Knee osteoarthritis (gonarthrosis) is understood to mean all wear-related (degenerative) diseases of the knee joint, which are characterized by increasing destruction of the articular cartilage with the involvement of joint structures such as bones, joint capsules and muscles close to the joint.
Together with a complex capsule and ligament apparatus (lateral and cruciate ligaments), three bones form the framework of the knee joint.
- the thigh (thigh rolls or femoral condyles)
- the tibia head (tibia plateau)
- the patella.
Bones of the knee are in close contact. So that pain-free and undisturbed mobility of the knee joint can also take place on the contact surfaces, the bones on the respective contact surfaces are covered with a very smooth, whitish layer of cartilage. It is only through them that painless and undisturbed mobility of the knee joint is possible.
In the case of knee osteoarthritis, there is wear of the knee joint. Signs of wear can occur in isolation, or preferably affect the inner or outer part of the knee joint.
The more detailed definition of knee arthrosis shows which part of the knee is mainly affected:
- Medial knee osteoarthritis: mainly the inner part is affected
- Lateral knee osteoarthritis: the outer part of the knee joint is mainly affected
- Retropatellar arthrosis: it mainly affects the patella joint surface
- Pangonarthrosis: All three joint parts are affected
- Osteoarthritis of the thigh roll (femoral condyle)
- Osteoarthritis of the tibia head / tibia plate (tibia plateau)
Osteoarthritis of the knee is a common adult disease with a high prevalence (27-90% depending on the study) among people over the age of 60. Due to this fact, there is a high socio-medical importance. Knee arthrosis affects not only the ability to work but also the personal quality of life. The female gender is significantly more often affected by knee osteoarthritis.
Causes Of Gonarthrosis
Causes of knee osteoarthritis:
- Axis deviations (X or O leg)
- Injuries to the knee, e.g. Fracture with joint involvement
- Systemic diseases, e.g. B. hemophilia
- Rheumatoid arthritis (rheumatism, chronic polyarthritis)
- Inflammation of the knee joint by bacteria (bacterial arthritis)
- Misplaced kneecap
- Muscular imbalances, e.g. paralysis
- Osteochondrosis dissecans
- Metabolic diseases, e.g. gout
Important influencing factors that favor knee osteoarthritis:
- Incorrect loading
- Endocrine factors (e.g. hormones, increased occurrence of osteoarthritis after the menopause)
- Torn ACL
Symptoms Of Gonarthrosis
After lying down or sitting for a long time, those affected often complain of a feeling of stiffness in the knee joint, combined with pain on starting.
The knee tends to swell and develop effusions, which increases the pain even with low loads.
Flare-ups, which tend to occur rarely at first, are more noticeable. In addition, the knee joint takes a long time to return to an irritation-free state.
The stress sensitivity increases more. Climbing stairs and going downstairs and downhill become painful more quickly. The patient's knee appears insecure, the irritation symptoms increase.
As the disease progresses, more and more pain causes the patient to stop, for example when walking. This significantly reduces the walking distance. Due to the pain-related relief, the muscles of the thigh shrink. Attentive observers have the impression that the stability of the knee joint decreases, especially on uneven ground.
This ultimately leads to the fact that joint mobility continues to decrease and sometimes severe complaints also occur when at rest (e.g. while sleeping). Axial changes of the knee joint, in the sense of bow legs (= varus - gonarthrosis or varus gonarthrosis) or X legs (= valgus - gonarthrosis or valgus gonarthrosis) can also occur.
Osteoarthritis of the knee can lead to fluid retention in the bones due to damage to the articular cartilage. This is mostly reflected in the clinical picture of a bone edema on the knee.
- Assessment of leg axis: muscle atrophy, leg length difference,
- Gait pattern, knee swelling, skin changes
- Effusion, swelling, dancing patella
- Crepitus, d. H. noticeable rubbing behind the kneecap
- Kneecap mobility
- Pain in displacement of the patella (zohlen - sign)
- Tenderness of the patella facets (tenderness to the right and left of the patella)
- Pressure pain at the joint space
Function test and pain test
- Assessment of range of motion and pain in movement, ligament stability
- Meniscus sign - to prove damage in the area of the inner meniscus or outer meniscus
X-ray of the knee joint in two planes.
