Types of arthrosis. Gonarthrosis of the knee joint: degrees, types, methods of treatment. What can be the consequences and complications of coxarthrosis?

The most complete answers to questions on the topic: “types of arthrosis of the hip joint.”

The main types of arthrosis of the joints include a wide range of pathologies covering different joints of the musculoskeletal system. All types of the disease have a similar clinical picture and are characterized by destruction of cartilage tissue with further involvement in the pathological process of the capsule, ligament, periarticular muscles and other parts of the joint. As the disease develops, it leads to loss of ability to work and disability, so it is very important to visit a medical facility in a timely manner and undergo a diagnostic examination, which will allow the doctor to determine the type of arthrosis and prescribe the necessary therapeutic course.

1. Types of arthrosis by etiology
2. Types of arthrosis according to the course of the disease
3. Treatment of arthrosis

Types of arthrosis by etiology

Arthrosis is a chronic disease and is a consequence of biological and mechanical effects on the joints. There are many reasons for its appearance. Depending on what caused the development of the pathology, two types of arthrosis are distinguished:

• primary (idiopathic) – observed mainly in people over 40 years of age and begins without any apparent reason;
• secondary - has obvious causes that lie in age-related changes in the body, mechanical damage to joints, inflammatory processes in bone tissue, metabolic disorders, endocrine diseases.

Types of arthrosis according to the course of the disease

When considering what types of arthrosis there are, it is worth mentioning the stages of development of the disease. Sometimes the disease proceeds for many years without any noticeable signs and only periodically reminds itself of itself with slight soreness during physical exertion. But it also happens that the disease develops very rapidly, moving from one stage to another in just a few months. Depending on the course, the disease is divided into three types:

• Arthrosis of the first stage - at this stage, the disease manifests itself only in changes in the synovial fluid and the membrane lining the inner surface of the joint capsule. In the absence of pronounced disorders of the joint, its ability to withstand the usual daily loads begins to be lost, it becomes inflamed and hurts.
• Arthrosis of the second stage - during the transition to this stage, primary destruction of articular cartilage occurs, which is accompanied by the formation of pathological growths (osteophytes) on the bone tissue.
• Arthrosis of the third stage - at the last, most severe stage, serious deformation of the joint is observed, which leads to shortening of its ligaments, impaired muscle contraction, and loss of performance.

Types of arthrosis by localization

When figuring out what types of arthrosis there are, it should be mentioned that this type of disease is the most common form of joint damage. The incidence tends to increase with the age of the population. In old age, about one third of people suffer from arthrosis. The most susceptible to pathology are the joints of the spine, hand, foot, knees, shoulder or pelvis, which are affected more often than others and pose the greatest threat to human health.

Knee arthrosis

Damage to the knee joints is called gonarthrosis and is the most common among all arthrosis. The risk group includes people with excess body weight and those who have suffered a meniscus injury, although the disease is often caused by increased loads, stress, and metabolic disorders. Often, gonarthrosis is diagnosed on both legs at once, but the signs of the disease on different knees can be expressed to varying degrees - weaker on one limb, more severe on the other.

The disease lasts for many years and initially makes itself felt with mild pain when moving. When moving to the second stage, the pain intensifies and appears not only during exercise, but also at rest. Next, the person notices deformation and swelling of the knee; sometimes when moving the leg, a characteristic crunching sound occurs in the joint. Gradually, the leg partially loses mobility, flexion and extension are accompanied by severe pain, and at a later stage the knee becomes completely immobile.

Ankle arthrosis

Ankle lesions develop mainly as a result of injuries, sprains, and dysplasia. Sometimes the causes of the disease are gout, diabetes or rheumatoid arthritis. The disease is characterized by degenerative processes with proliferation and deformation of bone tissue. At the first stage, arthrosis practically does not manifest itself, which makes it difficult to diagnose. With the subsequent development of the pathology, characteristic symptoms appear:

People whose work involves excessive stress on the ankle are more susceptible to ankle arthrosis. These include dancers, athletes, and women who regularly wear high-heeled shoes.

Shoulder arthrosis

Among the main causes of damage to the shoulder joints are congenital defects, metabolic disorders and disproportionate loads. The disease affects people in older age groups, and people of certain professions are more likely to get sick - painters, plasterers, and other specialists engaged in heavy manual labor. Treatment of the disease is considered easier compared to other types of arthrosis.

As in other cases, shoulder joint disease begins with minor pain, which often intensifies at night. In the initial stages, movements are not limited, but pain is felt when swinging the arm and moving it back. In second-degree pathology, the pain becomes more severe, movements are limited and accompanied by muscle spasms.

At the third stage, the patient cannot raise his arm, and a characteristic deformation is noticeable at the junction of the scapula and shoulder. It is worth noting that shoulder arthrosis rarely progresses to the last degree. This happens mainly to those people who continue to do hard work.

Osteoarthritis of the hip joint

Damage to the hip joint (coxarthrosis) is considered one of the most complex and difficult to tolerate diseases among the types of arthrosis. The pathology is equally characteristic of both sexes, but women have a more severe course. In most cases, the cause is natural aging of the body, but if the disease develops before the age of 40, it is most often due to joint dysplasia.

The disease is accompanied by pain, which radiates to the groin or lateral thigh when moving. After prolonged immobility of the joint (usually after sleep), stiffness is observed, which disappears after its return to working condition.

