Patellofemoral arthrosis and patellar arthroplasty | [Patellofemoral arthrosisPatellofemoral arthrosis and patellar arthroplasty

Patellofemoral arthrosis of the knee joint

In addition to the femur and tibia, the patella (patella) is another component of the knee joint.
It performs the main function in flexion and extension of the leg. When you bend your leg, the kneecap moves up and down like a groove in the bone of the upper leg between the two condyles. © Istockphoto.com / MedicalArtInc Patellofemoral arthrosis of the knee is caused by degenerative changes at the back of the patella (kneecap). Due to retropatellar arthrosis, arthrosis pain occurs primarily when a person descends from stairs or from a mountainous surface. In addition to the femur (Femur) and tibia (Tibia) bones, the patella is another component of the complex knee joint. The functionality of the knee joint also depends on the condition of the patella. Retropatellar arthrosis occurs most often in masons, tilers - people who do their work mainly on their knees, or in people whose work involves physical activity. Patellofemoral arthrosis can also occur due to unsuccessful surgery or deformation of the kneecap (knee dysplasia). Patellofemoral arthrosis of the knee joint is also observed in runners. Women suffer from this disease more often than men.

With arthrosis, the articular cartilage between the kneecap and the femur wears away due to pressure and inflammation (articular cartilage wear).

The condition of the patella is of great importance for the extensor movement of the knee joint during walking or standing. When a person bends his leg, the patella slides along the patellar groove of the femur, and when he straightens it, it moves forward. At this moment, patients feel a “failure” in the joint, but in reality, dislocation rarely occurs. Full functionality of the patella is also very important after knee surgery. Immediately after surgery, our knee specialists recommend restoring movement in the joint and foot, as this improves blood supply to the muscles of the lower limb and prevents swelling and blood clots. When the leg is flexed or extended, the kneecap moves up and down along the grooves of the tibia and femur, preventing their displacement. Additional fixation is provided by the patellar meniscus ligament and the quadriceps femoris tendon.

Patellofemoral arthrosis, x-ray: In this image, the patient lies on his back, legs bent at the knees. The image shows the condition of the joint space with two femoropatellar joints. On the left you can see the satisfactory condition of the joint space. The kneecap (patella) and the patella surface of the femur are located at a distance of more than 3 mm. from each other. Patellofemoral arthrosis is visible on the right: The patella and femur touch each other, the cartilaginous layer is completely worn out.© Gelenk-Klinik.de Anatomical image of a healthy knee and patella, lateral and cruciate ligaments, as well as the meniscus. Patellofemoral arthrosis is observed between the two condyles of the femur, the so-called femoropatellar sliding groove. Each person's kneecap and patellar surface of the femur are formed differently. In some patients, the structure of these elements leads to instability of the femoropatellar joint. In this case, there is a high position of the patella (patella alta) or its slight protrusion. The above factors can cause retropatellar arthrosis. © Istockphoto.com/MedicalArtInc

The onset of degenerative changes in the patellofemoral joint is marked by softening of the articular cartilage. This pathology is called “Chondromalacia,” during which morphological changes are observed in the cartilage of the patella. The onset of the disease can be acute injuries to the knee, but most often the disease is based on chronic overload of the patellofemoral joint.

Patellofemoral arthrosis is often accompanied by tibiofemoral (tibiofemoral) arthrosis of the knee joint. Often, arthrosis also damages the lateral (outer) part of the knee joint. Thus, patellofemoral arthrosis is often accompanied by an X-shaped (valgus) deformity of the external tibiofemoral part of the knee joint.

In 5-10% of patients, arthrosis behind the patella appears in an isolated form, without affecting the important components of the knee joint. In this case, patellofemoral arthrosis must be treated with special attention to prevent damage to the entire knee joint.

Is disability granted?

Disability status is given at this stage of degenerative-dystrophic changes in the knee joint, since the disease in this period leads to either partial disability or complete disability. Based on the severity of the clinical picture, disability group 1 or 2 is assigned. In the first case, the group is given when there is no movement in the joint, due to which the person cannot move and cope with basic self-care tasks. The second category of disability is given if movement is still partially possible, but not without assistance, and also if the problematic limb is shortened by 7 cm or more.

Patellofemoral arthrosis: causes

Causes of patellofemoral arthrosis

Dysplasia of the patella and patella of the femur (47%)
Injuries: Fractures, osteochondral lesions (8%)
Idiopathic factors: Excess weight, excessive exercise (41%)
Patella hypermobility, muscle imbalance (4%)

Very often, patellofemoral arthrosis occurs due to instability of the patella, which causes insufficient tension in the ligaments that fix and support it. Violation of the natural functions and shapes of the kneecap is also the cause of this disease. Changes in the shape of the patella can cause it to move out of its normal position and become dislodged from its sliding support. Such disorders are often accompanied by instability and dislocation of the patella.