Equipment tests useful in individual cases:
- X-ray functional images and special projections for planning the operation and assessing special forms of arthrosis
- Sonography (ultrasound): assessment of knee joint effusion, baker's cyst
- Magnetic resonance imaging of the knee: meniscal damage, cruciate ligament damage, osteonecrosis
- Computed Tomography: Fracture with Cartilage Level?
- Skeleton - Scintigraphy: Inflammation?
- Clinical-chemical laboratory for differential diagnosis = blood test: signs of inflammation?
- Puncture with synovial analysis: rheumatism, gout, bacteria?
Medical history / Anamnesis
Which facts play an important role in the collection of the medical history?
- Localization, functional restriction, duration, intensity, daily rhythm, radiation of the pain
- Load-bearing capacity
- Pinching, blocking, feeling of instability
- Pain-free walking distance
- Tendency to swell, complaints when going down or down the stairs
- Walking aids
- Previous accidents
- Previous patella luxation (kneecap dislocated)
- Previous knee disorders
- Prior conservative or surgical treatment
- MRI from the knee
- Magnetic resonance imaging (MRI) is a very good diagnostic method for determining the extent of knee arthrosis
The soft tissue, particularly the cartilage damage in the knee, is particularly good on MRI, but the bone can also be assessed. Since arthrosis has many sequelae, the MRI can be used very well to assess the course and can show consequential damage to the articular apparatus.
The MRI enables a high-resolution representation of the cartilaginous parts of the joint - the menisci. These are often affected and worn out in the context of osteoarthritis. The extent can be seen well on MRI images.
Concomitant injuries to the menisci, such as meniscus tears, can also be determined from the knee using MRI. With knee osteoarthritis, there are often irregular bony attachments in the joint area, the so-called osteophytes. These can also be detected at an early stage using MRI.
Inflammation of the joint mucosa (synovitis / synovitis) can also be seen on the MRI from the knee joint. A thickened and signal-enhanced joint mucosa appears. A joint effusion often forms, which leads to swelling of the knee.
However, MRI can also detect other pathological changes in the knee joint area, especially cartilage damage. If the blood supply to the bone is no longer guaranteed, osteonecrosis can occur. The bone dies in this area and can cause severe pain. MRI is the diagnostic method of choice to identify such changes early on.
Conservative Therapy For Gonarthrosis
Targeted exercises can make a great contribution to stabilizing the knee joint muscles and ability to coordinate and to relieve the affected joint. Ask your physiotherapist about individual, suitable exercises. In principle, selected exercise units should not be painful and should correspond to the possible range of motion of the knee osteoarthritis.
Warm up for about 5-10 minutes before starting the exercise and then carry out the exercises calmly and in a controlled manner. A short stretching phase is recommended after each workout to prevent muscle and ligament shortening. To achieve optimal training success, you should complete the exercises two to three times.
Two simple examples can be:
- Bridge: Lie on your back and put both legs up. Now lift the pelvis until only the shoulders are in contact with the floor. Now hold this position for 30 seconds and then carefully lower the buttocks. As a variation, one leg can alternately be released from the floor and stretched.
- Dangle legs: Sit carefully on a table top so that the legs hang freely in the air. Then move your legs alternately back and forth.
The main focus of drug therapy for knee osteoarthritis is pain control. At the beginning of therapy, medications such as ibuprofen, paracetamol, Voltaren® (Diclofenac) or novamine sulfone (Novalgin®) are suitable. The drugs mentioned have a good analgesic effect, but can cause damage to the stomach, kidneys and liver if they are taken continuously. To prevent gastric mucosal inflammation or gastric bleeding, supportive medicinal therapy should therefore be resorted to, especially when taking the stomach for a long time, with a gastric acid blocker (proton pump inhibitor, pantoprazole).
With advanced knee osteoarthritis and accompanying severe pain, stronger pain medication may have to be used. Agents from the group of opioids, such as Tramadol or Tilidine.
From a long-term perspective, drug therapy for knee osteoarthritis is only a symptom check and does not eliminate the trigger. Permanent and regular use of painkillers, especially ibuprofen etc., should be avoided due to the many side effects!
Physiotherapy / Manual Therapy
Physiotherapy and manual therapy are an important component in the therapy of knee osteoarthritis. Targeted physiotherapy exercises strengthen the muscular system, stabilize the knee ligaments and promote the patient's ability to coordinate.
