Header: Arthrosis (Osteoarthritis)

Arthrosis (Osteoarthritis)

The joints of the human body have to withstand enormous stress. If during the course of time, degenerative arthritis occurs as a result of wear and tear, chronic pain and problems will affect the quality of life. It is therefore all the more important that an accurate diagnosis is ascertained and an appropriate treatment is started as early as possible.

 

Joint structure

A joint consists of two bones, a cartilage layer, covering the bones, stabilizing ligaments and a joint capsule surrounding the joint. A mucous membrane lining the joint capsule on the inside produces synovial fluid to reduce friction between the joint - similar to the engine oil in an engine -. Throughout life it may come to a wearing down of the cartilage layers. The consequences are painful inflammations in of the joints.

What is "Athrosis”/Osteoarthritis?

Commonly, arthrosis is a generative joint disease, meaning it is caused by normal wear and tear on your joints and cartilage. However, there are large gradations. They range from a mild, incipient osteoarthritis to a serious, advanced osteoarthritis, in which a large area of the articular surfaces is abraded. The development of this abrasion is often a lengthy process that can take years. Although osteoarthritis is not curable, its progression can be stabilized.

Which joints are affected by arthrosis/osteoarthritis?

In general, all joints of the body can develop osteoarthritis. Most frequently, however, osteoarthritis develops in the large joints of the lower limbs. Most commonly, the hip joint is affected, followed by the knee and the ankle joint. Osteoarthritis of the shoulder and elbow joint is relatively rare.

What persons are most vulnerable to arthrosis/osteoarthritis?

There are a variety of risk factors, which are connected to a higher likelihood of developing osteoarthritis. Obesity is a major risk factor for the development of hip or knee osteoarthritis. Other risk factors, accidents involving joint damage or misaligned joints (for example, bandy legs or knock knees). Since osteoarthritis is a slow, insidious process, older people are by nature more often affected. But even at an early age a joint osteoarthritis may develop for no apparent reason, when a there is a certain predisposition to osteoarthritis.

How to recognize arthrosis/osteoarthritis

Indications for the presence of osteoarthritis are generally joint pain, which typically occur during physical exercise. There are often so-called start-up pains occurring at the beginning of the movement after a long rest, but becomes less once the person moves around for a while. Pain in the joints after exercising may also indicate osteoarthritis. Another characteristic is a joint inflammation, which may be accompanied by swelling and an overheating of the joint.

How is arthrosis/osteoarthritis diagnosed?

In addition to typical examinations determining where pain is present in the affected joint X-rays or magnetic resonance imaging (MRI), allow for an accurate diagnosis.

What are the treatment options for arthrosis/osteoarthritis?

In general, the body cannot regenerate worn cartilage. It is therefore essential to diagnose and treat cartilage damage as early as possible. The primary aim is to prevent a progression of the cartilage damage, e.g. avoid arthrosis. The further the damaged cartilage has progressed in the joint, the more difficult the treatment. The treatment plan must be determined according to the location and size of the cartilage damage and the individual needs of each patient.
Possible treatments for arthrosis”/osteoarthritis are:

  • General measures and self-help
  • Medications
  • Alternative measures (physical therapy, acupuncture)
  • Surgery

What can I do in case of arthrosis/osteoarthritis?

Important principles are: Also worn joints need regular exercise! Straining and overloading of the affected joint should be avoided! Regular moving through gentle, circular movements (for example, cycling, walking, swimming, etc keep the joints mobile. Weight reduction, soft soles and possibly cushioning insoles are useful to reduce the harsh impact on the joints. Muscle strengthening exercises ensure improved joint congruency and stability. Gymnastics and physical therapy can improve the joint function and decrease the pain. Slight swelling and pain of the joints can be relieved by cold packs. Generally, the symptoms of osteoarthritis are less pronounced in warm, dry climates.

Medicinal treatment of arthrosis”/osteoarthritis

There are numerous medications that work well in the treatment of osteoarthritis. Depending on the severity and intended effect, medication in the form of ointments, tablets or injections are helpful. Ointments have a comparatively low effect. Tablets may be irritating to the stomach. However, injections into the affected joint are very effective.

Effective drugs in tablet form are:

  • Anti-inflammatories / analgesics, such as diclofenac, ibuprofen
  • Cartilage nutrition supplements, for. Example, glucosamine, chondroitin sulfate
  • Homeopathic remedies

drugs that are injected, include:

  • Hyaluronic acid ( "artificial synovial fluid")
  • Cortisone preparations (acute inflammation)
  • Homeopathic remedies
  • Autologous blood (ACP = autologous conditioned plasma)

The treating orthopedist will decide in each individual case which drug to is most beneficial.

