Orthopedics - Oleksa A.P. 2006

Joint Diseases
Degenerative and Dystrophic Joint Diseases

Degenerative and Dystrophic Joint diseases account for nearly 3% of all orthopedic pathologies, ranking first in frequency among joint disorders. They are accompanied by prolonged loss of working capacity and are frequently a cause of disability.

The fundamentals of degenerative-dystrophic processes were introduced as early as 1743–1759 by the Hunter brothers, while the term "Arthritis deformans" was coined by Rudolf Virchow in 1869. However, at that time, degenerative-dystrophic processes were not differentiated by Etiology and were considered a rheumatic process. It was not until A. Hoffa and G.A. Wollenberg (1908) separated them from the group of arthritides into an independent category. The term "arthrosis" was introduced in 1911 by Müller, who distinguished it as a separate nosological unit.

Over time, degenerative joint disease has had more than a dozen designations, although all of them referred to the same pathology.

Currently, we use the terms "deforming arthrosis" and "osteoarthritis," both of which are valid. Depending on the cause, disease duration, and patient age, clinical and radiological manifestations may vary yet share similarities. The disease leads to impaired joint biomechanics, which largely depend on biochemical disorders in the articular Cartilage, synovial membrane, and synovial fluid (Erlich M., Mankin H., 1975; Odenbring et al., 1992).

In some cases, pathological changes are exclusively limited to the involvement of joint elements; in others, they extend to the periarticular Bone Structure and surrounding soft Tissues.

Depending on the duration of the disease, pathological Changes in the joint may over time be further complicated by synovitis, as well as alterations in the bone adjacent to the cartilage and in the soft tissues. The underlying mechanism is driven by degenerative-dystrophic rather than inflammatory changes, which is why arthrosis is rarely accompanied by exudation.

Based on the etiopathogenesis of osteoarthritis, it can be divided into Primary and secondary forms.

Primary (idiopathic) forms comprise those degenerative-dystrophic joint alterations where the underlying cause cannot be identified using available Methods. A certain role may be played by genetically predetermined, albeit yet unproven, abnormalities in The structure of articular cartilage, which can undergo degradation—even under normal loads and joint function—subsequently leading to The Development of osteoarthritis.

Sometimes the onset of the disease is attributed (Freeman M., 1980) to an unknown factor that initially triggers focal degenerative-dystrophic changes in the cartilage, and later involves adjacent structures, progressively engaging all elements of the joint.

Primary osteoarthritis invariably follows a chronic, gradually progressive course. It most commonly occurs in individuals over the age of 60, who typically seek medical attention for coxarthrosis or gonarthrosis.

Secondary Osteoarthritis may develop As a result of congenital or acquired malformations, various joint diseases, as well as post-traumatic incongruities of the articular surfaces, among other causes.

We suggest adhering to the most practical Classification of secondary deforming arthroses based on their etiology: 1) dysplastic; 2) static; 3) post-traumatic; 4) post-infectious; 5) post-aseptic necrosis.

This classification enables a differentiated assessment of pathological changes within the joint and provides a pathogenetic approach to selecting the optimal Treatment strategy for the patient.

The problem of deforming arthroses remains highly significant from both social and medical Perspectives, as evidenced by the sheer volume of recent periodical literature and proceedings from international orthopedic congresses and conferences dedicated to this topic.