Gonarthrosis: What are the symptoms and degrees of osteoarthritis of the knee? Exercise therapy?

Gonarthrosis: What are the symptoms and degrees of osteoarthritis of the knee? Exercise therapy?
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Gonarthrosis is osteoarthritis of the knee, ie non-inflammatory degenerative changes of the knee joint. The damage is not only due to older age. Knee pain has a multifactorial basis.


Gonarthrosis is a non-inflammatory degenerative disease of the knee joint, which has a multifactorial basis. Damage does not only occur for older age. 

Knee pain and swelling (water in the knee) at rest or after exertion,
cracking and squeaking? 
And that's not all.
But why is this happening? 
How long can a suit or acetate ointment last and help? 
We offer answers to other questions in the article ...

This is the most common musculoskeletal problems,
which stipulates that affects approximately 12% of adults.
And 70% of people over the age of 65 have structural knee damage that can be diagnosed by imaging.

Gonarthrosis, also known as: 
Knee osteoarthritis or osteoarthritis of the knee joint.

The disease changes not only affect the cartilage of the knee, but also the nearby structures. The damage also affects the bone.

In addition to knee pain, it is also characterized by other difficulties, which often reduce the quality of life, in the most severe stage ending in disability.

Difficulties are exacerbated by the strain on the knee, walking up the stairs, and, later on, normal walking and pain can also occur at rest.

The role of the cartilage of the knee joint is to dampen and absorb shocks that occur during movement, in everyday life, or in sports activities.  

Cartilage is not connected to the rest of the body by blood vessels. It obtains the nutrients needed for its metabolism from synovial fluid, which washes it and also serves as a lubricant.

Movement helps with this.

In addition, waste harmful substances that arise as a product of metabolism must be removed.

Want to know more about knee damage and pain
What is the cause
What other symptoms accompany knee pain
How can you help with knee pain
Read on to us.

Osteoarthritis of the knee as a painful and non-inflammatory degenerative form of cartilage damage also occurs as a result of wear and tear, which is divided into 5 stages.

Stages and degrees of osteoarthritis :

  • stage 0 - healthy cartilage
  • stage I  - 1st degree, cartilage is undamaged and intact, sclerosing occurs - so-called pulping and softening of the cartilage
  • stage II  - 2nd degree, damage to the cartilage surface and its roughening, the narrowing of the joint space begins, osteophytes are formed, ie bone growths
  • stage III - 3rd degree, structural damage reaching deep, deep cracks are formed, a significant narrowing of the joint space is attached, the joints are deformed and are unstable
  • stage IV - 4th degree, complete damage and loss of cartilage, two ends of bones rub against each other, destroyed tissue and surrounding structures die

In addition to cartilage damage reaches the disease process and to surrounding structures such as bone, sleeve joints, muscles, ligaments, tendons, and tendons

Overall, the space of the joint is reduced, the joint space is narrowed, osteophytes are formed, ie bone growths, and the joint is deformed

In the most difficult stage, the cartilage is completely damaged and the opposite bones rub and collide.

At this time, there is already peaceful pain and a significant reduction in quality of life.

Gonarthrosis invalidates.

More complicated, therefore, is osteoarthritis as a pathological process that involves:

  • articular cartilage damage
  • abnormal bone formation  - osteophytes
  • reactive changes in the synovial membrane - which is a thin layer covering the cartilage
  • pathology of synovial fluid - excessive production of articular sebum with a possible change in quality

It is also described as an imbalance between weardamage, and the formationrepair of cartilage.  

Ultimately, it leads to cartilage loss = makes walking impossible, and causes disability.

Asymptomatic osteoarthritis occurs in 20% of people around the age of 30
30% of people over 75 have symptoms of osteoarthritis. 
80% of people over the age of 80 have osteoarthritis.
Osteoarthritis most often affects the knee = gonarthrosis


You ask: What causes gonarthrosis?

In this case, degenerative wear and tear is most often mentioned, and is generally used in humans.

However, gonarthrosis also affects the young.


We already know that gonarthrosis is a degenerative non-inflammatory chronic and common disease of the knee joint

In connection with osteoarthritis, 5 main causes are mentioned :

  1. injuries and accidents in everyday life and in sports
  2. excessive physical activity, for example at work
  3. congenital joint disease and anatomical position, axial deviations of joints, hypermobility, or shortening of one limb
  4. metabolic disorders
  5. overweight, especially with a BMI over 27

However, the initial folding that causes gonarthrosis is not always known. 

It is stated that it is the action of several factors at the same time. It, therefore, has a multifactorial basis

Plus, it's an imbalance between wear and tear and cartilage regeneration.

Risk factors for gonarthrosis are:

  • aging of the organism and natural wear and tear
  • genetic predisposition and heredity
  • female gender and hormonal effects
  • injury, meniscus damage, knee fracture 
  • excessive physical overload during sports, activity, or work
  • overweight and obesity
  • osteoporosis
  • incorrect movement habits 
  • uneven terrain under mechanical load
  • lack of exercise, inactivity, and a sedentary lifestyle
  • lack of muscle strength
  • flat-foot
  • DNA - accumulation of uric acid crystals in the joints and other  metabolic or endocrine diseases
  • rheumatoid arthritis is also a risk of developing knee arthrosis
  • smoking

Due to the cause, it is also divided into primary and secondary gonarthrosis.

The primary form has no precise reason for its origin. On the contrary, the secondary occurs as a result of another illness or injury.

Primary osteoarthritis is also referred to as idiopathic.

For secondary reasons, important are, for example, congenital joint diseases, congenital form of joint freedom - laxity (weakness of ligaments), flat foot and hip joint disease, unilateral congestion during sports or workload, but also injuries or inflammatory joint diseases - arthritis, which can lead subsequently to osteoarthritis.