Osteoarthritis of the knee joint: internal and external damage. Patella with obvious damage to the cartilage of the femoropatellar joint. Characteristic at the progressive stage of arthrosis is the formation of bone growths (osteophytes). © Viewmedica

Well-known factors such as excess weight put stress on the patellofemoral joint, especially in older people.

In younger patients, patellofemoral arthrosis is caused mainly by deformation of the knee joint or deformation of the patellar surface, overload and deformation of the patella. Another cause of this disease is injury.

Reconstruction of the anterior cruciate ligament after a fracture using part of the patella tendon can also cause patellofemoral arthrosis of the knee.

Isolated patellofemoral pathology without disruption of the forms and functions of other parts of the knee joint is very often accompanied by an O-shaped curvature of the legs (varus deformity).

Video on the topic:

The phrase arthrosis of the patellofemoral joint is used only by traumatologists or surgeons. In the world classification of diseases ICD-10, this disease is called patellofemoral syndrome of the knee joint.

According to WHO, about 13% of all patients who complain of knee pain have pathological changes at the patellofemoral junction.

Usually the disease occurs against the background of other inflammatory processes, but there are cases when the cause may be injury or improper exercise. One of the factors in the development of the disease is old age.

Content

Patellofemoral arthrosis: Symptoms

Symptoms of patellofemoral arthrosis

Pain in the front of the knee.
Pain when climbing stairs.
Pain when rising from a chair after a long sitting position.
Swelling and hyperthermia.
Pain when squatting.
Crunching sounds in the joints.

Patients with patellofemoral syndrome typically have pain in the front of the knee, primarily after walking down stairs, rising from a chair, bending their knees, or squatting. Often patients feel a certain crunch in the joint behind the patella or numbness. Sometimes the knee seems to be completely motionless, especially when there is bone-on-bone friction at the joint between the patella and the femur. Inflammatory diseases cause increased temperature in the patellofemoral joint and effusion of the knee joint.

Anatomy of the disorder

The knee joint is what is called a rotating joint. This means that it can bend and turn. The joint consists of three bones, the femur, tibia and patella. Osteoarthritis of the patellofemoral joint of the knee is one of the most common causes of knee pain in middle-aged patients and is often associated with pallotemopherol deficiency.

The patella is a bone that protects the knee, but sometimes stops functioning due to injury or another problem.

The correct diagnosis is made by reviewing the patient's history and physical and radiographic examination of the knee.

Possible causes of the disease

Patellofemoral arthrosis, or patellofemoral pain syndrome, is a typical disease of the patellar joint (patellofemoral joint). The causes of the disease may also be in the muscles of the back, hip joint or legs.

One of the most common causes is a fracture of the knee joint, which can lead to bone damage. In addition, the cause may be imbalances in the position of the spine and hip joint, which lead to incorrect alignment, which results in overload of the tendon or increased pressure in the knee. The result is a characteristic burning or throbbing pain. There may also be changes in the anatomy of the knee joint itself.

The cause of pain may be retropatellar osteoarthritis (changes in the cartilage in the kneecap), caused by excessive stress that the cartilage cannot withstand. These include, for example, any type of combination of constant overload (especially in knee flexion), misalignment of the leg axes, persistent patellar dislocations or damage to the joint (for example, falling on the knee).

Osteoarthrosis and femoropatellar arthrosis

Osteoarthritis is the chronic degeneration of articular cartilage and the accompanying imbalance between bone accumulation and breakdown. Osteoarthritis is a complex phenomenon involving both physical and metabolic factors.

In a joint, cartilage covers the bone ends and contributes to low joint mobility. Cartilage cells are renewed to the same extent as they are degraded. The joint retains its unrestricted ability to move.

If cell renewal is slower than deterioration and/or physical stress (impact, repeated friction) is too severe, the metabolic balance of the joint is disrupted. Cartilage wear begins with cracks that gradually become deeper until regular craters (ulceration) appear.

Patellofemoral syndrome as a manifestation of patellofemoral osteoarthritis of the knee joint is a disease characteristic of older people, requiring much more serious and long-term treatment. Initially, the first set of drugs is used that improve blood microcirculation, regulate metabolism, reduce blood flow, and slow down cartilage degeneration. The next step is the appointment of physical therapy, including:

electrophoresis;
ultrasonic radiation;
radon and turpentine baths, as well as mud therapy.