In later stages, atrophy of nearby muscles may occur. Due to pain, a person is in a bent state, and if arthrosis is unilateral, then his pelvis is forced to tilt towards the affected joint. The patient is forced to use a cane and, while walking, tries to balance his body in a healthy direction. Subsequently, the diseased limb shortens, the general condition worsens, the person becomes depressed and suffers from insomnia.

Cervical arthrosis

A disease that develops in the neck area is called uncoarthrosis. Its causes may be traumatic injuries, excess weight, low mobility due to sedentary work. Sometimes congenital anomalies lead to the disease. With the development of arthrosis, damage occurs to the joints located between the cervical vertebrae. The main features are:

• acute pain in the neck;
• irradiation of pain in the thoracic and lumbar regions;
• limited neck mobility;
• crunching or clicking sounds when turning the head;
• dizziness;
• increased blood pressure;
• headache.

The disease is very serious, since the proliferation of osteophytes leads to damage to blood vessels and pinched nerves. With the disease, vertebral artery syndrome may develop, which manifests itself in the form of lumbago in the head, dizziness, and sometimes loss of consciousness.

Osteoarthritis of the hands and fingers

This disease refers to several types of pathologies that cover different areas of the hand - the wrist joint, distal or proximal interphalangeal joints, etc. The disease is more common in women, and often develops during menopause.

When the interphalangeal joints are affected, nodules appear on the fingers, which in appearance resemble peas, and upon palpation give pain. Depending on the location, the nodes are called Heberden or Bouchard. The former are formed mainly on the back of the fingers, the latter - on the sides.

In addition to the development of nodes, the patient experiences a burning or tingling sensation, limited finger movement, crunching in the joints when moving, and swelling. Over time, the muscle fibers atrophy, the fingers “curl” and cannot perform their direct functions.

Spondyloarthrosis

With spondyloarthrosis, damage occurs to the cartilage and joints of the spinal column. Predisposing factors to the development of the disease are age (usually over 65 years), female gender, which is associated with maximum estrogen production during menopause, as well as excess fat or bone mass. Like other types of disease, this disease begins with pathological changes in cartilage tissue and leads to gradual sclerosis (replacement of bone tissue with connective tissue) with the development of an inflammatory process.

Based on the course of the disease, a wide range of types of spondyloarthrosis is distinguished - deforming, facet, polysegmental, degenerative, ankylosing. Regardless of the type, the main symptoms of the disease include:

• stiffness of the spine after waking up in the morning;
• pain when moving, and in later stages - even at rest;
• crunch;
• back pain when the weather changes;
• limited mobility.

If the pathology appears in the costovertebral joints, then additional signs may be neuritis in the affected area, and with disease of the joints in the lumbar region (lumboarthrosis), a person’s gait and posture are disturbed.

Treatment of arthrosis

The types and treatment of arthrosis are of interest to every person who is faced with this serious disease. Before prescribing therapy, any specialist identifies the form and degree of the disease, for which several types of research are used:

• assessment of the severity of violations using special tests of the NFNC and the Lequesne index;
• radiography;
• CT scan.

Treatment of arthrosis is a rather lengthy process and is carried out mainly on an outpatient basis. The treatment measures are based on physiotherapeutic procedures, limiting the load on the sore joint, exercise therapy, and eliminating symptoms through painkillers and anti-inflammatory drugs. Additionally, chondroprotectors, laser therapy, and intraosseous blockades are used. In some cases, the doctor considers it advisable to perform joint replacement.

Spa treatment and a special diet aimed at strengthening cartilage tissue play an important role in therapy. Patients are recommended to eat foods high in collagen (for example, jellied meat), vegetables, fruits, and fish oil. In addition, the patient is advised to reconsider his lifestyle and give up bad habits - smoking, excessive alcohol consumption.

Once you realize that you are suffering from arthrosis, you should not panic. Timely treatment can stop the degenerative destruction of cartilage and, if not completely get rid of the disease, then at least return a person to a normal quality of life.

Coxarthrosis is a chronic disease during which damage and destruction of the hip joint occurs, namely the articular surfaces of the bones that form this joint. There are many reasons for the development of this process, however, the main determining factor is chronic (

that is, long-term, often repeated

) joint injury and malnutrition of intra-articular structures. As the disease progresses, the articular surfaces of the bones become deformed and become thinner, which leads to a narrowing of the joint space and limited mobility in the joint, up to its complete disappearance.

Coxarthrosis affects people of all age groups, with the exception of young children. Men get sick somewhat more often than women, since their physical activity is more pronounced. The maximum incidence rate occurs in older people, which is associated with the aging of all components of the body, impaired tissue nutrition and a decrease in their regenerative abilities.

Interesting Facts

• Developed coxarthrosis can be finally cured only surgically. All other therapeutic measures provide only a temporary effect.
• Hip replacement is the most commonly performed operation for coxarthrosis.
• Coxarthrosis in children under 1–2 years of age is practically not detected. This is explained by the fact that before the start of upright walking, the load on the hip joint is minimal, and the disease cannot develop.

Anatomy of the hip joint The hip joint is the largest and most powerful joint in the human body, which is due to its function - it is this joint that bears the maximum load during upright walking. As the name suggests, the joint itself is formed by the articular surfaces of the pelvic and femur bones.