During physiotherapy, those affected are gradually introduced to the exercises or equipment and, ideally, taught to be able to carry them out at home. For knee osteoarthritis, for example, Water aerobics is excellent, since the joint is relieved.
Many patients also suffer from lymphatic drainage disorders in the affected joint - the knee swells and becomes fat. With manual therapy, special massage and wrapping techniques can provide relief and drain the lymph.
In the case of knee osteoarthritis, surgery should only be carried out in those patients in whom all conservative therapeutic measures have been tried out over a reasonable period of time and could not bring about any improvement in the symptoms.
In principle there are three different surgical interventions that can be considered:
- Arthroscopy (joint mirroring, it can be done open or closed), possibly in combination with a removal of damaged menisci (meniscus tear), cartilage fragments or the joint mucosa, a cartilage smoothing, a so-called bioprosthesis (abrasion chondroplasty) or a microfracture.
- A changeover operation (osteotomy), in which existing X-legs or bow legs are corrected.
- The implantation of an artificial knee joint, i.e. a knee prosthesis. Which technique is chosen depends on various factors, especially age, general condition, individual suffering and pain and the stage of the disease.
- During the changeover operation, the physiological axes in the knee joints are restored in order to prevent the incorrect and excessive stresses in the joint caused by the X or O legs and thereby prevent the progression of the arthrosis.
Arthroscopy removes parts of the cartilage that have become detached as a result of osteoarthritis and lead to symptoms. The damaged layer of cartilage is also strengthened. This measure is usually only carried out in patients in whom the osteoarthritis is still at a relatively early stage and where there is still a thin layer of cartilage. The advantage of this operation is that it enables the patient to relieve the knee relatively painlessly immediately after the procedure.
However, if the arthrosis has progressed, the cartilage layer has been completely lost at least in places and there is exposed bone in the joint. Such "bone holes" can be filled with tissue made of fibrous cartilage.
Microfracturing involves inserting tiny holes in the bones and then covering them with blood that contains stem cells. Over time, these form new cartilage tissue that can now cover the articular surfaces and is almost as stable and resilient as the original cartilage.
In abrasion chondroplasty, the entire upper bone layer is removed with a knife-like device. This leads to bleeding in the joint, which ultimately triggers a healing process, which ultimately, like microfracturing, also results in the formation of cartilage replacement tissue.
These two techniques are preferable to the endoprosthesis, if you have the choice, because they regain greater resilience of the knee and represent an endogenous repair process in which nothing is implanted and therefore there is no risk of rejection or the need for a new operation, once the prosthesis is worn out.
The knee replacement (= endoprosthesis) is therefore carried out especially in older patients, who on the one hand usually do not put as much strain on their knees as younger people and, moreover, the limited durability of the artificial joint is not so important. Even in very severe cases of knee joint arthrosis in younger patients, an endoprosthesis can be used after careful consideration of the advantages and disadvantages.
In addition to surgical therapy methods, there is also the option of treating knee osteoarthritis without a surgical intervention. Which therapy method promises the best therapy success in an individual case depends on a number of different factors. Individual factors of the person concerned, such as age, job, exercise, weight and the extent of osteoarthritis, as well as the patient's personal preferences, have an influence on the decision of the therapy procedure.
In most cases, knee osteoarthritis is initially treated conservatively. Only if conservative therapy is unsuccessful is a surgical measure the last option to treat osteoarthritis of the knee. It is important to know that osteoarthritis of the knee cannot be treated causally. Neither conservative nor surgical procedures can treat the wear and tear and reverse damage to the articular cartilage. All available therapy options aim to improve symptoms and slow the progression of the disease.
The most important measure of conservative therapy is taking pain and anti-inflammatory drugs (see: Medications for knee osteoarthritis). So-called NSAIDs are usually taken, which in addition to alleviating symptoms also promise an improvement in the local inflammatory response at the knee joint.
Local measures involve injecting anti-inflammatory drugs or hyaluronic acid into the joint. With this measure, the symptoms of osteoarthritis can be improved for a certain period of time.
Alternative therapy options also exist in a targeted physiotherapy which can take up different treatment approaches. In addition to professional physiotherapy, which is usually useful for osteoarthritis, heat treatment, acupuncture or stimulation of the nerve endings on the knee (TENS) can improve the typical symptoms.
Depending on the cause of the osteoarthritis, orthopedic measures can also help to minimize the progression of the disease and improve the symptoms. Wearing orthopedic insoles is often recommended in the treatment of arthrosis.