Based on the results of the X-ray examination and laboratory tests, the doctor prescribes a set of medications and procedures that may be required for the operation.

Another disease related to patellofemoral syndrome is femoropatellar arthrosis, which most often occurs in athletes. This condition is popularly called “runner's knee”, as athletes’ legs are subject to great stress and injury. It should be noted that female athletes suffer from this type of arthrosis more often than men.

Treatment of femoropatellar arthrosis of the knee joint initially consists of relieving pain symptoms. To do this, apply cold compresses and rub the knee with anti-inflammatory ointments.

It is imperative to stop physical activity and ensure rest. Massaging a sore knee helps a lot.

But we must remember that this disease will never go away on its own. It is necessary to contact an orthopedist, traumatologist, arthrologist. The doctor will examine the knee and prescribe treatment. Diagnosis of this disorder is carried out using x-rays.

Symptoms of patellofemoral syndrome

The cardinal symptom of patellofemoral pain syndrome is pain. The pain may be unilateral, bilateral, or alternating. In the initial stages, the pain may be less and over time it will increase to a large extent as the movement of the knee is not smooth and the muscles become tense during movement. Other pain symptoms:

Pain in the kneecap area.
Temporary pain after prolonged strain on the knee joint.
The pain intensifies after exercise, when climbing stairs, while squatting.

Patients often complain of limited mobility or a typical stretching sensation caused by swelling in the area of the patella.

Stages of patellofemoral arthrosis

Stage 1: Mild arthrosis, more than 3 mm. cartilaginous layer.
Stage 2: Moderate form of arthrosis, the distance between the patella and the patella surface of the femur is less than 3 mm.
Stage 3: Severe arthrosis, contact between the patella and the femur.
Stage 4: Very severe arthrosis, continuous bone contact, absence of cartilage.

Examination of edematous pain in the knee with fluid accumulation, which may be caused by damage to tendons and ligaments, as well as articular cartilage. Using ultrasound, the doctor examines the motor elements of the knee joint. © Gelenk-Klinik / Prof. Dr. Sven Ostermeier

Treatment methods

In the treatment of patellofemoral arthrosis of the knee joint, new combinations of therapeutic drugs from various pharmacological groups should be used. To achieve the maximum therapeutic effect, it is necessary to eliminate the causes that may provoke an exacerbation of the disease.

Therapy is of the following types:

conservative,
surgical,
physiotherapeutic,
Exercise therapy exercises to restore the patellofemoral joint.

Drug treatment of the patellofemoral joint of the knee joint includes taking the following drugs:

NSAIDs (in injections and tablets),
chondroprotectors,
painkillers,
vitamin preparations,
hormonal drugs (if urgently needed).

Before starting treatment for a pathology, first consult with your doctor.

For advanced second or third stages of the disease, surgical treatment is used.

The following intervention options are used:

Arthroscopy using special endoscopes. A good way to diagnose and remove dystrophic changes. Also, using this technique, you can inject medicinal drugs into the joint cavity and pump out joint fluid.
Side release. This method is aimed at correcting the position of the kneecap. Using surgical instruments, the external ligaments are cut and the position of the patella is restored.

Physiotherapeutic treatment methods are aimed at eliminating pathology in the patellofemoral joint. During the procedures, the processes of blood circulation and metabolism in cartilage tissue improve.

The most common methods:

mud baths,
magnetotherapy measures,
electrophoresis with anti-inflammatory ointments,
paraffin therapy,
acupuncture,
water procedures.

Physiotherapy is an additional treatment method and is prescribed only after a complete examination.

How is patellofemoral arthrosis of the knee joint diagnosed?

History of the disease

Is there bilateral knee pain?
Are there any knee injuries?
Is there swelling of the knee?
Does your knee hurt when you start to move your leg?
Do you feel knee stiffness in the morning?
Does knee pain get worse when walking?
Is there general weakness in the knee?
Is knee pain reducing your maximum walking distance?
Are there any restrictions in the movement of the knee?

When taking a medical history, the patient tells the doctor about his pain and symptoms. For the effectiveness of the examination and correct diagnosis, the doctor determines whether the patient has experienced repeated pain in the anterior part of the knee and dislocation of the patella.

The patient is also asked questions regarding accidents in which a patella bruise could occur. In addition, factors such as physical activity during work and patellar subluxation play an important role in making the diagnosis. First, a clinical examination is performed, during which the specialist checks the mobility and stability of the knee joint and observes the patient's gait. At the same time, the doctor pays special attention to the mobility of the patella during flexion. Also, a qualified orthopedist at our Gelenk-Klinik in Fribourg determines the degree of swelling of the knee and checks whether the temperature of the knee has increased due to arthrosis caused by the inflammatory process.

