laser therapy, magnetic therapy, shock wave therapy, and UHF therapy are performed. The main goal of physiotherapy is to reduce the severity of symptoms and increase the body’s sensitivity to the effects of pharmacological drugs.
Massage and manual therapy
Sessions of classical, vacuum, acupressure help strengthen the muscles of the leg affected by gonarthrosis. Blood circulation in the joint improves, the removal of tissue breakdown products from it is accelerated, and destructive processes are inhibited. Unlike a massage therapist, who treats only weakened or spasming muscles, a chiropractor works on joint structures. The result is an increase in the distance between them, eliminating compression of blood vessels and sensitive nerve endings.
Exercise therapy complex
Daily physical therapy exercises can reduce the dose of systemic medications. This occurs by strengthening the muscle frame of the knee and improving the blood supply to its structures with nutrients. A set of exercises is compiled by a physical therapy doctor individually for each patient, taking into account age, severity of symptoms, and degree of immobility of the knee joint.
| Physical therapy exercises for grade 3 gonarthrosis | ||
| Lying on your back | Sitting on a chair | In a standing position with support on the back of a chair |
| Alternately pulling the bent right and left knees to the chest | Alternating lifts of first straight and then bent legs | Abduction of first straight, then bent legs to the right and left |
| Simulation of cycling | Leg extensions holding them at the top for a few seconds | Alternately raising straight legs as high as possible |
| Crossing straight legs (“scissors”) | Rotation of the feet first in one direction, then in the other direction | Smooth rolls from toe to heel and back |
Diet therapy
For overweight patients, orthopedists recommend losing weight to reduce the load on all joints of the legs. It is necessary to exclude from the daily menu foods high in fat and simple carbohydrates - confectionery and sausages, fatty meats, smoked meats, semi-finished products, and baked goods. The basis of the diet should be clear broths, puree soups, fresh or stewed vegetables, baked chicken, beef, rabbit, cheeses, cottage cheese, dried fruits.
Application of traditional medicine
Medicines prepared according to traditional medicine recipes are not used in the treatment of grade 3 gonarthrosis due to ineffectiveness. It is possible to use herbal teas with St. John's wort, valerian, motherwort to improve the quality of sleep.
Drug treatment of arthrosis
The main role in the fight against the manifestations of gonarthrosis is played by non-steroidal anti-inflammatory drugs and chondroprotectors.
- Non-steroidal – relieve inflammation and eliminate pain. However, if you take them for a very long time, the symptoms of the disease are “masked” and it becomes impossible to prescribe adequate treatment. In addition, according to recent studies, drugs of this particular group negatively affect the synthesis of proteoglycans, which is why the affected cartilage is destroyed even faster.
- Chondroprotectors – nourish and restore the functioning of cartilage tissue. At the third stage, these medications can no longer help - they are not able to restore completely destroyed cartilage or return the knees to their original shape.
The positive effect of treatment with chondroprotectors occurs only after 6-18 months
- Medicinal ointments and creams only alleviate the patient’s condition.
- Compresses have an anti-inflammatory and analgesic effect, but, like ointments, they are only an adjuvant in the treatment of osteoarthritis and arthrosis.
Rehabilitation after surgical treatment
At the initial stage of rehabilitation, patients are prescribed antibiotics, anticoagulants, and hepatoprotectors to prevent postoperative complications. 2-3 days after installation of the endoprosthesis, you are allowed to stand up and walk around the ward and hospital corridor on crutches. Daily physical therapy exercises under the guidance of a rehabilitation physician are required. After endoprosthetics, patients are advised to undergo sanatorium-resort treatment to accelerate the restoration of joint function. Applications with ozokerite and paraffin, mud, mineral waters, hydrogen sulfide, radon, and pearl baths are used.
Main characteristics
Most often, this disease appears in people after the age of 45, since it is during this period that age-related changes occur in the body. The tissues begin to thin out and become vulnerable to injury and damage. In younger people, such negative changes occur as a result of active participation in professional sports.
