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Gonarthrosis – Causes, Symptoms and Treatment

Gonarthrosis is a degenerative disease of the knee joint in which the articular cartilage progressively breaks down. It causes pain, stiffness, and reduced mobility.

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Things worth knowing about "Gonarthrosis"

Gonarthrosis is a degenerative disease of the knee joint in which the articular cartilage progressively breaks down. It causes pain, stiffness, and reduced mobility.

What is Gonarthrosis?

Gonarthrosis (also known as knee osteoarthritis or degenerative knee joint disease) is a chronic condition in which the cartilage within the knee joint gradually wears away. Over time, the underlying bone, joint capsule, and surrounding soft tissues can also become involved. Gonarthrosis is the most common form of osteoarthritis and one of the most prevalent joint diseases worldwide.

Causes and Risk Factors

Gonarthrosis develops when the mechanical load on the knee exceeds the capacity of the cartilage to repair and regenerate itself. Two main types are distinguished:

Primary gonarthrosis: Occurs without an identifiable underlying disease and is mainly related to age-related wear, genetic predisposition, and excess body weight.
Secondary gonarthrosis: Develops as a consequence of another condition or injury, such as knee trauma, meniscus damage, rheumatoid arthritis, or joint malalignment (bowleg or knock-knee deformity).

Additional risk factors include:

Older age (significantly more common after age 50)
Female sex, especially after menopause
Overweight or obesity (increased mechanical stress on the joint)
Physically demanding occupations or high-impact sports
Weakness of the thigh muscles surrounding the knee

Symptoms

Symptoms of gonarthrosis typically develop gradually and worsen over time. Common signs include:

Start-up pain: Pain at the beginning of movement after periods of rest
Load-related pain: Pain during walking, climbing stairs, or prolonged standing
Morning stiffness of the knee joint
Swelling and warmth of the knee during inflammatory episodes
Crepitus (crackling or grating sounds during movement)
Reduced range of motion and increasing joint instability
In advanced stages: resting pain even without physical activity

Diagnosis

Diagnosis of gonarthrosis is established through a combination of clinical examination and imaging studies:

Medical history and physical examination: The physician assesses pain characteristics, range of motion, and joint stability.
X-ray imaging: Standard method to evaluate joint space narrowing, bone spurs (osteophytes), and bony changes.
MRI (Magnetic Resonance Imaging): Provides detailed information on cartilage, menisci, ligaments, and soft tissues.
Ultrasound: Used to detect joint effusions and soft tissue changes.
Laboratory tests: To rule out inflammatory causes such as rheumatoid arthritis.

Treatment

Conservative Treatment

In early and moderate stages, conservative management is the first-line approach:

Physiotherapy and exercise therapy: Strengthening of joint-stabilizing muscles and improving range of motion.
Weight loss: Substantially reduces mechanical load on the knee joint.
Pain management: Use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac, paracetamol, and topical analgesics.
Intra-articular injections: Corticosteroids for acute inflammatory flares; hyaluronic acid to improve joint lubrication.
Orthopedic aids: Insoles, braces, or walking aids to offload the joint.
Physical therapy: Heat or cold applications, electrotherapy, and therapeutic ultrasound.

Surgical Treatment

In advanced gonarthrosis with insufficient response to conservative treatment, surgical options may be considered:

Arthroscopy: Minimally invasive joint inspection to remove debris or repair the meniscus (in early stages).
Osteotomy: Correction of leg axis malalignment to redistribute load away from the affected compartment.
Total knee arthroplasty (TKA): Full replacement of the knee joint with a prosthesis in cases of severe cartilage degeneration.
Unicompartmental knee arthroplasty: Partial knee replacement when only one compartment of the joint is affected.

Prognosis and Outlook

Gonarthrosis is a chronic and progressive condition that cannot be fully cured. However, with targeted treatment, disease progression can be slowed, pain can be significantly reduced, and quality of life can be greatly improved. Early diagnosis and consistent management are key to a favorable long-term outcome.

References

Deutsche Gesellschaft fuer Orthopaedie und Orthopädische Chirurgie (DGOOC): S2k Guideline on Gonarthrosis (2018). Available at: www.awmf.org
Vina E.R., Kwoh C.K.: Epidemiology of osteoarthritis: literature update. Current Opinion in Rheumatology, 2018; 30(2):160-167.
World Health Organization (WHO): Musculoskeletal conditions. Available at: www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions

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