gonarthrosis

Generality

Gonarthrosis is knee osteoarthritis.

Better known as osteoarthritis, osteoarthritis is a common form of degenerative arthritis. The inflammation of the joints that distinguishes it derives from the thinning of the typical layers of articular cartilage, and from the consequent rubbing of the bony portions involved in the joint.

As a rule, gonarthrosis is the result of a combination of causative factors. Among the most common causes of gonarthrosis, we note in particular: advanced age, excessive body weight, a past history of repeated knee injuries, meniscal removal operations and the presence of a genetic predisposition to osteoarthritis .

Both unilateral and bilateral, gonarthrosis is generally responsible for: knee pain, joint stiffness, redness of the skin at the knee, crunching from the knee and swelling.

Currently, there is no specific treatment for gonarthrosis, but only symptomatic treatments.

Symptomatic treatments for gonarthrosis include conservative therapies and surgical therapies; normally, conservative therapies take precedence over surgical therapies.

Short anatomical reference of the knee

The knee is the important synovial joint of the human body, placed between the femur (superiorly), tibia (inferiorly) and patella (anteriorly).

Several anatomical elements take part in its constitution, including:

Articular cartilage . Located on the lower surface of the femur, it serves to protect the latter from friction damage.
The synovial membrane . It covers the joint from the inside and produces a lubricating fluid, called synovial fluid . Synovial fluid reduces friction between the various components of the joint complex.
A series of tendons and ligaments . They are essential in guaranteeing the right stability to the joint, during the movements of the lower limb. Their correct functioning is, in part, linked to the lubricating action of the synovial fluid.
The synovial bags . They are small synovial membrane pockets, filled with synovial fluid. They have a lubricating function and anti-rubbing function.
The internal meniscus (or medial meniscus ) and the external meniscus (or lateral meniscus ). Consisting of cartilage and located on the upper surface of the tibia, the two menisci provide stability to the joint and protect the tibia from the stresses coming from the femur, during movements of the lower limb.

With its position and its structural components, the knee plays a fundamental role in supporting the weight of the body and in allowing the movements of extension and flexion of the leg, during a walk, a run, a jump etc.

Figure: anatomy of the human knee.

What is gonarthrosis?

Gonarthrosis is knee osteoarthritis .

Osteoarthritis, or arthrosis, is that chronic inflammatory condition, which results from the degeneration of the cartilages of a (usually) synovial joint.

Therefore, in light of what has just been stated, gonarthrosis is the chronic inflammation of the knee, which results from the degeneration of the cartilages located on the lower surface of the femur and on the upper surface of the tibia.

OSTEOARTHRITIS IS A FORM OF ARTHRITIS

Osteoarthritis is a form of arthritis; to be precise, it is the most common form of arthritis in human beings (only in the United States it affects as many as 27 million people!)

In medicine, the term arthritis refers to any inflammatory process involving one or more joints.

GONARTROSI: MONO- OR BILATERAL PHENOMENON?

Gonarthrosis can be a mono- or bi-lateral condition .

However, it should be pointed out that, in more than half of the clinical cases, it is characterized by the involvement of both knees ( bilateral gonarthrosis ).

Causes

In general, gonarthrosis is the result of a combination of causal factors ; it is, in fact, rare that it results from a single cause.

Among the possible causes / risk factors of gonarthrosis, they certainly deserve a quote:

Advanced age . It is the most common cause / risk factor. The normal aging process determines the generalized degeneration of the cartilages of the human body and reduces the body's ability to cope with this degeneration;
Excessive body weight ( overweight or obesity ). A high body weight leads to considerable stress for the knees, particularly for the articular cartilages;
Genetic predisposition to osteoarthritis . Some genetic diseases, which can affect the human being, involve a predisposition to arthrosis in the most important joints of the body, including the knee;
Membership in the female sex . Several statistical surveys have shown that women over the age of 55 have a greater tendency, compared to men, to develop gonarthrosis;
A history of repeated knee injuries . Injuries to the knees are typical problems of those who practice sports at high levels or a job in which the continuous lifting of weights is expected.
Among the sports most at risk of gonarthrosis, we note: football, rugby, basketball, running on bumpy surfaces, American football and tennis;
The association with other forms of arthritis (eg: rheumatoid arthritis) or with some metabolic disease (eg: Paget's disease);
Surgery to remove the medial or lateral meniscus . Surgically removing part of the meniscus means removing part of the normal cartilage layer of the knee.

PATHOPHYSIOLOGY

In gonarthrosis, inflammation depends on degeneration and the consequent thinning of the cartilages of the knee. In fact, with the degeneration and thinning of the aforementioned cartilages, the inferior surface of the femur and the upper surface of the tibia come into direct contact and, rubbing among themselves, bring mutual damage. The aforementioned inflammation arises from the damage in question and the typical symptoms of gonarthrosis derive from inflammation.

In essence, therefore, the inflammation of the gonarthrosis is the result of the damaging rubbing of the femur on the tibia, after the protective cartilage layer has failed on the lower surface of the first and on the upper surface of the second one.

Symptoms, signs and complications

The typical symptoms and signs of gonarthrosis are:

Pain in one or both knees . It is a painful sensation that increases with movement or physical activity and is attenuated with rest.
Generally, a very marked pain is indicative of a severe inflammatory process and a notable degeneration of the articular cartilage;
Joint stiffness . It is present especially in the morning, just after waking up, and after long periods of immobility (eg: after a few hours drive);
Redness and heat at one or both knees;
Swelling ;
Emission from one or both knees of sounds, such as creaking or crackling, with each movement of the joint.