Alternative treatment methods for arthrosis/osteoarthritis

Although, is not possible to successfully treat an etiological osteoarthritis with acupuncture, acupuncture can possibly help to lessening pain and inflammation symptoms. The same applies for neural or osteopathy treatments. More recent study results indicate, however, that a regeneration of the cartilage cannot be induced through physical measures such as pulsed signal therapy, bioresonance therapy or magnotherapy.

Surgical treatment procedures for arthrosis/osteoarthritis

Am Beispiel des Kniegelenks werden nachfolgend die wichtigsten operativen Behandlungsmethoden dargestellt. Grundsätzlich sind dieUsing the knee joint as an example, the main surgical treatment methods are presented below. Basically, these options are applied to other joints.

Arthroscopic joint lavage and cartilage smoothing

The arthroscopic joint lavage and cartilage smoothing surgeries are relatively minor surgeries since they are performed minimally invasively via two small incisions. The benefit of the procedures depends, however, on whether there is freely floating or loose cartilage in the joint parts, which can be removed in such a way as to improve the mechanics of the joint.

Microfracture ("bioprosthesis")

In a microfracture, a bone in the area of cartilage damage is intentionally “injured“ within the scope of an arthroscopic surgery. This injury leads to a bleeding, whereby the clotting of the blood is transformed into scar tissue thereby functioning as the body's own cartilage replacement (bioprosthesis). A microfracture is recommended only if specifically indicated cartilage is damaged and the remaining cartilage is not yet affected.

Cartilage bone grafting / osteochondral transplantation (OCT)

In a bone-cartilage transplantation, also called OCT or OATS, cartilage-bone cylinders are arthroscopically removed from a less weight-bearing area of the joint and transplanted into a heavily load-bearing defect area that has previously appropriately drilled (tiny fractures in the underlying bone). Thus, the heavily loaded defect area is covered with high-quality, hyaline cartilage. The results of this surgical procedure are with smaller, specifically indicated damages (up to 2 x 2 cm) in the load-bearing portion of a joint sufficient. Overall, it must be remembered, however, that at in a cartilage bone grafting also damages of healthy cartilage surfaces are created that can lead to discomfort at the cylinder outlet.

Autologous chondrocyte implantation (ACI)

First, cartilage cells are extracted arthroscopically from the patient's healthy cells. In a special laboratory, the cartilage cells are first propagated and subsequently imbedded into carrier membrane. In a second step, the cartilage cell-containing membrane is implanted into the damaged area. This procedure ensures that the cartilage damage will be completely repaired and healed. Currently, a cartilage transplant can only be performed in patients with specifically indicated cartilage damage. However, a further development of this innovative treatment method is anticipated and the application in other cartilaginous disorders is expected.

Correction of the leg axis (osteotomy)

If only the inner or the outside of the knee joint is worn down and the arthrosis is not too advanced, the patient can possibly be helped with a correction of the leg axis. The goal is to reduce weight-bearing of the one-sided worn joint part. In this procedure, the tibia is severed just below the knee and a wedge is inserted and fixed with a plate and screws to the bone until completely healed, just like in a bone fracture. Such an operation is often, combined with a microfracture (s. above), so that, if necessary, replacement cartilage can form in the area of the cartilage defect.

Joint partial prosthesis (sledge/sled prosthesis)

In advanced osteoarthritis confined to the inner side of the joint, the option is a partial joint replacement, the so-called sledge/sled prosthesis. In this procedure only the inside of the joint is crowned with a small prosthesis. The healthy parts of the joint are preserved.

Artificial joint replacement (resurfacing)

In advanced osteoarthritis the artificial joint replacement offers the best solution for the patient to become fully pain free and to lead an active life again. In an artificial joint replacement, the worn joint surfaces are crowned with metal surfaces, usually titanium. Between these surface replacement is sliding layer of plastic (polyethylene).
Due to the recent advances in prosthesis design and the development of the materials used, the durability of endoprosthesis has significantly improved. Artificial joints generally have a life time of about than 20 to 25 years. In case an artificial joint is worn after this time, it can be replaced.

Arthrosis/Osteoarthritis is not curable!

Arthrosis/osteoarthritis (degenerative joint disease) is not curable, that is why it is important to accurately assess joint pain as early as possible. Only then can an otherwise often rapidly progressing wearing-of the joints be stabilized.

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