The hip joint includes:

• The acetabulum. The articular surface of the pelvis is the so-called acetabulum, which is shaped like a hemisphere formed by the pelvic bones. Its inner surface is covered with smooth and slippery hyaline cartilage, which reduces friction of the articular surfaces during movements and absorbs shocks and loads.
• The head of the femur. The head of the femur is a ball-shaped bony structure that fits into the acetabulum to form the hip joint. Its articular surface is also covered with hyaline cartilage, the thickness of which is approximately 4–6 mm.
• Joint capsule. The capsule is a dense tissue that is attached to the edges of the acetabulum and completely surrounds the entire joint and head of the femur.
• Intra-articular (synovial) fluid. All intra-articular surfaces (except articular cartilage) are covered with synovial membrane. Its main function is the production of a viscous and elastic fluid that fills the joint cavity. Synovial fluid reduces friction between composite surfaces, plays the role of a shock absorber during exercise, and, together with the synovial membrane, provides nutrition and metabolism in intra-articular structures. The cartilage covering the articular surfaces of the bones is also nourished by synovial fluid - when the load on the joint is reduced, the cartilage, like a sponge, “absorbs” a certain amount of synovial fluid. With the next load on the joint, the cartilage contracts, and the synovial fluid again enters the joint cavity, where it is enriched with nutrients.
• Ligamentous apparatus. The strength of the hip joint is ensured by a powerful ligamentous apparatus. The hip ligaments (iliofemoral, pubofemoral, ischiofemoral and femoral head ligaments) are located both within the thickness of the joint capsule and outside of it.

The structural features of the joint make it possible to perform the entire range of movements (flexion and extension, adduction and abduction, rotation inward and outward) in three planes.
Causes of arthrosis of the hip joint

Research in recent years has established that the development of arthrosis of the hip joint occurs as a result of the interaction of many factors, of which the determining ones are microtrauma of the articular cartilage and disruption of its trophism (

that is, the supply of nutrients

Mechanism of development of coxarthrosis

Regardless of the causes, the pathological changes in this disease are always similar. Under normal conditions, the articular surfaces of the bones in the hip joint are congruent, that is, they completely correspond to one another, which ensures the most even distribution of the load. As a result of the influence of causative factors, deformation or structural restructuring of the hyaline cartilage in the articular cavity occurs, as a result of which the congruence of the articular surfaces is disrupted.

The consequence of this process is uneven distribution of load during movements. The part of the articular cartilage that is subject to greater load gradually begins to change both anatomically and functionally. In a place of chronic (

long-term

) as pressure increases, sclerotic processes develop and cracks appear in the cartilage. The articular surfaces of the bones become uneven and rough.

This process certainly entails the development of compensatory reactions. Initially, there may be a proliferation of cartilage tissue in and around the area of ​​damage. If the load continues, over time the cartilage tissue dies, and bone tissue may appear in its place. In addition, bone growths can appear not only at the site of injury, but also around it, forming so-called

osteophytes

– bone outgrowths directed into the joint cavity.

During the development of coxarthrosis, other components of the joint are also damaged. In the articular capsule, formation of fibrous (

cicatricial

) fabrics. It thickens, becomes less mobile and stretchable. Intra-articular ligaments become less strong and can adhere to the synovial membrane, in which foci of fibrosis also appear. If treatment is not started in a timely manner, the final stage of development of the pathological process will be fibrosis and fusion of intra-articular components, pronounced proliferation of osteophytes, convergence of the articular surfaces of the bones and narrowing of the joint space, which will lead to a significant limitation or complete absence of mobility in the joint.

Depending on the cause of occurrence, there are:

• senile coxarthrosis;
• congenital (dysplastic) coxarthrosis;
• coxarthrosis after injury;
• coxarthrosis caused by infection;
• coxarthrosis caused by aseptic necrosis of the femoral head;
• coxarthrosis after Perthes disease;
• idiopathic coxarthrosis (the cause of which cannot be determined).

Senile coxarthrosis As the human body ages, all biological processes in it are disrupted. At the joint level, this is manifested by a slowdown in the regeneration process (that is, constant cellular renewal) of hyaline cartilage, which, combined with a disruption of mineral metabolism throughout the body, leads to their deformation. The cartilage gradually becomes thinner and its surface becomes uneven, which leads to increased stress on some of its areas. At the same time, there is a decrease in the amount of synovial fluid produced, which impairs the nutrition of intra-articular components.

Confusion in the designation of osteoarthritis has existed for a long time; many clinicians who directly deal with arthrosis designate primary and secondary arthrosis differently (classified by the reasons for the development of the disease). In essence, various designations, such as arthrosis, osteoarthritis, osteoarthritis and arthrosis deformans, are combined into one subclass of MC diseases and represent the same disease.

According to the degree of development, arthrosis is divided into:

1. first;
2. second;
3. third;
4. conditionally, the fourth is deforming, namely:

• gonarthrosis (deforming arthrosis of the knee joints);
• coxarthrosis (deforming arthrosis of the hip joints).

By location:

1. hip joint;
2. knee-joint;
3. arthrosis of the hands;
4. spine;
5. arthrosis of the feet.

According to the form of localization:

1. localized and
2. generalized (polyarthrosis).

By type of localization:

1. knee joint (gonarthrosis);
2. hip joint (coxarthrosis);
3. elbow joint;
4. shoulder joint;
5. ankle joint;
6. cervical arthrosis;

Classification and description of rare types of disease

In general, the most common types of arthrosis are described sufficiently, but the rare ones require special attention.

