Arthritis of the knee. Diagnostics & Therapy
How knee osteoarthritis is diagnosed and treated.
The type of treatment for osteoarthritis of the knee depends primarily on the extent of joint wear. In addition, however, the age, work and leisure time activities and the degree of restriction of mobility and quality of life play an important role. A thorough diagnosis helps to find the right individual therapy in knee osteoarthritis.
For mild degenerative joint disease in the knee, the first attempted is to relieve the symptoms with conservative measures, such as physical therapy, physical treatments and medications. If a satisfactory improvement can't be reached, also an arthroscopy with joint reconstruction and cartilage smoothing can be performed.
In case of massive joint destruction, the replacement of the defective knee joint is necessary - an artificial joint.
The Schön Klinik offers you the entire spectrum of medical treatment for knee osteoarthritis - from investigation to rehabilitation.
Diagnostics, therapy & treatment of knee osteoarthritis.
Diagnostics. How arthritis of the knee is diagnosed
How is arthritis of the knee identified?
After a detailed discussion with our patients we here at the Schön Kliniken decide on a course of action if there is suspected arthritis of the knee. Then during an initial physical examination the knee is examined for swelling and its mobility tested. Movement-related pain can be clarified quickly by various hand grips and techniques to confirm any initial suspicions.
The examination is normally painless. During the examination our specialists look out for:
- Range of movement
- Capsular swelling
- Abnormal positions
An X-ray is the most important pointer.
Imaging procedures are indispensible. An X-ray examination is the first and most important pointer. Change to the bony shape of the joint can be identified without problem in this way. The distance between the bones and a narrowed joint space allows conclusions to be made about the state of the joint cartilage. The smaller the joint space the less joint cartilage there is remaining in the joint to act as a protective layer. Therefore the smaller the joint space the more advanced the arthritis.
Ultrasound and Nuclear spin tomography (MRI) for further clarification.
„Additional to an X-ray, ultrasounds, magnetic resonance tomography (MRT/MRI) or computed tomography (CT) can follow on to diagnose arthritis of the knee“ says knee specialist Prof. Dr. Pavel Dufek Consultant Orthopaedist at the Schön Klinik Neustadt. „With the the help of an ultrasound examination soft tissues such as muscles or capsules can be clearly seen while the MRI images clearly depict ligaments, tendons and muscles.“
With suspected rheumatic or bacterial joint inflammation, a blood test may also be necessary or even a puncture of the joint.
Therapy. Treatment possibilities of knee osteoarthritis
What types of treatment are available for knee osteoarthritis?
Arthritis does not mean an artificial joint immediately. For many patients this is certainly a clear improvement, but there are numerous options in the first instance for treating arthritis of the knee conservatively &; i.e. without an operation.
We at Schön Klinik always give the treatment of pain top priority. The combination of medication, physiotherapy, electrotherapy or X-ray irradiation can possibly alleviate knee symptoms – especially at an early stage. In individual cases products that build up cartilage can bring an improvement.
Preserve the patient's own joint - Operations for Arthritis of the Knee.
Only when all the conservative options have been exhausted in terms of improving pain and mobility should an operation be given consideration. An artificial joint does not need to be used straightaway. There are surgical procedures available which clean the natural joint - for instance a corrective osteotomy. This may possibly avert or delay an implant.
Small meniscus and cartilage damage can be reconstructed with a joint endoscopy operation (arthroscopy). A corrective operation (osteotomy) can improve the statics of the natural joint. This can also correct malpositions such as bandy legs and knock knees. If ligaments are damaged and the knee joint particularly unstable because of this, a joint stabilisation operation is recommended.
Comparison: Joint cleansing versus prosthesis
Artificial joint? Or preferably joint cleansing? Which method is suited to which patient...
Artificial joint - the right point in time.
Damaged. Destroyed. Total damage: If arthritis in the knee is already far advanced, an artificial joint replacement is the final option. When should you decide on this? „Professor Dr. Pavel Dufek, Consultant Orthopaedist at Schön Klinik Neustadt is certain that the right time for an operation has come when your quality of life is considerably impaired.&ldquo.
„The correct time to operate is when mobility is severely reduced, the pain has become hard to bear and conservative measures have not eased symptoms sufficiently – then most certainly the right time has come for an operation.“
Artificial joint - what is possible today?
When it comes to deciding on a knee prosthesis, what has been there up to now is not just removed and replaced by something artificial. All that is replaced is simply the uppermost layer of the joint bone. The prosthesis so to speak is superimposed and the joint bones receive a new surface. So the prosthesis takes on the function of the joint cartilage. It ensures that the femur, tibia and patella do not rub against each other. It is fitted as a place holder. There are two different types of artificial knee joints: The partial surface replacement described in professional terms as a 'unicondylar (unicompartmental) resurfacing of the knee joint'. A complete surface replacement is also possible. This is described as a knee endoprosthesis. Fitted and adjusted down to the last millimetre with the aid of a computer, an artificial knee joint sits as if cast into place.
Computer utilisation during surgery
Artificial knee joints can be inserted and fitted with greater precision with computer assistance.
Individual knee prostheses.
Today's prostheses are made to be very individual. The artificial joint should imitate as best possible the mechanics of the person's own joint. Depending on the extent of the arthritis, bone quality, joint stability and axial misalignment, we make an individual choice of possible implants here at Schön Klinik in the period prior to the operation. The patient's age, gender, bone quality, weight and, last but not least, the activities of daily living also play a role in this decision. At the present time an artificial joint will last from 8 to 15 years. Then it has to be replaced by a new one.
Different types of knee joint endoprosthesis.
Surface replacement or cap endoprosthesis.
Similar to surface replacement of the hip joint, here in a bone-saving way, the damaged joint surface only is replaced by the prosthesis. In addition, the natural ligaments of the knee joint are retained as stabilisers. Apart from important bone preservation, in this way natural mobility of the new joint can be achieved by preserving the anatomic soft parts. If only part of the knee joint is worn, partial replacement of the damaged area only (unicondylar replacement) is possible instead of total surface replacement (bicondylar replacement). For many years, the focus of endoprosthetics has been the implantation of knee joints using modern computer navigation systems. This enables substantially more precise and reliable positioning of the joint components and balancing of the capsular ligamentous apparatus than with conventional methods. As with the hip, in suitable cases, knee endoprostheses can be inserted using minimum invasive methods, i.e. in a particularly tissue-protecting way.
Coupled (hinged) or partly coupled prostheses.
In certain cases, in the event of unstable knee joints, marked malformations or replacement operations, implants have to be chosen which have sufficient stability even in case of insufficient or a lack of ligaments. Due to the modularity of our implants, depending on the needs, different degrees of coupling can be chosen. In addition, by using stems and metal blocks, it is also possible to achieve secure anchoring of the prosthesis even if the bone situation is poor.
Arthritis in the knee
A knee is like a creaking door: If the knee becomes less and less mobile, then very likely the joint will be damaged.
Arthritis of the knee. FAQ
What is a coupled knee endoprosthesis? What risks are there with an operation? You have the questions and we have the answers.
Our Specialised clinics & hospitals for diagnostics, therapy and treatment of arthritis and diseases of the knee joint.