Diagnosis of patellofemoral arthrosis depends on the symptoms of the disease. During preventive medical examinations of patients without any complaints of pain in the patella, specialists still note a crunching sound or excessive mobility of the patella. These patients had never seen a doctor for knee pain and therefore did not require medical intervention.

Exercise and Diet

Diet and physical therapy exercises at any stage of arthrosis pathology are an integral part of the treatment program. A severely deformed knee, in order not to provoke increased pain, must be unloaded by reducing body weight. Of course, losing weight applies exclusively to people whose weight exceeds normal values. The patient is recommended nutritional therapy for body weight correction, specially developed by the attending physician. The diet is developed in such a way that the amount of microelements and vitamins received from food satisfies the body's needs, while the extra pounds go away.

Excess weight is unacceptable.

Doctors prohibit the consumption of alcohol, dishes made from fatty meats, various kinds of canned food, fast foods, spicy and smoked foods, sweet carbonated drinks and unhealthy sweets, white baked goods, baked goods, fatty sauces and creams, fried foods. Preference should be given to dishes made from lean meat, cereal products (except rice and semolina), fresh vegetables and fruits, beans, freshly squeezed orange and pomegranate juices, and fermented milk products. The diet should be fractional: you should eat food five times a day in small portions.

Eat a healthy diet.

You must be aware that the diet must be combined with special physical activity. It is important to perform a set of exercises compiled by a specialist under his supervision. The joint, of course, will not recover through exercise therapy at an advanced stage, but you can reduce the effects of degenerative-dystrophic disease on the leg muscles and the musculoskeletal system as a whole. Specifically, the problematic knee joint should not be strained now, since it can be easily injured, which will further aggravate the already difficult quality of life. Therefore, an unskilled approach is not even considered here!

Important! At the third stage, weight loss and therapeutic exercises are mainly necessary as preparation for the upcoming operation. Such preoperative measures, by strengthening the muscular system, will make it easier to endure the rehabilitation period, more quickly restore the lost motor functionality of the operated limb, and achieve better postoperative results.

X-ray of the patellofemoral joint

Patellofemoral arthrosis causes a discrepancy between the shape of the patella in relation to the patellar surface of the femur. By examining the pattern of movement of the patella during flexion and extension of the leg, a specialist can narrow down the possible causes of the disease. © Prof. Dr. Sven Ostermeier X-ray of the knee joint in a frontal projection is one of the most important methods for diagnosing joint space in the patellofemoral joint. During this examination, the patient's legs are flexed. Thus, a more accurate distance of the patella to the patellar surface of the femur can be determined. In addition, specialists at the Gelenk-Klinik in Freiburg in Germany perform an X-ray of the knee in a lateral projection: If the image shows a narrowing of the joint space, this indicates gradual wear of the cartilage due to the inflammatory process.

Diagnosis of pathology

If a patient experiences alarming signs that may suggest the development of a dystrophic-degenerative condition, it is necessary to seek help from an orthopedic traumatologist as soon as possible. The doctor must conduct an initial examination and refer the patient for tests and x-rays. If during X-rays a questionable picture is observed in the diagnosis of the disease, you can send the patient for further examination, for example the following types of instrumental studies:

MRI or ultrasound if there are signs of soft tissue damage or suspicion of arthritis. According to indications, a study of the sacral joint may be prescribed for the differential detection of ankylosing spondylitis in the initial stages.
CT. This method allows you to see pathological changes in joints and cartilage until they become visible on an x-ray. Computed tomography allows you to identify adverse pathological changes in the joints before the onset of the clinical picture of the disease.
Arthroscopy is the most accurate diagnostic method. With the help of the study, you can detect all possible pathological changes in the joints at any stage of the disease.

X-rays allow us to examine the signs of the disease at stages 2 and 3 of development, when discomfort, a feeling of stiffness and crunching in the knees have already occurred. There is a narrowing of the joint space, signs of inflammation and deformation in the cartilage plate.

To differentiate the pathology from other similar conditions (various types of arthritis), a number of laboratory tests are required, including:

Biochemical blood test with kidney samples.
Rheumatoid factor.
Complete blood count with determination of ESR.
C-reactive protein.
General urine analysis.

Carrying out these tests allows us to exclude other serious pathologies, such as reactive or rheumatoid arthritis, gout.

Patellofemoral arthrosis of the knee joint: Conservative treatment

Most injuries to the posterior surface of the patella are treated with conservative methods. For example, such a temporary pathology as “runner's knee” occurs in younger patients and is treated by selecting the right loads and physical therapy. When diagnosing this injury, you should avoid unnecessary training loads, as pain on the front side of the knee may occur again.