• Uncoarthrosis

When lifting heavy weights, degenerative changes in the cervical spine can occur

A pathological process that develops in the cervical spine, since it is here that the uncovertebral joints (hook + vertebra) are present.

The causes of uncoarthrosis can be congenital or acquired causes, in particular developmental anomalies or traumatic injuries of the cervical spine, as well as the consequences of flat feet. Provocative factors for the development of uncoarthrosis can be a sedentary lifestyle and excessive weight; it is these factors that are dangerous for urban residents, and stress provokes the disease in people involved in heavy sports.

Major changes in cartilage tissue

Uncoarthrosis is characterized by damage to the intervertebral disc, where cartilage tissue acts as a shock-absorbing “pad” located between the vertebrae. Its direct function is to protect against damage to intervertebral nerves and blood vessels.

When arthrosis develops, the cartilage disc loses fluid and becomes less elastic and thin, which leads to compression of nearby tissues, which is why the patient feels pain. Subsequently, osteophytes, a kind of sharp spines of bone tissue, begin to form on the cervical vertebrae. Since they grow towards each other, the sensitive ligaments of the spine are injured.

Important! Uncovertebral joints are joints (neoarthrosis) that form between the uncinate processes of the cervical vertebrae and the base of the arch and/or the body of the overlying vertebra. Normally they do not exist; they are formed as a result of a decrease in the height of the intervertebral discs.

Symptoms of uncoarthrosis

The main symptoms that appear in patients:

1. severe pain in the affected joint, especially with sudden movements or after being in one position for a long time (sitting);
2. subluxation of the joints between the facet processes;
3. clearly defined crunching sound when turning the head;
4. dizziness and headaches;
5. surges in blood pressure.

If such symptoms occur, it is important to undergo an urgent examination by an orthopedist-vertebrologist and neurologist. It should be remembered that in the final stages, treatment brings only short-term relief.

• Hyparthrosis

This is a disease that does not exist in nature. Apparently, patients have difficulty translating their doctor's handwriting.

• Defarthrosis

The development of the disease is based on metabolic disorders in cartilage tissue caused by inflammation, intoxication and injury.

Sounds like “deforming arthrosis” - sometimes this diagnosis is prescribed in the patient’s chart as an abbreviation. This disease is of a degenerative-dystrophic nature, characterized by a chronic course and irreversible changes that gradually lead to disability. Primary deforming arthrosis can occur anywhere, but most often deforming arthrosis occurs in the hip and knee joints.

The main cause leading to the development of defarthrosis cannot be identified, since degeneration is preceded by a whole complex of changes. There are primary (idiopathic, genuine) and secondary defarthrosis, which arise as a result of ligament injuries and bone fractures. Primary deforming idiopathic osteoarthritis is diagnosed when no visible cause of the disease is found. It is believed that the main cause of defarthrosis may be a hereditary factor, when the development of the components of articular cartilage, its biochemical structure and shell, is disrupted.

Secondary defarthrosis is usually preceded by the following factors:

1. mechanical. Joint injuries, intra-articular fractures, constant microtrauma and increased load on the joint, skeletal development abnormalities and obesity;
2. joint disease. Inflammation (arthritis), hemophilia (hemarthrosis of the right knee joint) when hemorrhage occurs in the joint, primary aseptic necrosis of bone tissue;
3. endocrine diseases and metabolic disorders. There is a disruption of metabolic processes in the body, changes in the production of sex hormones and somatostatin (growth hormone);
4. disorders of the blood supply to tissues (atherosclerosis of the vessels of the lower extremities, varicose veins, obliterating endarteritis), when there is a decrease in access of blood and nutrition to the joint.

As long as the cartilage cells (chondrocytes) are working hard, defarthrosis does not appear, but as soon as the reserves are depleted and the number of chondrocytes is reduced to a minimum, the hyaline cartilage becomes thinner, becomes fibered and cracks form. They gradually increase and deepen, which leads to increased load on the underlying bone tissue, sclerosis and the formation of osteophytes.

• Rheumatoid arthrosis

Manifests itself in the form of characteristic severe pain in the joints of the hands and feet. With rheumatoid arthrosis, symmetrical changes are observed, in contrast to reactive arthritis of infectious origin (asymmetrical in nature), when not both joints ache, but one, and the pain smoothly “flows” from leg to leg.

It is important to remember: gout, rheumatoid and reactive arthritis, osteoporosis and rheumatism are not arthrosis, but other diseases that require different treatment.

Arthrosis is a disease of the joints when cartilage is destroyed. Inflammation occurs later and may not be constant. Rheumatoid arthrosis can occur when inflammation from the synovium (rheumatoid arthritis) spreads to cartilage and degenerative changes occur.

• Patellofemoral arthrosis

In MC, this disease is absent; there is patellofemoral syndrome, although the term is often used in domestic and foreign literature. Patellofemoral arthrosis = patellofemoral syndrome.

Very often, changes in the knee joint begin with patellofemoral syndrome, and the same set of changes will be observed with repeated damage to the joint and excessive loads. Pain occurs between the surfaces of the patella joint and the adjacent part of the thigh, but there is no inflammation.

Signs of patellofemoral arthrosis (syndrome) in healthy people are found during clinical examination; laboratory and imaging observations are not required. When palpating, painful points are found under the edge of the patella, and pain can also occur when the thigh muscles contract and when the patella is kept from moving upward. Patellofemoral syndrome (arthrosis) does not require special treatment, but if pain interferes with movement, it must be dealt with.

