Koenig's disease - a kind osteochondropathy, which often affects young men between the ages of fifteen to thirty years (sometimes there are patients older and younger age groups).This condition is characterized by a limited portion of the area of necrosis of the internal femoral condyle (+ articular cartilage adjacent bone).In this disease the bone covering the affected area cartilage gradually flake off and eventually even be completely separated from the bone
Koenig's disease - causes of
exact causes of this disease have not been established.There is speculation that the development of necrosis precedes disturbed for any reason the average circulation knee artery branches, developing as a result of trauma to the joint, or excessive exercise.However, due to the fact that the rejection of necrotic takes quite a long period of time to trace a clear link between the preceding and the affected joint disease Koenig is usually not possible.
Even despite the fact that the ne
addition suspected following predisposing factors of this disease: occlusive disease, thromboembolism, thrombosis, some diseases of internal organs and certain endocrine disorders.
impact of all these factors leads to disruption of the blood supply to the bone tissue and cartilage further education under the focus of avascular necrosis, which leads to the formation of clots in blood vessels and bone destruction.The most common disease Koenig develops in the knee joint, much less affected hip, ankle, elbow and beam joints
Koenig disease - symptoms and effects
Symptoms Koenig in the early stages volatile and inexpressive.Sometimes the place of the lesion becomes hot and swollen skin can appear dull pain and temporarily limited mobility.At this stage, the disease is rarely detected, but continues to progress.At the stage of necrosis swelling of the skin and joint pain are constant.
most prominent symptom is a complete blockade of the joint with the impossibility of it any movement.This suggests that preventing the movement began to separate delaminated portion.Completely it is not yet flaked off, but the process is progressing.Sometimes the blockade of the joint takes place independently, and sometimes results in a patient in a hospital bed due to pronounced swelling and pain.
If the blockade of joint and joint pain were ignored by man, there is a complete separation of the necrotic area of the bone and necrotic tissue causes swelling, severe pain and inflammation sharp
stages and diagnosis of disease Koenig
1 stage.This stage is characterized by the appearance of mild pain and discomfort in the joints associated with exercise or transfer to the injured leg body weight.On radiographs seen the collapse of the center bone oval or wedge-shaped
Stage 2.At this stage, joint pain increases, it joins the inflammatory process, which is expressed in his pain when bending or palpation and severe swelling.Not radiographs more clearly visible collapse of the center bone
Stage 3.At this stage, there is an incomplete separation of the affected area of bone necrosis, which often leads to permanent joint contractures.On radiographs clearly visible shadow necrotic necrotic bone (joint "mouse")
stage 4.For the fourth stage is characterized by a complete separation from his bed necrotic, increased inflammation and pain (due to the movement of osteoarticular fragment).On radiographs clearly determined intra-body
addition to X-ray studies for diagnosis is shown holding a magnetic resonance imaging, computed tomography, ultrasound and radioisotope.Also, according to testimony, carried out arthroscopy, which is to study, using the arthroscope (introduced through microcuts skin) the internal surfaces of the joint
disease Koenig - treatment
disease treatment Koenig in the initial stages is carried out by conservative methods, which include massage, the application improves blood circulation and metabolism of the joint cartilage and bone in the tissues of certain drugs, physiotherapy (electrical and so on.).It is mandatory to maximize unload the joint.The duration of treatment can take up to one and a half years, during which time it is necessary to completely eliminate the physical stress on the affected joint, and then in the absence of pain joins physiotherapy.
Conservative treatment of diseases Koenig is usually quite little chance of a positive outcome.The disease does not matter that it will continue to progress and a fragment of cartilage with attached bone sooner or later will separate.
Unfortunately most conservative treatment is effective in adolescents and children, in adults is usually applied operative (surgical) treatment in which the joint cavity is opened, necrotizing fragment was removed, followed by recovery of plastic tissue defect.
Indications for surgery:
- Despite the conservative treatment of the moving fragment preserved
- Even a disciplined patient there is no effect of conservative treatment
- MRI or radiograph has been increasing or saving changes
- There is almost complete, orcomplete closure of the epiphyseal growth zones.In such cases, a surgical intervention (in adults) is shown, regardless of the current stage of the disease.
Selecting surgical treatment is determined by the current stage of the disease.There are two ways of treatment - removal of the fragment and then performing for educated scratch hondroplastiki (hondroplastika - attempt to restore cartilage grafts nadkostichnye, mosaic hondroplastika, tunneling, etc.) And the fixation of the fragment back.
Osteoarthritis of the knee is a major complication of the disease Koenig.The probability of its development depends on the size of the fragment, localization of disease, as well as the adequacy and timeliness of the treatment.