Physiotherapy and lifestyle adaptations

The symptoms of patellofemoral arthrosis are stabilized by strengthening the thigh muscles, as well as losing excess weight. Patellar pain can be reduced by avoiding activities such as squatting and climbing stairs. Muscle stretching exercises improve the lateral (side) mobility and movement of the patella in the patella surface of the femur.

Orthopedic prostheses

For severe pain in the patella, orthopedic prostheses (orthoses) help, which temporarily limit the mobility of the patella and relieve it of stress. The specialists of our clinic will provide you with qualified assistance when choosing this type of treatment for pain syndrome.

Pain therapy and medications

The progress of the disease is controlled with the help of painkillers and anti-inflammatory medications (non-steroidal anti-inflammatory drugs).

Injection treatment

For complex inflammations, a cortisone injection helps. However, this method is not recommended to be used constantly. Injections of intra-articular lubricant (hyaluronic acid) improve the gliding ability of the knee joint, but are not used as a form of etiotropic therapy for retropatellar arthrosis. This form of treatment can be successful only if there is a certain amount of articular surface, as well as with a long-term positive result.

Limits of conservative treatment

When there is no cartilaginous surface and bones rub against each other, conservative treatment is almost powerless. Highly qualified orthopedic surgeons at the Gelenk-Klinik will consider each case individually and try to help the patient using conservative methods. If the doctor determines that conservative treatment will not bring the desired result, the patient will be offered other forms of treatment for patellofemoral pathology.

How to treat the disease?

Depending on the degree of neglect of patellofemoral syndrome, therapy can be carried out using both conservative and surgical methods. With a conservative approach to the treatment of this disease, medications are first selected for the patient to suppress inflammation, eliminate symptoms and prevent further destruction of the articular surfaces.

Among other things, the conservative treatment regimen includes physiotherapeutic procedures, exercise therapy, wearing orthoses and special orthopedic shoes, etc. You can use folk remedies to a limited extent.

Medications

To stabilize the condition of the joint with arthrosis, first of all, the patient is selected drugs from among non-steroidal anti-inflammatory drugs. Medicines in this group include:

Ibuprofen.
Diclofenac.
Ketorolac.
Indomethacin.
Ketoprofen.

In addition to anti-inflammatory drugs in the form of tablets, patients are prescribed ointments and gels that help eliminate the inflammatory process, improve local blood circulation and help restore the elasticity of damaged ligaments and muscles. Such medications include:

Diclak gel.
Voltaren.
Viprosal.
Nicoflex.
Apisatron.
Finalgel.

For compresses and rubbing of the affected joint, it is recommended to use Dimexide. In the presence of severe pain, intra-articular administration of anesthetics, chondroprotectors and glucocorticosteroids may be indicated. Often, patients with progressive patellofemoral arthrosis are prescribed long courses of tablet forms of chondroprotectors. Such medications include:

Chondroitin.
Teraflex.
Structum.
Don, etc.

Among other things, multivitamins are often included in the treatment regimen. They help eliminate the deficiency of nutrients in the body and launch regeneration processes.

Treatment of deforming arthrosis of the knee joint grades 1, 2, 3, its causes and symptoms

Physiotherapy

In the complex conservative treatment of patellofemoral arthrosis, a number of physiotherapeutic procedures are used. Laser therapy is often used for this disease. This procedure involves exposing the affected area of the joint to a special beam of ultraviolet and infrared light. The course of treatment is 5–7 procedures. This physiotherapeutic method of treatment is especially effective in stages 1 and 2 of the pathological process.

In addition, magnetic therapy is often used in the treatment of arthrosis. This physiotherapeutic method can achieve significant improvement in approximately 50% of patients. Dry and liquid cryotherapy is often prescribed for this pathological condition. The liquid version of the procedure is more effective.

To eliminate the discomfort in the knee observed with this disease, paraffin wraps, mud treatment and ozokerite baths are often prescribed. In this case, the therapeutic effect is achieved to a greater extent through dosed exposure to heat.

Also, in the treatment of this pathological condition, electrophoresis with Dimexide, sulfur, zinc, lithium and other substances is often used.

Therapeutic exercises

There are special gymnastics to strengthen the muscles and tendons that support the knee. In the early stages of patellofemoral arthrosis, such exercises can achieve a positive effect even without other conservative methods of therapy. With this knee disease, static exercises give the best effect.

Slowly performed half-squats help develop the knee joints. The pace of the exercise should be as slow as possible. You should do 10–15 squats in one approach. If the patient leads a sedentary lifestyle, he is recommended to perform this exercise every hour.