• Synarthrosis

A completely immobile connection of bones using connective (syndesmosis), cartilaginous (synchondrosis), and bone (synostosis) tissue. Literally – “joint together.”

• Diarthrosis

A sedentary connection between bones or a continuous connection in which free movements occur (true joint). All articular ends are covered with hyaline cartilage, and the bones themselves are connected to each other by a ligament (capsule), the inner layer of which is formed by a thin synovial membrane. It produces synovial fluid. These joints differ in the type of connection of the bones and the type of movement carried out in them: hinge joint, flat joint, spherical joint, condylar joint, trochlear joint, saddle joint.

• Neoarthrosis

This is the formation of a joint in an unusual place (between the surfaces of bones that are in mechanical contact during movements, between the massive transverse processes of an abnormally developed transitional lumbosacral vertebra and the lateral masses of the sacrum). Very often, neoarthrosis occurs when there is a long-term untreated dislocation or fracture of a bone inside the joint.

• Neoarthrosis

Refers to false joints. Another name is pseudarthrosis, when the continuity of the bone is disrupted with the development of pathological mobility (occurs after treatment of open and closed fractures).

Contributes to the development of the disease:

• infection;
• disorder in the blood supply to the bones;
• mobility of bone fragments due to their imprecise contact, short-term or unstable immobilization;
• choosing the wrong method of fixation during osteosynthesis surgery and with frequent changes of plaster casts;
• with suppuration of the fracture site and complications with postoperative osteomyelitis;
• congenital problems due to abnormal intrauterine bone development.

In the fracture zone, connective and cartilaginous tissue develops instead of bone formation.

• Arthrosis of the foot (feet)

Arthrosis of the joints of the feet is a degenerative disease in which cartilage tissue is destroyed.

Degenerative-dystrophic changes in the area of ​​the feet of a chronic form, when the shape of the fingers is distorted, sharp pain occurs when walking, sometimes at rest. Painful calluses form in areas of increased stress. The most common joint that is affected is the big toe joint, but in very rare cases the problem occurs throughout the entire foot.

Often, patients are initially diagnosed with grade 1 arthrosis together with flat feet. It all starts with heel pain, and then the disease progresses, the feet begin to “burn”, sometimes it seems that “something is itching” inside, pain occurs when the foot bends inward and it becomes difficult to step on the feet.

Arthrosis in the foot area is preceded by repeated hypothermia of the legs, constant low pressure in which the arms and legs are almost always cold (blood “does not reach” the feet), excessive loads (carrying heavy objects, pregnancy, prolonged exposure to heels). Very often, problems in the foot area are accompanied by enlarged veins above the knee on the back of the leg; they hurt when squatting and “burn.”

Doctors note a predisposition to arthrosis of the feet - women most often suffer from small weight (up to 50 kg) and height (up to 165 cm), thin, nervous, pedantic, “eating themselves,” twitchy.

• Cruzarthrosis

In other words, “osteoarthrosis of the ankle joint”, occurs most often as a secondary manifestation of arthrosis, developed against the background of an injury in the ankle joint or as a result of rheumatoid arthritis. These may be severe fractures of the ankles, destruction of the distal epiphysis, combined injuries with rupture of the distal tibiofibular syndesmosis, separation of large fragments of the anterior and posterior edges of the tibia

Many doctors note that cruzarthrosis occurs in patients in 9-25% of all cases of arthrosis. An important aspect of this disease is intra-articular friction. Clinically, osteoarthritis, as a secondary manifestation of damage to the ankle joint, is characterized by limited mobility in the joint, pain, which manifests itself especially when rolling from heel to toe and when walking on uneven roads.

At stages 1 and 2, for crusarthrosis, conservative treatment is carried out, and for rheumatoid causes, synovectomy is indicated; at stages 3, only arthroplasty is performed.

Arthrosis of the big toe is called “bunions”, which manifest themselves with degenerative changes in the foot, as well as with transverse and longitudinal flat feet. Often arthrosis of the thumb develops after a severe injury or with constant overstrain associated with loads (ballet, wearing narrow shoes with heels).

• Osteoarthritis of the metatarsal joint

Means the same damage to the big toe. There are three degrees of the disease, each of which is characterized by its own symptoms:

• 1st degree, tear of single fibers, presence of injury, pain in the area of ​​the tarsometatarsal joint, slight swelling of the dorsum of the foot, pain when loading the metatarsal bones and gentle lameness;
• Stage 2, there is a partial rupture of several ligaments or a complete rupture of one of the ligaments (except for the Lisfranc ligament). It is impossible to lean on the injured foot, swelling of the dorsum of the foot is pronounced and there is pain in the area of ​​the Lisfranc joint. Some time after the injury, hemorrhage occurs on the plantar part of the foot, and a hematoma of the deep cellular space of the foot;
• 3rd degree, complete rupture of ligaments, including rupture of the Lisfranc ligament (or separation of it with bone fragments from the base of the second metatarsal bone). Sharp pain syndromes appear, swelling is pronounced, pain on palpation in the area of ​​the Lisfranc joint, increased pain when loading the metatarsal bones. It becomes impossible to lean on the sore leg, the presence of Barsky's symptom is noted.

With changes in the big toe, arthrosis cannot be completely cured, but it is still possible to stop the process in the early stages. It is important to eliminate all factors that contributed to the occurrence of “bunions.”

