Arthritis of the Knee (Gonarthrosis)

Arthritis is characterised by progressive deterioration of joint cartilage. If these degenerative changes occur in the knee joint, the condition is referred to as arthritis of the knee (gonarthrosis). The ends of the bones forming the knee joint are covered with cartilage, which serves to make these contact surfaces as smooth and frictionless as possible. Over the years, progressive deterioration of these cartilage surfaces occurs. The causes of arthritis are diverse and, in many cases, multiple. First and foremost is, of course, excessive wear and tear on the joints. Although progressive wearing is "normal" and occurs in everyone, some families have a genetic predisposition to arthritis. Secondly, knee deformities such as bowlegs (genu varum) and knock-knees (genu valgum) result in uneven weight distribution across the knee. As a result, some compartments of the knee are overloaded and overused. Early joint surface damage (arthritis) develops at these sites. Obesity and physical inactivity also promote the development of arthritis. Any trauma resulting in torn ligaments or bony lesions in the knee over the course of time contribute to the development of arthritis.
Once the cartilage damage has occurred, it does not go away because the cartilage is unable to repair itself.

Depending on the severity of the disease, arthritis produces a number of different symptoms, but the primary symptom is pain. In the early stages of the disease, pain occurs when performing certain movements, such as climbing stairs and walking uphill, and later occurs during other activities. Knee swelling and fluid accumulation may also occur, especially after physical activity. Another common symptom is resting pain, which occurs in the affected joint when the patient is not performing any activity but simply lying in bed, etc. The range of motion of the joint decreases progressively, firstly, because the patient tends to avoid using the joint to avoid pain and, secondly, because of the degenerative changes occurring in the joint (see Self-Test).

Most patients report some or all of the characteristic symptoms mentioned above. X-rays of different levels of the knee should always be obtained to establish the diagnosis. The actual physical signs of arthritis can be seen well on X-rays.

An MRI scan may be obtained for precise assessment of cartilage surfaces. MRI allows very precise visualisation and diagnosis of cartilage defects.

Treatment of arthritis of the knee varies greatly depending on the extent of the disease and, above all, on the symptoms experienced by the patient. Symptoms can vary greatly from one patient to another. Pain is the chief complaint in some patients, and physical disability in others. The patients' subjective perception of the disease can also be extremely variable and differentiated. Therefore, we conduct an extensive consultation in order to determine which treatment plan is best in your specific case. Physiotherapy is a crucial element of treatment of knee arthritis. Consequently, physiotherapy is included in all treatment plans.

Viscosupplementation consists of the injection of "artificial joint lubricant" directly into the joint. It is an important component of arthritis treatment. A substance called hyaluronic acid is injected directly into the joint. Hyaluronic acid is produced naturally by the body and serves to reduce friction and act as a shock absorber in the joint. Arthritis leads to more rapid breakdown of hyaluronic acid, resulting in an imbalance. Consequently, the layer of synovial fluid in the joint becomes too "thin". As a result, the cartilage is inadequately hydrated and protected.
The hyaluronic acid used for injection therapy is produced synthetically. When injected directly into the joint, hyaluronic acid covers defects on the cartilage surface, reducing stiffness and pain in the joint. Three to five hyaluronic acid injections are administered in biweekly intervals. The duration of effect of the injections is variable. In most cases, there is a significant reduction of symptoms lasting for several months.

Arthritis is not only associated with degenerative changes in the cartilage, but also with "over-irritation" of the entire joint. A number of different structures inside the knee are affected. Arthritis can affect the mensical cartilage, resulting in degenerative meniscal tears. The mucosal lining of the knee is also affected by the degenerative process. This results in hyper-irritation, inflammation, and overproduction of joint fluid.
A procedure called debridement may be performed during knee arthroscopy. This involves the removal of damaged parts of the meniscus and of hypertrophied and damaged mucosa while smoothing degenerated parts of the cartilage (cf. Knee Arthroscopy).
The treatment results in a significant reduction of symptoms in most patients.

Corrective osteotomy is a surgical procedure used for treatment of deformities of the knee, namely, bowlegs (genu varum) and knock-knees (genu valgum). These deformities result in overloading and overuse of a compartment of the knee. This results in the early development of arthritis. Corrective osteotomy can be considered if the disease is not in the advanced stages, if the patient is relatively young, if the knee is otherwise healthy, and if all conservative options have been exhausted. In corrective osteotomy, a wedge of bone is removed from the tibia (shin bone) at a site determined during preoperative planning in order to correct the deformity and establish an anatomically correct leg axis. The surgery achieves good to excellent results in approximately 80 percent of cases.

Knee replacement surgery should be considered if all other treatment attempts have failed and if the disease is so severe that it is impairing your activities of daily living and physical activities and reducing your overall quality of life. Knee replacement surgery entails replacement of the damaged joint surface; thus, the procedure is also referred to as surface replacement. The damaged joint surfaces at the ends of the femur and tibia are removed and replaced with femoral and tibial metal implant components. A polyethylene cushion is placed between the two implant components. The damaged surface on the rear of the kneecap (patella) may also be replaced, if necessary. At OZM, we use the latest generation of knee replacements and decide which type of implant to use in your specific case. (Link to Witschger knee replacement page)
After surgery, you can expect to stay in the hospital for approximately 10 to 14 days, with an overall rehabilitation period of about 3 months.