Gonarthrosis :  Symptoms, Treatments and Prevention

Pathophysiology: understanding gonarthrosis or arthrosis of the knee

Gonarthrosis (arthrosis of the knee) develops when the cartilage covering the ends of the knee bones gradually wears away. This cartilage serves as a cushion in the joint, allowing the bones to move without pain. When it thins or disappears, the bones can rub directly against each other, causing pain and inflammation. This degeneration can be accelerated by several factors. Identifying them is crucial for better managing and preventing the progression of the disease. Cartilage wear can lead to the formation of osteophytes, bony outgrowths that can worsen pain and joint stiffness.

There are several types of knee osteoarthritis:
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• Tibiofemoral (medial or lateral)
• Patellofemoral
• Tricompartmental

Causes and Risk Factors

• Being overweight: Excess weight puts increased pressure on weight-bearing joints like the knees, accelerating cartilage wear. Additionally, body fat has a pro-inflammatory effect, accelerating pain sensation and inflammation.
• Previous Injuries: Sports injuries or accidents affecting the knee can damage the cartilage and supporting structures, accelerating joint degeneration.
• Genetic Factors: A family predisposition can play a role in susceptibility to osteoarthritis, making some individuals more vulnerable. A family history of osteoarthritis increases the risk of developing the disease.

Gonarthrosis symptoms

Gonarthrosis symptoms vary in intensity but tend to worsen over time. They include:
• Pain: Pain, often worsened by physical activity and relieved by rest, is one of the first symptoms of knee osteoarthritis. It can be diffuse or localized and tends to increase with movement.
• Stiffness: Joint stiffness is particularly noticeable in the morning or after a period of inactivity. While it might decrease after a few minutes of movement, persistent stiffness can limit daily activities.
• Swelling: Swelling around the joint is due to internal inflammation. This swelling can fluctuate with activity and weather conditions.
• Decreased Mobility: Reduced joint mobility can make daily activities like climbing stairs, walking long distances, or getting up from a chair difficult. This decreased mobility can also lead to muscle weakness and deterioration in a person’s general physical condition.

Diagnosis of primary gonarthrosis

The diagnosis of primary gonarthrosis combines a clinical evaluation of symptoms and imaging tests to confirm the extent of joint damage. An accurate diagnosis is essential for deciding on the most effective treatment.
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• X-rays: X-rays are typically the first imaging method used to diagnose knee osteoarthritis. They detect bone changes such as osteophyte formation and reduced joint space, indicative of cartilage wear. X-rays are also used to assess limb alignment, which is crucial for determining the treatment plan.

• MRI: Magnetic resonance imaging provides a detailed view of soft tissues and cartilage, allowing visualization of lesions not visible on X-rays. MRI is particularly useful for evaluating the condition of ligaments, tendons, and internal knee structures, providing a complete picture of the joint. MRI is not mandatory if osteoarthritis is already visible on X-rays.

Non-surgical treatments for gonarthrosis of the knee

Non-surgical treatment options for gonarthrosis of the knee (medial or lateral, tricompartmental) aim to relieve pain and improve joint function, delaying the need for surgery as long as possible.
• Medications

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These drugs reduce inflammation and relieve pain. They can be taken orally or applied topically as creams or gels. NSAIDs are effective in managing symptoms but should be used with caution due to potential side effects, such as stomach ulcers and kidney problems.
• Hyaluronic Acid Injections: These injections improve the joint’s lubrication, reducing pain and improving mobility. Hyaluronic acid acts as a lubricant and shock absorber in the joint, facilitating movement and reducing friction.
• Platelet-Rich Plasma (PRP): This involves using the platelets in your blood to reduce inflammation inside your joint. PRP can be used alone or in combination with hyaluronic acid.

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• Physiotherapy

• Exercises: A specific exercise programme helps strengthen the muscles around the knee and improve flexibility, supporting and protecting the joint. Exercises may include stretching, muscle strengthening, and low-impact aerobics activities such as swimming and cycling.
• Manual Therapies: Physiotherapists use techniques such as massage, joint mobilizations, and stretching to improve knee function and reduce discomfort.

Gonarthrosis surgery

When non-surgical treatments are no longer effective in relieving the pain of gonarthrosis, surgery may be considered to restore joint function.

Types of Surgery

• Osteotomy: This procedure realigns the bones to reduce pressure on the damaged part of the knee. It is performed in patients who have a misaligned leg. This surgery can correct load imbalances on the knee, delaying the progression of arthritis and the need for arthroplasty.

• Arthroplasty: Total or partial replacement of a damaged knee joint with a prosthesis is an effective solution for advanced cases of osteoarthritis. This surgery can significantly improve a patient’s quality of life by reducing their pain and restoring their mobility. Total knee arthroplasty replaces all joint surfaces, while partial arthroplasty replaces only the damaged part of the joint, preserving more bone tissue and allowing for faster recovery.

Professeur Etienne Cavaignac will propose a treatment tailored to your case, regardless of the type of osteoarthritis you suffer from (medial, lateral or tricompartmental).

Prevention and Long-Term Management

Long-term management of knee osteoarthritis (bilateral or not) includes maintaining a healthy weight, exercising regularly, and ongoing monitoring by healthcare professionals.

Preventive Strategies

• Maintaining a Healthy Weight: Reducing excess weight decreases the pressure on the knee joints, delaying the progression of osteoarthritis. A healthy weight is also beneficial for your cardiovascular and overall health.
• Regular Exercise: Low-impact activities help maintain joint mobility and strengthen muscles without putting too much stress on the knee. Regular exercise also improves endurance, balance, and coordination, reducing the risk of falls and injuries.
• Regular Medical Monitoring: Regular consultations with a doctor are needed to monitor the disease's progression and adjust the treatments accordingly. Healthcare professionals can adjust the treatment based on the patient's progress and changes in the joint's condition.

Orthense for Effective Follow-Up

Orthense is a digital healthcare solution deployed by Professor Cavaignac to assist patients before and after knee surgery. This platform allows for remote monitoring, thereby reducing the need to come to the hospital. Online interactions, such as questionnaires and specific information, enhance communication between the patient and surgical teams, contributing to more effective and tailored rehabilitation.

A thorough understanding of knee osteoarthritis and its potential impacts is crucial for effective management. With appropriate diagnosis, suitable treatments, and targeted prevention strategies, individuals with knee osteoarthritis can maintain an active and satisfying quality of life. By adopting a proactive approach and working closely with their care team, patients can effectively manage their knee symptoms and prevent long-term complications. Rigorous management and a positive attitude will allow you to live a full life, despite this degenerative condition.