• Arthrosis of the temporomandibular joint (TMJ)

The disease is chronic and characterized by dystrophic changes in connective, cartilage and bone tissue.

Causes of the disease:

1. neurodystrophic, metabolic, endocrine disorders and infectious diseases;
2. inflammatory process in the joint, load on the articular surface of the head of the lower jaw (bruxism), lack of teeth, deformation of the dentition.

With arthrosis of this joint, the surfaces become significantly thinner, and when moving, pain and limited movement appear in it.

With arthrosis of the temporomandibular joint, the cartilage covering the articular surface of the head of the condylar process undergoes degeneration and partially disappears, subsequently perforation of the disc occurs, the head is deformed - it becomes hook-shaped or club-shaped.

• Osteoarthritis of the wrist joint

It is very rare and can be post-traumatic, as a complication after a fracture or dislocation of the wrist bones. Develops over a long period of time (weeks, months), is characterized by a crunch in the joint, pain that occurs only with certain movements, especially when flexing and extending “all the way.”

Patients, when doctors diagnose arthrosis of the wrist joint, are very surprised, since the disease does not appear outwardly in any way - the hand looks healthy. Visible deformation can only occur when the disease is caused by a fracture with severe displacement.

Treatment of arthrosis of the wrist joint almost always gives a good result, but only when the damaging factor is eliminated, microtraumas are prevented and the wrist joint is immobilized with a special bandage.

• Generalized arthrosis (polyarticular, polyarthrosis)

Arthrosis, characterized by multiple joint damage. All symptoms appear according to the stage and location of the disease, and treatment is prescribed taking into account the complexity of the lesion.

• Polyarthrosis

With polyarthrosis of the joints, dystrophic changes occur in several joints simultaneously. As a rule, this is the primary form of the disease and develops in old age under the influence of menopausal disorders, endocrine-metabolic, toxic and other reasons. Sometimes it occurs at a young age. Polyarthrosis is characterized by combined lesions of the spine and joints of the extremities, with manifestations of Heberden's nodules.

• Rhizarthrosis

It is a special case of osteoarthritis of the finger joints (5%). The lesion concerns the joint, which is located at the base of the thumb, connecting the metacarpal bone to the wrist joint.

It is not difficult to make a diagnosis when rhizarthrosis is a consequence of polyosteoarthrosis of the fingers. But in a quarter of cases, rhizarthrosis is an independent disease that manifests itself in people who put a lot of stress on the thumb. In this case, it is quite difficult to distinguish rhizarthrosis from de Quervain's tenosynovitis, since the symptoms of these diseases are similar.

With de Quervain's tenosynovitis, X-rays rarely show only changes in the soft tissues above the joint, and with rhizarthrosis, deformation of the bones of the diseased joint occurs.

• Gouty arthrosis

With gouty arthrosis (arthritis), it should be remembered that “classic” gout (gouty arthritis) is more common in men, unlike women. Affects any joints on the hands and feet, manifests itself at the age of 20-50 years with inflammation of the joints of the toes and hands or ankle joints.

In treatment, trying to push aside psoriatic arthritis, they combine therapy against psoriasis and against arthritis of the joints.

With gout, acute attack-like phenomena occur; completely unexpectedly, they usually begin against the background of complete health, and, most often, at night. They “make you want to climb the wall,” and the joint itself turns red, the skin becomes bright purple and hot to the touch. The attacks last from 3 to 10 days, and pass suddenly, without consequences.

• Intermittent hydrarthrosis

This is a chronic disease with frequent relapses, which is characterized by acute attacks of hyperproduction of synovial fluid. There is an increase in the volume of the joint, discomfort, and stiffness. Hydarthrosis is mainly observed in large (knee) joints.

• Psoriatic arthritis

Psoriatic arthritis (arthrosis) is called inflammation of the joints due to psoriasis. At the same time, reddish spots appear on the skin covered with white or grayish flaky scales. Psoriatic arthrosis occurs in approximately 10% of patients with psoriasis, but the exact cause of its occurrence is unknown. Perhaps the development of the disease is due to the interaction of immune and genetic factors, as well as environmental factors.

The first method for diagnosing arthrosis is x-ray. The clinical and radiological stages are listed below (according to N. S. Kosinskaya):

Stage I. There is a slight restriction of joint movement; movements are limited only in one specific direction; X-ray examination of a patient with arthrosis does not show the presence of bone growths; the surface of the joint is uneven; ossified areas are observed on the joint; The joint gap is narrowed, but not very much.

Stage II. The joint is moderately limited in movement; when the position of the joint changes, a rough crunching sound is observed; the muscles adjacent to the joint are partially atrophied; X-ray examination shows the presence of significant bone growths, the joint gap is narrowed to a large extent - 2-3 times narrower than normal; there is subchondral sclerosis.

Stage III. There is a pronounced deformation of the joint affected by arthrosis, its movement is sharply limited. The joint space with arthrosis disappears almost completely, most of the surface of the joint becomes ossified, it increases the area due to noticeable marginal growths of the joint; “articular mice” appear, entering the bone areas of the tissues and joint.

Another popular method for diagnosing arthrosis is a blood test; in case of reactive synovitis, ESR increases up to 25 mm/h.

There is also another method for diagnosing arthrosis - analysis of synovial fluid. Deviation from the norm: reactive synovitis provokes a decrease in the number of neutrophils to such a level that they become no more than 50%.