Treatment of the disease in the initial stages of development involves the use of conservative methods. Men over 45 years of age, as well as women over 55 years of age are at risk. Also, the risk of developing gonarthrosis is present in people who have a genetic predisposition to diseases of the musculoskeletal system.
Osteoarthritis of the knee joint is a non-inflammatory disease; it progresses slowly. As it develops, the quality and quantity of cartilage tissue changes. The main symptoms include pain. Most often they appear in the following cases:
- during joint flexion;
- when climbing stairs;
- after prolonged sitting.
In the initial stages of development, stiffness and pain occur in the morning after waking up. After some time, these symptoms go away on their own. As the disease progresses, the duration of unpleasant symptoms increases.
If irreversible changes occur in the cartilage tissue, inflammatory processes may develop in the joint. In this case, the disease, which is initially non-inflammatory in nature, is complemented by an inflammatory process. The main goal of therapy is to reduce the frequency and duration of the period of inflammation.
Articular cartilage gradually wears out, and its amount between the rubbing surfaces of the bones decreases. Gonarthrosis is one of the most common diseases in the world among older people. Age is considered a significant risk factor.
Consequences and prognosis
The course of grade 3 gonarthrosis is complicated by spontaneous hemarthrosis, the development of secondary reactive synovitis, and external subluxations of the patella. But the most serious consequence is ankylosis. The joint space is completely fused and the knee is immobilized. This leads to disability of the patient due to the inability to move independently. This development of events can only be avoided by knee replacement.
Degrees of mountain narthrosis
The gradual development of pathology allows us to classify gonarthrosis of the knee joint and distinguish its three degrees. Each of them has specific symptoms.
1st degree
Grade 1 knee joint gonarthrosis is the onset of the disease. There is no significant damage to the articular cartilage yet, functions are not impaired, and mobility is not limited. However, it has insufficient density and a not entirely smooth surface.
Gonarthrosis of the knee joint of the 1st degree is accompanied by periodic discomfort, aching or tightening pain, mainly after strong physical exertion (long walking, running, standing for a long time). Unpleasant sensations may occur in the morning after waking up, lying or sitting for a long time, but after a while they disappear.
In rare cases, with grade 1 gonarthrosis of the knee joint, slight swelling appears, which disappears over time. It is possible to develop synovitis - accumulation of fluid in the joint cavity. In this case, the knee takes on a spherical shape and becomes swollen, which limits motor activity. A person is in no hurry to see a doctor and believes that periodically occurring negative manifestations will pass without medical help.
Grade 1 gonarthrosis of the knee joint is determined on an x-ray in the form of single osteophytes, while the joint space is slightly narrowed.
2nd degree
Grade 2 gonarthrosis of the knee joint is characterized by the appearance of prolonged and severe pain even after minor physical activity. The man begins to limp. To alleviate the condition, a long rest is needed.
During movement, the knee joint begins to “crunch.” With grade 2 gonarthrosis of the knee joint, bending the leg is difficult and is accompanied by severe pain. In the evening, my calves ache.
The development of synovitis becomes regular, and its clinical picture becomes more pronounced.
Gonarthrosis of the knee joint of the 2nd degree on x-rays is manifested by pronounced degenerative foci in the tissues, the joint space is narrowed significantly.
3rd degree
With grade 3 gonarthrosis of the knee joint, the cartilage is subject to complete deformation, which causes unbearable suffering. The pain syndrome becomes permanent, the patient is deprived of a full life, due to pronounced, persistent discomfort - he cannot rest and fall asleep.
The joints are inflamed and swollen, the knees do not bend or straighten completely. The legs take on an O or X-shape. With grade 3 gonarthrosis of the knee joint, motor activity is extremely limited, often movement is only possible with the use of a cane or crutches.
In the process of diagnosing grade 3 knee joint gonarthrosis, a narrowed joint space is visible along with multiple osteophytes. Surgery is required.