WHEN TO REFER TO THE DOCTOR?

An individual with suspected gonarthrosis should contact their doctor or an orthopedic specialist in knee diseases, when the pain and stiffness of the joints are such as to prevent the performance of the simplest daily activities (eg climbing stairs, getting into a car, etc.). ).

Diagnosis

In general, the diagnostic procedure for the detection of gonarthrosis starts from the physical examination and from the anamnesis. Then, he continues with an evaluation of family history, to see if there is a recurrence of knee osteoarthritis in the patient's family. Finally, it ends with X-rays and nuclear magnetic resonance at one or both knees (depending on the symptomatology complained of by the patient).

X-RAYS: WHAT ARE THEY FOR?

In the diagnosis of gonarthrosis, X-rays clarify whether the aforementioned inflammatory condition is associated with osteophytosis .

In medicine, osteophytosis is the term that indicates the process of formation of osteophytes at the skeletal level. Also known as bone spurs, osteophytes are small bony projections, most often similar to a rose thorn or a claw, which develop along the articular margins of bones subjected to erosive or irritative phenomena of a chronic nature (exactly like those triggered from osteoarthritis to the knee).

RMN: WHAT IS IT FOR?

In the diagnosis of gonarthrosis, nuclear magnetic resonance is most likely the most significant test. In fact, in addition to ascertaining what emerged in the previous diagnostic tests, it makes it possible to clarify the extent of degeneration and thinning on the cartilages of a joint.

Only thanks to the information provided by the nuclear magnetic resonance to the knees, the orthopedic doctor is able to establish the most appropriate treatment.

Therapy

Unfortunately, at the present time gonarthrosis is a condition for which there are no specific treatments, but only symptomatic treatments . In other words, it is impossible to heal from gonarthrosis, but it is possible to alleviate the symptoms.

Briefly, the main purposes of symptomatic treatments for gonarthrosis are:

Reduce pain when using the knees (ie during flexion or extension movements);
Restoring a part of the joint mobility that knees are normally provided with.

Symptomatic therapy for gonarthrosis may be conservative (or non-surgical) or surgical .

In general, doctors give precedence to symptomatic treatments of a conservative nature, reserving the right to resort to surgery only if the conservative practice has not provided any result (or if the results provided are unsatisfactory and the patient continues to show intense pain, joint stiffness, swelling etc).

CONSERVATIVE SYMPTOMATIC THERAPY

Conservative treatments for gonarthrosis include:

A diet plan aimed at reducing body weight . This is clearly true in all those cases where one of the triggers of gonarthrosis is obesity or overweight.
Physiotherapy exercises aimed at strengthening the muscles of the lower limbs (thigh in particular) and increasing the joint mobility of the knee.
A stronger thigh musculature relieves the burden of body weight on the knee, with enormous benefits for the latter.
The administration of pain medication and non-steroidal anti-inflammatory drugs (ie NSAIDs ). Among the most used painkillers and NSAIDs in case of gonarthrosis, paracetamol, ibuprofen and naproxen sodium are reported.
In most patients, they provide appreciable results.
Injections in the knee of corticosteroids and / or hyaluronic acid . Corticosteroids are powerful anti-inflammatories, whose prolonged or inappropriate use can cause serious side effects (hypertension, obesity, glaucoma, etc.); for this reason, doctors prescribe them only in cases of real need and only when NSAIDs are ineffective.
Hyaluronic acid, on the other hand, is a lubricating substance, physiologically present within the synovial joints; with its administration, the doctors intend to restore part of the normal joint structure, lost due to gonarthrosis.
The practice of a moderate but constant physical exercise for the lower limbs . The purposes of this physical exercise are, in fact, the same as for physiotherapy. Contrary to what one might think, for the patient with gonarthrosis immobility and inactivity are only a source of benefits.
Clearly, physical exercise must be targeted and must in no way cause further damage to the knees.
Use of a specific brace for knee affected by gonarthrosis . There are many types of braces for the knee affected by arthrosis; the choice of the most suitable type of guardian is up to the attending orthopedist and depends, in general, on the conditions in which the affected joint is located.

SURGICAL SYMPTOMATIC THERAPY

There are at least 3 different types of surgery:

The "cleansing" of the knee cartilages performed in arthroscopy . It is the least invasive option, but also less effective. In general, orthopedic surgeons reserve it for younger patients, with an early gonarthrosis.
Osteotomy of the femur or tibia . The osteotomy is a surgical practice that involves the remodeling of a particularly deteriorated joint bone, with the final aim of better redistributing the body weight within the joint.
In general, knee osteotomy is reserved for people with cartilage damage of only one of the two bone portions involved in the joint.
The installation of a prosthesis in place of the true knee . The installation of a knee prosthesis is a very invasive and delicate surgery; however, if it is successful, the benefits that the patient can derive are more than appreciable.
Although nowadays the most modern knee implants last even 20 years, even today orthopedists recommend them only to elderly patients (aged 55 and over).

Prognosis

Gonarthrosis is a chronic disease, which tends to get worse over time and from which it is impossible to heal. Therefore, the prognosis in his presence can never be positive.

However, it should be emphasized that, by now, today's medicine provides patients with gonarthrosis with very effective treatments against the symptoms of the disease.