And finally, the last way to diagnose arthrosis is a histological examination of the synovium. With arthrosis, there is no proliferation of integumentary cells, and fibro-fatty degeneration is observed. Atrophic villi appear, the number of vessels is reduced.

Types of arthrosis

Arthrosis of the hip joint (). This form of arthrosis is the most widespread and causes the most trouble. Arthrosis of this type occurs with equal frequency in men and women after forty years, but women most often have a more severe course of the disease. If arthrosis of the hip joint develops before the age of 40, then its presumed cause is dysplasia of the diseased joint.

The most easily diagnosed symptom of such arthrosis is pain in the joint when moving, which forces the patient with arthrosis to limp.

Palpation of the diseased joint causes pain, but there is no swelling or hyperemia. If arthrosis is in an advanced stage, then atrophy of various muscles (thighs, buttocks, legs) may be observed. A patient with arthrosis is forced to be in a partially bent (hip joint) state. With arthrosis, disturbances in separation and rotation are observed. A patient with arthrosis develops compensatory lumbar hyperlordosis, and the pelvis is forced to tilt towards the joint affected by arthrosis. Arthrosis provokes the occurrence of scoliosis, a disease of the spine.

The pain in the joint disappears if the patient with arthrosis does not make any movements. Arthrosis of the hip joint, in which the joint is affected on only one side of the body, causes a limp when walking, but if both joints are affected by arthrosis (symmetrically), then the so-called. "duck walk"

Gonarthrosis is one of the most common types of arthrosis, the name given to a disease that affects the knee joints. In ICD-10, a separate heading is allocated for it, M17, in which 7 subheadings are allocated for certain types of gonarthrosis (primary bilateral and other, post-traumatic bilateral and other, other secondary, unspecified). In clinical practice, when making a diagnosis, other details, features of the occurrence and course of the disease are often specified, and its type is indicated. What types of arthrosis of the knee joint exist, and what criteria are used to classify gonarthrosis?

Classification by etiology

Depending on the causes that caused the disease, all arthrosis, including the knee joints, are divided into primary and secondary:

• primary (idiopathic, sometimes the term genuine is also used) begins to develop in a joint that has a normal structure, has not been previously injured, or has not become inflamed. It is also not possible to connect the development with any disease the patient has. That is, it is the cause of which has not been established;
• secondary – affects a pathologically changed joint or develops against the background of an existing disease.

Primary gonarthrosis most often develops in older people against the background of natural aging of the body, slowing down regeneration processes. It is also susceptible to people who put excessive stress on their joints and people with a genetic predisposition. A special case of secondary gonarthrosis is post-traumatic. Since knees are often injured, this is a common cause; it is not without reason that the ICD considers it in two separate subheadings.

The remaining causes of secondary arthrosis can be divided into several groups:

• inflammatory (destructive activity of inflammatory mediators);
• biochemical (the activity of certain compounds, enzymes, pigments that inhibit the synthesis of cartilage tissue or provoke its destruction);
• endocrine (hormonal imbalance);
• metabolic (nutrient deficiency or production of compounds aggressive to cartilage tissue against the background of metabolic disorders);
• anatomical (congenital or acquired leg deformities, dysplasia, patellar pathologies, vascular pathologies).

Classification by localization, prevalence

Like any arthrosis of paired joints, gonarthrosis can be bilateral or unilateral. One-sided is divided into and. Symmetrical damage to both joints is more typical for primary osteoarthritis. Post-traumatic is most often unilateral, and secondary gonarthrosis of a different nature can affect both one or both joints. Pathological processes in both legs do not always begin at the same time and proceed at the same speed; sometimes arthrosis of the left knee joint of the 2nd degree is combined with arthrosis of the right knee of the 1st degree, and vice versa.

Gonarthrosis can occur as monoarthrosis, in which case only the knee joints are affected, one or both. But often it is one of the components of polyarthrosis (affects 2-3 articular groups) or generalized arthrosis (more than 3 articular groups). Rapidly progressing arthrosis of the knee joint can lead to damage to nearby joints and develop into polyarthrosis.

The knee joint has a complex structure, it is formed by the condyles of two tubular bones (femur and tibia) and the patella (patella). With arthrosis of the knee joint of 2nd degree and especially 3rd, all components of the joint are usually affected, but at an early stage the process of destruction of cartilage can be localized in one of the departments.

In accordance with this criterion, the following types of gonarthrosis are distinguished:

• medial, affects the inner side of the joint;
• lateral, localized on the outer side;
• arthrosis of the femoral condyle (upper articular platform);
• arthrosis of the head of the tibia (lower articular platform);
• retropatellar (articular surface of the patella);
• pangonarthrosis – all components are affected.

Patellofemoral syndrome and prearthrosis

Sometimes you can find references to such a disease as patellofemoral (femoropatellar, femoral-patellar) arthrosis; the term patellofemoral syndrome is more often used. It is resorted to if increased loads on the articulation of the upper part of the patella with the anterior edge of the femoral condyle lead to pain in the anterior part of the knee. The femoral-patellar joint is part of the knee joint, so patellofemoral arthrosis can be considered a type of gonarthrosis of limited localization. But it proceeds according to a scenario atypical for arthrosis, is treatable, and thinning of the patellar cartilage (chondomalacia) begins only at a late stage.