In addition, gentle stretching may be recommended. To carry it out, you need to stand up straight and lunge forward and backward with each leg in turn. In one approach you should do 20-30 such movements with each leg.

Another effective exercise for developing the knee joint is performed while lying on your back. In this position, you should bend your left leg at the knee, and with your right toe extended, raise it above the surface by 15–20 cm. You should stay in this position for 20–30 seconds, and then change the position of your legs. In one approach you need to do 5 such exercises on each leg. If your condition allows, you need to do 2 approaches with an interval of 5–7 minutes.

Folk remedies

Various folk remedies for the treatment of patellofemoral arthrosis can only be used as auxiliary methods of therapy.

Osteoarthritis of the knee joint treatment at home

It is advisable to consult a doctor before using various formulations based on herbs and natural ingredients.
A positive effect in this disease can be achieved with daily use of compresses based on iodine, medical bile, ammonia, honey and glycerin. All components must be taken in equal proportions. These ingredients should be mixed thoroughly and placed in a dark place for 2 weeks. Before application, the composition should be slightly warmed up. The compress is applied to the affected joint for 20–30 minutes.
In addition, in the treatment of patellofemoral arthrosis, celandine-based compresses can be used. To prepare the product, you need to take approximately 50–70 g of the succulent leaves and flowers of this plant and grind it to a pulp. The paste should be applied to the knee and covered with gauze. The compress should be kept for 30 minutes. This remedy should be treated for 7 days.
Carrying out the operation
If conservative treatment does not achieve significant improvement, the patient may be prescribed surgical treatment. Arthroscopy is most often prescribed. This procedure involves making a small incision through which a laparoscope equipped with a camera and light source is inserted. This procedure allows you to evaluate the condition of the joint from the inside and, if necessary, replace the affected areas of cartilage with artificial tissue.
Often a lateral incision is made, which involves cutting the ligament in the area of the kneecap. This allows you to normalize the physiological location of the joint. After this, comprehensive rehabilitation is required to restore normal functioning of the joint.

Patellofemoral arthrosis of the knee joint: Surgical treatment

Soft tissue operations

Soft tissue surgery for anterior knee pain

Mobilization of the lateral patellar ligament suspensory patella
Reconstruction of the medial patellofemoral ligament
Vastus medialis surgery

Patelofemoral arthrosis and its symptoms in the early stages are improved by surgically changing the strength and direction of traction of the various ligaments leading to the patella. The choice of surgical method depends on the affected area behind the patella. By shortening or lengthening the tendons, adaptation of the patella in the patellar surface of the femur is achieved.

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Gonarthrosis 3 degrees: causes, symptoms and treatment of this disease

Have you been trying to heal your JOINTS for many years?

Head of the Institute for Joint Treatment: “You will be amazed at how easy it is to heal your joints by taking it every day.

Gonarthrosis is typical for older people, with women more often affected.

Contents of the article: Causes and risk factors How the disease develops Symptoms Treatment methods

excessive loads on the knee joint associated with carrying heavy loads, excess weight, playing sports, etc.;
knee injury;
deformities of the lower extremities (flat feet, valgus or varus curvature);
disruption of the formation of synovial fluid or changes in its properties;
genetic predisposition;
disruption of the process of self-renewal of cartilage tissue.

How does gonarthrosis develop?

Stages of the disease

Depending on the degree of damage to the knee joint and disruption of its functioning, 3 stages of gonarthrosis are distinguished:

Symptoms of the disease

As mentioned above, symptoms are most pronounced at stage 3 of the disease. This:

Features of bilateral gonarthrosis

Disability due to gonarthrosis

Treatment of gonarthrosis has the following directions:

Drug treatment

Gonarthrosis requires taking medications from various pharmaceutical groups.

Corticosteroids

Chondroprotectors

These funds are necessary for the maintenance and some restoration of cartilage tissue.

Means to improve blood circulation

Muscle relaxants

Synovial Fluid Prostheses

Preparations: Hyalual, Sinokorm, Otrovisk.

Physiotherapy

Orthopedic treatment

Surgical treatment

Cure arthrosis without drugs? It's possible!

Transplantation of autologous cartilage cells

Autologous cartilage cell transplantation involves transplanting the patient's autogenous articular cartilage into the damaged area behind the patella. This method makes sense only when only one articular surface is damaged. If both articular surfaces are damaged, this method of surgical treatment is not performed.

