Knee joint arthrosis - Osteoarthritis of the knee
Conservative & prosthetic care
ÜBERSICHT
Osteoarthritis is defined as a degenerative change in a joint. This leads to wear and tear of the joint cartilage until it is partially or completely depleted. As a result, the bone becomes deformed (deforming osteoarthritis) and misalignments of the leg axis worsen (bow leg, knock-kneed leg)
Cause of osteoarthritis of the knee joint
The knee joint is biomechanically a very complex joint that reacts very sensitively to disturbances. Increased strain due to excess weight or one-sided incorrect loading due to atypical axial misalignments (knock-knee or bow-leg) lead to premature wear and tear of the joint cartilage. In the case of varus gonarthosis (bow leg), the degenerative changes occur on the inside of the knee. Valgus gonarthrosis (knock-knee) is characterized by increased wear on the outside of the knee. Also Meniscus damage which have been treated with partial meniscus removal (partial meniscus resection) also lead to gonarthrosis in the long term, with a partial lack of buffer function of the meniscus. Similarly, instabilities of the knee joint, such as after a cruciate ligament rupturelead to increased wear of the meniscus and joint cartilage.
Symptoms of osteoarthritis of the knee joint
As with osteoarthritis of the hip joint, the joint pain is typically load-dependent, as is the initial pain in the morning, which can improve again after a little movement, depending on the extent of the osteoarthritis. The formation of effusion, usually in the evening or after excessive strain, is also characteristic of osteoarthritis of the knee. With advanced disease, many patients already complain of pain at rest , which torments them when lying down and especially at night.
This is a progressive disease with increasing symptoms. Phases of freedom from symptoms as well as intermittent exacerbations are typical.
- Exercise-induced joint pain
- Morning start-up pain
- Effusion formation
- Walking distance reduction
- Intermittent exacerbation
Diagnosis of osteoarthritis of the knee joint
In addition to the exact medical history (course of the disease), cracking noises (crepitations) on examination are a sign of damage to the joint cartilage and, subsequently, osteoarthritis. A knee joint with a chronic joint effusion is usually slightly overheated but not reddened. A so-called Baker’s cyst (cyst in the hollow of the knee) usually forms due to chronic irritation in the joint and is easily palpable in the hollow of the knee from a certain size. A restriction of movement both in flexion and even more so in extension (extension inhibition) can be detected and become apparent during a gait analysis.
Specific x-rays are usually sufficient to confirm the clinical diagnosis. The malalignment (knock-knee or bow-leg) can be measured well in the whole-leg X-ray.
How is osteoarthritis of the knee treated?
In the early stages , conservative therapy is always in the foreground. The initial symptoms can be alleviated and the relapsing course controlled with physiotherapy exercises and the temporary use of anti-inflammatory medication. Exercise must be maintained under all circumstances. Weight reduction can also significantly reduce the strain on the damaged joint in the event of such problems.
If this no longer leads to the desired success, injections with cortisone can be administered directly into the joint (intra-articularly) to support the anti-inflammatory effect. Injections with hyaluronic acid and autologous plasma (ACP) are also a good way of alleviating pain and offer a good option for conservative treatment of knee joint arthrosis.
Total knee joint endoprosthesis / K-TEP
With increasing suffering and life-limiting pain , the last option is artificial joint replacement(knee joint prosthesis). The X-ray image only gives an indication of the extent of the osteoarthritis. The pain and changes to everyday life are problematic for each patient individually, so the indication for surgery is determined together with the patient. YOU decide when the operation should be performed.
Knee joint prostheses are planned by me in advance using a standardized planning X-ray to determine the prosthesis size and position individually. Only then can the best possible result be achieved. If the joint is worn on one side and the ligaments are intact, half-slide prostheses are also used to protect the remaining unaltered parts of the joint.
Life is like a bicycle. In order not to lose your balance , you have to keep moving .
Follow-up treatment after a knee prosthesis
The hospital stay is approx. 10 days, but is very individual. An increase in mobility can be started on the first day after the operation using physiotherapy and a passive motor splint. Adequate pain therapy is important in this phase. In the first 3 months, a rehabilitation stay has proven successful in order to increase mobility and mobility as soon as possible.
Frequently asked questions
Osteoarthritis of the knee is an irreversible disease. Once the diagnosis has been made, the right time for the operation must be found. The aim is to improve your quality of life.
Persistent pain, regular use of pain-relieving medication and a reduction in performance due to the discomfort indicate that it is time for a knee joint prosthesis.
If you wait too long, the leg muscles atrophy due to reduced movement. Poor coordination and reduced musculature prolong the rehabilitation phase after surgery and worsen the clinical outcome.
Partial weight-bearing with 2 forearm support crutches should be maintained for 4-6 weeks after the operation. The prosthesis needs this time to bond firmly with the bone.
The pain will improve from week to week. Nevertheless, pain is to be expected until the 8th week. Swelling can even occur for up to 1 year.
Modern prostheses have a service life of approx. 15-20 years. This depends on the load placed on them. This is increased, for example, by sporting activities but also by being overweight.