Untreated or incorrectly treated gonarthrosis can lead to complete damage to the knee, its immobilization and disability. Therefore, early detection of symptoms, its diagnosis and early treatment are important.


The main symptom of gonarthrosis is knee pain

People associate knee osteoarthritis mainly with older age. The truth is that it also affects young people.

As many as 20% of people in the third decade of life have gonarthrosis and do not even know about it. It is symptom-free - asymptomatic.

Symptoms of the disease include:

  • knee pain, prick in the knee
  • pain is exacerbated by physical exertion
    • on the contrary, it is dampened by the rest
    • the highest intensity of pain throughout the day, on the contrary, in the morning there is more pain relief
    • however, long-term inactivity and inactivity worsen the course of the disease and the difficulties
    • pain is present from the beginning when running, walking on stairs and uneven terrain, and during higher physical exertion
    • later, with more joint damage, knee pain is associated with normal walking
    • in the last stage of gonarthrosis, there is also pain at rest, also  nocturnal pain
  • swelling of the knee
  • the feeling of heat and heat in the joint
  • joint dysfunction = impaired mobility
    • mobility gradually deteriorates and the pain persists
    • curvature
    • walking up the stairs, getting in the car, or getting up from the chairs is difficult
    • in case of total disappearance of cartilage and inability to move the knee
    • joint stiffness after inactivity
  • cracking, creaking, and cracking in the joint, feeling of sand in the joint
  • joint deformity and formation of bone growths
  • joint instability and feeling of instabilityweakness in the knee
    • there is also a so-called state of  giving away - when walking and lifting the limb, the foot drops, which may be accompanied by a fall
  • reddening of the skin above the joint
  • muscle weakness in the joint area, shortening
  • change in the position of the pelvis and spine
    • disorders of spine statics
    • wrong movement pattern
    • limb shortening

Knee pain is exacerbated, for example, by poor limb position or weather.


The diagnosis of gonarthrosis begins with a history, so it is a description of the difficulties that a person feels. Adding physical examination and examination of the knee.

The doctor evaluates the functional condition of the joint, the range of motion, its stiffness or the nature of the pain, and any deformity and swelling.

In general, imaging examination, such as X-ray, CT, MRI, USG, scintigraphy, is important in osteoarthritis.

Bloodor synovial fluid test will be added. Thus, a differential diagnosis is performed. This is to reveal the exact cause of the disease, such as rheumatoid arthritis (presence of RF) and other rheumatic diseases.

Arthroscopy is another examination when the knee is invasively approached. The doctor then assesses the condition of the cartilage directly. 


What is the course of gonarthrosis? 

As it is a chronic degenerative disease that worsens with age, the course is characterized by long-term progression

The difficulties worsen over time.

It is said that he begins at a young age, at the age of 30. Then gonarthrosis may be asymptomatic, meaning that it has no symptoms.

Osteoarthritis can affect one or both knees (bilateral - bilateral gonarthrosis).

Gradually, slight knee pain is associated, which is accentuated when walking up the stairs, with the descent down the stairs or downhill making it a bigger problem.

It is aggravated by a longer walk and a painful knee is usually all day long. Especially during and after the physical exertion of higher intensity, when the knee is more stressed.

Peace brings relief and in the morning there is low-intensity pain. It can have the character of a prick. It may manifest itself as a knee ache or other unpleasant sensation.

On the contrary, in the morning there is a more pronounced stiffness of the knee, which recedes after warming up or moving.

The process of damage to the knee cartilage is associated with a disorder of joint function, and thus momentum.

Knee swelling is also connected at the same time. The so-called water in the knee is technically referred to as Baker's cyst. It is an accumulation of synovial fluid in the area of ​​the popliteal fossa - a popliteal cyst.

As the cartilage damage progresses, so do the difficulties. 

How the damage to the knee cartilage proceeds
→ the cartilage becomes thinner, defibered
→ deep unevenness is formed in it, cracks
→ joint joint shrinks
→ bone growths are formed
→ cartilage and joint gap disappear 
→ joint deforms
= loses ability to move. 

Pain is present even with mild exertion. Pain is typical, which is accentuated after a period of inactivity at the beginning of the movement, for example when walking. It is technically referred to as starting pain.

There is a curvature while walking, in the knee, it growls, it cracks. All this is accompanied by a feeling of sand in the knee and its instability, a feeling of weakness in the limb.

Progression is characterized by resting pain and pain during passive movement and exacerbation of pain in poor limb position. And at this time, there is also night pain, which wakes up from sleep.

The cartilage and menisci are so destroyed that the adjoining bones, that is, the femur and the bones of the forelegs, rub against each other - literally colliding with each movement. This contact destroys the periosteum, in which the nerve endings are sensitive to pain.

Disease changes also affect bone, muscles, tendons, and their attachments. Bone growths form. The knee is unstable, the joint is deformed, the surrounding muscles are shortened and atrophied.

Until the knee joint becomes completely still.

The worst condition is permanent knee pain that does not respond to commonly available analgesics.

How it is treated: Gonarthrosis

Treatment of gonarthrosis with exercise? Medication, rehabilitation and lifestyle

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Interesting resources

  • medi.de  - pdf with article by Knee Arthrosis
  • webmd.com  - Osteoarthritis of the Knee (Degenerative Arthritis of the Knee)
  • ncbi.nlm.nih.gov  - Gonarthrosis - pathomechanism and diagnosis
  • ncbi.nlm.nih.gov  - Treatment of Advanced Stage Gonarthrosis With Prolotherapy: Case Report 
  • bauerfeind.ca  - GONARTHROSIS Causes and treatment options