With minor damage to the cartilage, it is possible to grow it again. During arthroscopic surgery, a small portion the size of a grain of rice is separated from the less congested retropatellar cartilage. Using the resulting cartilage mass, a large number of cartilage cells are formed in a special laboratory. After 6-8 weeks, these cells are transplanted to the affected areas behind the patella. After about 3 months, strong cartilage tissue with stable hydraulic permeability is formed from cartilage cells. Transplantation of autologous cartilage cells is suitable for younger patients. Regeneration of the cartilage surface prevents arthrosis diseases, as well as the implantation of a patellofemoral prosthesis.

Patellofemoral Partial Prosthesis: A metal implant on the hip between the two femoral condyles covers the patellofemoral surface of the femur. The connection of the polyethylene and titanium implant on the back of the patella forms a sliding surface. Our specialists prefer HemiCAP designs to cemented implants. © 2med

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Classification

Patellofemoral arthrosis has three stages of the disease. Each degree is characterized by its own clinical features and radiological changes. You need to understand that for each degree, the doctor prescribes different treatment and selects appropriate rehabilitation measures.

As the degree of the disease increases, dystrophic changes in the joint and its fixing apparatus increase.

1st degree

The first or early degree is characterized by the fact that the patient has no specific complaints. Sometimes, while working or standing in one place for a long time, minor discomfort may occur, which goes away after the load stops. Unnoticed by the patient, a gradual decrease in the amplitude of movements occurs. Sometimes in the morning after waking up you may feel a little stiff.

The X-ray picture is practically unchanged; there may be slight thinning of the cartilage and reaction of the periosteum.

2nd degree

Patellofemoral arthrosis of the knee joint of the 2nd degree has severe symptoms with specific radiological and clinical signs. At the beginning of the second stage, frequent discomfort occurs in the knee joint, patella and lateral parts of the patellofemoral joint. There is morning discomfort that lasts more than an hour; when walking or putting pressure on the knees, there is a sharp pain that does not allow you to continue moving. Pain reduces the functionality of the knee joint. The x-ray clearly shows a narrowing of the space between the patella and the femur, thinning of the cartilage and the appearance of a small number of osteophytes.

3rd degree

The third or terminal degree is characterized by the fact that cartilage tissue almost disappears and bone friction occurs. The patient cannot walk normally, the pain occurs even at rest and does not go away after stopping the load. Severe pain is localized near the patella and on its lateral surfaces. Morning stiffness can last for about several hours. The X-ray shows a complete absence of space between the patella and the thigh. The images show a large number of osteophytes. There is a complete change in the patellofemoral articulation. Treatment is usually symptomatic and surgical.

Partial patellofemoral knee prosthesis

Reasons for implanting a prosthesis

Isolated arthrosis of the patellofemoral joint.
Failed conservative treatment.
Unsuccessful surgical treatment of ligaments.
Pain and restrictions in daily life.
Good condition of the meniscus
Good condition of cruciate ligaments
Joint stability and range of motion are normal.

The progress of medical technologies in the manufacture of prostheses, as well as modern understanding of how the patellomoral joint is structured, contribute to improved treatment results.

The results of surgery for implantation of a partial patellofemoral prosthesis depend entirely on the quality of the examination, medical indications, as well as on the exact placement of the components. The key to success in this case is experience.

The patient's weight plays an important role in the preservation of the prosthesis: The more a person weighs, the less the retropatellar prosthesis is preserved.

When is a patellofemoral partial denture implanted?

If the articular cartilage and patella are in the stage of destruction or are completely worn out, it no longer makes sense to carry out joint-preserving treatment. However, if the other part of the knee joint—the inner and outer tibiofemoral joints between the femur and the tibia bone—is not damaged, partial patellar replacement is a very good alternative.

Advantages of partial patellofemoral prosthetics

To prevent patellofemoral arthrosis from affecting the main components of the knee joint, timely surgery is necessary. With this intervention, our specialists preserve the natural structure of the knee joint and replace only the damaged area. A timely operation for partial patellofemoral prosthetics prevents complete endoprosthetics for many years.

When is partial patellofemoral prosthetics prohibited?

Contraindications

Rheumatic inflammations
Osteoporosis in an advanced stage
Bacterial infections
Soft tissue and tendon instability

If arthrosis also affects other parts of the knee joint, an isolated operation to replace the patella no longer makes sense.

In order for the patellofemoral prosthesis to last for many years, there should be no surgery on the knee joint to correct its instability and shape. The longitudinal axis of the knee joint should be straightened. Valgus or varus deformity is undesirable. However, if patients present with such leg pathology, doctors perform an accompanying intervention such as tibial osteotomy to straighten the axis.

For a more precise explanation of the reasons and contraindications for partial patellofemoral prosthetics, the patient should contact experienced specialists.

Total arthroplasty is a good treatment for arthrosis of the knee joint. However, unipolar/partial prosthetics allows you to preserve ligaments and parts of the cartilaginous bone tissue in healthy parts of the knee, and also helps to improve flexion functions.