Is there a zero stage of arthrosis? It stands out within the framework of radiological classifications. Since the severity of clinical and radiological signs in this disease often does not coincide, prearthrosis is sometimes diagnosed. It is used if a person is at risk for arthrosis and clinical symptoms suggest the initial stage of this disease, but there are no radiological signs. At this stage, a number of preventive measures are recommended: limiting the load on the joints, doing exercises, taking chondroprotectors. often considered as a harbinger of gonarthrosis, its zero stage. If measures are taken in time, damage to the knee joint can be avoided.

Stages of the disease

There are 3 stages in the development of gonarthrosis:

• 1 – early (initial, moderate clinical manifestations). Only the cartilage is affected, its characteristics change, and destruction begins. Compensatory mechanisms are not involved;
• 2 – developed (pronounced clinical manifestations). The destruction of cartilage progresses, the process involves bone tissue, synovial membrane, and periarticular structures. Compensatory mechanisms are activated and so far cope with their task (stage of relative compensation or subcompensation);
• 3 – late (significantly pronounced clinical manifestations). Irreversible bone deformations occur, and the possibilities of compensatory mechanisms are exhausted. The disease becomes decompensated.

The early stage occurs with mild clinical symptoms or asymptomatic. There are mild, periodic short-term pain, initial stiffness, and increased fatigue of the legs. According to the Kellgren-Lawrence radiological classification, this is questionable or mild gonarthrosis (stage 1–2). One may suspect a narrowing of the joint space; there are no osteophytes or only isolated ones, in their infancy. Osteoarthritis of the knee joint grade 2 Kellgren-Lawrence is classified as moderate.

Among the radiological signs, it is characterized by a pronounced narrowing of the joint space, multiple osteophytes, and in some places areas of osteosclerosis. At this stage the disease is accompanied by:

• frequent intense pain of various types - inflammatory, vascular, muscular, paroxysmal pain blockades;
• limited mobility of the leg at the knee;
• crunching, crackling in the knee when moving;
• muscle wasting and shortening of ligaments;
• episodes of synovitis with swelling, redness of the knee, local increase in temperature (hyperthermia).

Stage 3 - severe gonarthrosis according to Kellgren-Lawrence. The severity of all symptoms increases and noticeable bone deformations are added, which are visible not only on an x-ray, but also during a visual examination.

Character of the current

Gonarthrosis is a chronic disease that develops in only one direction and progresses. Treatment allows you to achieve more or less long-term remission, but not recovery; degenerative-dystrophic changes in the joints are irreversible.

What is hyperarthrosis, acute arthrosis?

Sometimes progressive arthrosis of the knee joint or any other joints is referred to as hyperarthrosis, but it is used quite rarely. Osteoarthritis can progress quickly, slowly and very slowly. If the patient’s condition practically does not worsen over the years, the term hyperarthrosis is inappropriate; more often it characterizes a rapidly developing disease. But if you find a diagnosis of hyperarthrosis in your medical history, it means that the doctor made a mistake when writing the word or you incorrectly deciphered his notes. Most likely, they meant hyperarthrosis, they just missed one letter. And if the handwriting is very illegible, this mysterious word may well mean gonarthrosis.

Arthrosis, unlike many diseases, is not divided into acute and chronic. When they talk about acute gonarthrosis, they mean that it is in the acute stage. During arthrosis, the following periods are distinguished:

• acute, with severe symptoms, intense pain, severe limitation of mobility. usually provokes joint overload, hypothermia, infectious disease or intoxication of the body;
• subacute – pain decreases, joint functions approach normal;
• a period of remission, when the symptoms are smoothed out, the pain syndrome is eliminated, and the functions of the joint are restored.

It is not always possible to achieve remission with gonarthrosis; the etiology of the disease and its stage matter. As the disease progresses, exacerbations become more frequent and remissions become shorter.

Rate of progression

In most cases, arthrosis progresses slowly; if 3 to 8 years pass between stages 1 and 2, it is considered subcompensated. Slowly progressing arthrosis of the knee joint periodically worsens, accompanied by episodes of synovitis. Usually subcompensated gonarthrosis is combined with diseases of the cardiovascular system. If the disease can be delayed at the initial stage for 9 years or more, it is characterized as arthrosis without noticeable progression (compensated). It occurs without exacerbations, is not complicated by synovitis, and is not accompanied by concomitant diseases. In this scenario, the prognosis is the most favorable; usually, primary gonarthrosis develops.

And sometimes the development is rapid, from the appearance of the first, barely noticeable symptoms to pronounced clinical manifestations of gonarthrosis takes less than 3 years. In this case, they speak of rapidly progressing arthrosis. Most often, this scenario develops, and it usually begins with acute manifestations. Secondary arthrosis caused by severe pathology that cannot be treated (advanced rheumatoid arthritis, severe diabetes mellitus, osteochondropathy of the knee joint bones) can also be decompensated. In addition to the rapid increase in symptoms, it is characterized by frequent relapses of synovitis.

Gonarthrosis is one of the types of arthrosis, arthrosis of the knee joints. In turn, it is divided into several varieties. There is no single approach to the classification of gonarthrosis; most often they resort to division into primary and secondary, unilateral and bilateral. The most dangerous is post-traumatic secondary gonarthrosis; it is characterized by an acute onset, rapid development, and can lead to disability at a young age.

Osteoarthritis of the knee joints goes through 3 stages of development. Depending on the speed with which the stages change, it can be characterized as compensated, subcompensated and decompensated. The terms deforming gonarthrosis and osteoarthritis of the knee joints are not designations of any specific type or stage of the disease, these are synonymous concepts.