Ointments For Knee Osteoarthritis
There are different approaches to eliminating the symptoms of knee osteoarthritis and preventing the disease from progressing. Since knee osteoarthritis of the knee is a wear and tear disease of the articular cartilage, there are only limited possibilities to get to the place where the pain develops. In addition to medications taken orally or agents injected into the joint, there is also the option of applying ointments to the knee. As a rule, these are ointments that contain pain and anti-inflammatory substances such as diclofenac. However, it should be noted that the active ingredient contained in the ointments is unable to penetrate into the interior of the joint. Rather, as with oral intake, the active ingredient is distributed throughout the body and can reach the affected joint via the bloodstream.
Progression or healing of the knee osteoarthritis cannot be achieved by applying ointments. If symptoms are present, a doctor should be consulted in any case, who can assess the individual joint damage and make a therapy recommendation.
Prognosis For Knee Osteoarthritis
Is knee osteoarthritis curable?
Despite intensive research and development of new therapeutic options, it has so far not been possible to cure the knee osteoarthritis. This is because once the articular cartilage is destroyed, it cannot fully regrow and regenerate. Even with modern therapy methods, it is usually only possible to improve symptoms and prevent the disease from progressing.
Although some alternative therapy methods promise to cure osteoarthritis, they should be viewed very critically, since scientific evidence for their effect has not yet been able to be provided. In order not to risk any financial or health damage to these therapies, detailed advice on possible therapeutic procedures from a treating doctor is recommended.
However, since the progression of the disease can be prevented, treatment of osteoarthritis makes sense in any case. An improvement in symptoms can also be achieved in most cases using conventional medical methods.
When knee osteoarthritis is well advanced, implanting a new joint can help restore original mobility and freedom from pain. However, since the implantation of an artificial joint is not a measure that is understood as complete healing of the joint, osteoarthritis is still considered incurable.
Final stage of knee osteoarthritis
Arthrosis of the knee joint is a wear and tear disease that attacks the cartilage of the joint. In the course of the disease, this is worn down to such an extent that free bone sites are created. If arthrosis is not treated, the progression of the disease is guaranteed. This leads to a severe loss of cartilage, particularly in the case of long-standing arthrosis diseases and in the case of untreated arthrosis.
A total of four stages of osteoarthritis can be distinguished. The final stage of the disease is stage 4. Here there is a total loss of cartilage in the joint. Stage 3 is also a severe finding of arthrosis and describes deep cartilage damage.
The treatment options in stage 4 arthrosis are limited compared to the other stages. Surgical treatment of the joint is often necessary in order to be able to remedy the symptoms of wear and tear. Advice on individual therapy options can best be given by the attending doctor.
Jogging For A Knee Osteoarthritis
Knee osteoarthritis is a gradual, progressive wear disease of the knee joint. Which cause is responsible for the individual development of the disease can often not be definitively discussed.
Especially when young people develop osteoarthritis of the knee, however, an overloading of the joint due to sport and a genetic predisposition are suspected of being the trigger for the wear. However, sport alone can only be blamed for osteoarthritis in rare cases. It is even discussed that regular sporting activities are a protective factor against the development of osteoarthritis. In most cases, regular jogging leads to the development of osteoarthritis of the knee.
When a knee osteoarthritis of the knee is diagnosed, the question arises in many people whether this is the end of the sporting activity, especially for jogging. In most cases, targeted exercise combined with appropriate therapy and performing specific exercises can help improve the symptoms of osteoarthritis of the knee.
When jogging, however, care should be taken to ensure that the knee joint is not subjected to particularly heavy loads. This can be achieved by using special shoes and choosing the jogging route. Sprints and sudden stopping should also be avoided. It is also important that training should be interrupted if pain occurs.
If the load is only possible with painkillers, a load such as that which occurs when jogging is not recommended. In these cases, targeted physiotherapy can help strengthen the leg muscles and thus improve the symptoms of osteoarthritis of the knee.
If the arthrosis has been treated by surgery, strict protection of the joint is recommended. In the course of the healing, a partial load as well as a full load on the knee joint and muscle building can be possible and useful. At which point in time resuming training does not pose a risk to the healing process can be best assessed by the treating surgeon, taking into account the surgical method and individual factors.
In general, the resumption of training with simultaneous knee osteoarthritis should not be carried out without consulting the doctor in charge.