HEMICAP® Patellofemoral Prosthesis

Over the past years of development of endoprosthetics, the HEMICAP® patellofemoral prosthesis has proven itself well. Implantation of this type of prosthesis is carried out without the use of cement. The back of the prosthesis has a bone-preserving rough structure. A screw is inserted into the tibial spine through a small incision under arthroscope control. Thanks to a special structure similar to the real one, local damage to the cartilage is compensated and the original position of the joint is restored. The strong connection between the surface of the prosthesis and the bones allows patients to exercise without pain.

Lateral x-ray after implantation of a patellofemoral prosthesis.

Implantation of other prostheses involves the use of cement, but the bone anchorage with the HemiCAP® prosthesis ensures long-term stability of the implant without cement mass. Unlike other cemented patellofemoral joint prostheses, implantation of the HemiCAP® prosthesis does not involve separation of the bone substance. Modern medicine offers various types of such prostheses in order to restore the shape of any patella surface of the femur.

The posterior surface of the kneecap is not always covered with a polyethylene implant: If the cartilaginous surface is still intact, it is preserved and used to slide the prosthesis.

If the cartilage structure behind the patella is severely damaged, a polyethylene implant is used to achieve maximum glide. A sliding plastic “liner” made of durable, highly cross-linked polyethylene is inserted on both sides of the patella.

Local arthrosis can be controlled with the HEMICAP patellofemoral prosthesis without the use of cement or the need to separate the femoropatellar joint bone.

This knee replacement allows the original functions of the knee to be preserved. Experienced specialists at our clinic respect the anatomical shape of the knee joint and thus maintain the sliding of the articular surfaces without pain. Often this operation is performed in a minimally invasive form, which shortens the postoperative period and is much easier for patients to tolerate.

Implantation of a cemented patellofemoral prosthesis

During this intervention, the articular surface is freed from the remaining cartilage and then leveled. To strengthen the sliding surfaces, a small particle is carefully separated from the cartilaginous surface. When implanting a patellofemoral prosthesis, the back of the kneecap is covered with a suitable shaped polyethylene “liner”. When replacing a worn-out joint, part of the tibia and femur bone is removed and replaced with a metal component. The components of the patellofemoral prosthesis are fixed with durable bone cement.

Medical request

How to treat stage 3?

At the very beginning of this section, we have already given important information on how to treat severe pathology in the late course. Lost mobility and normal anatomical proportions will have to be restored to the knees through endoprosthetic surgery. This is the only medical and orthopedic technology that is capable of maximally or completely returning to a person the quality of life that was before he fell ill with insidious gonarthrosis.

The essence of endoprosthetics is to remove a joint distorted by the disease and install an endoprosthesis in its place - an artificial joint structure that replicates the functions and structure of a healthy knee joint. The unnatural organ takes root well because its structural parts are made from high-tech nanomaterials with a high degree of biocompatibility with the human body. Modern endoprostheses, subject to high-quality implantation and ideal step-by-step postoperative care, last for an average of 20-25 years.

What the surgeon sees during joint surgery.

Prosthetics are performed in a specialized clinic that practices this type of surgery. It is better to undergo it abroad, where the complex surgical process is carried out by highly qualified specialists who brilliantly master all the intricacies of knee implantation. Today, as reviews from world experts and patients show, medical centers in the Czech Republic have great opportunities.

If for some reason the patient cannot undergo high-quality surgical treatment, he will be recommended classical conservative therapy. It is aimed primarily at relieving pain and swelling, which are persistent and pronounced at this phase. Conventional anti-inflammatory compounds from the NSAID class have little or no effect, so often, to help feel relief, the question arises of the need for intra-articular injections based on corticosteroids. However, steroid therapy cannot be used for a long time, since the hormonal substances included in such medications are dangerous due to severe side effects.

It is too late to slow down the degenerative process with chondroprotectors, hyaluronic acid and any other stimulators of metabolism in joint tissues. There is no need for them at all now. It is recommended to wear special orthopedic devices (knee pads, insoles, orthoses, etc.), a kind of exercise therapy without stress on the joint, movement is allowed only with a cane or crutches. Sometimes limb traction is prescribed in combination with physiotherapy procedures.

If there is pathological fluid inside the knee, the patient is periodically sent for puncture (removal of its excess). If prosthetics are contraindicated or impossible due to certain circumstances, the surgeon advises to undergo arthrodesis (complete closure of the knee) or tibial osteotomy (axis correction), but these methods, despite their aggressiveness, have a short-term effect and do not restore full range of motion.