Numerous people suffer from patellar osteoarthritis as they age. It is a progressive process in which damage and subsequent breakdown of the articular cartilage behind the kneecap occurs. Especially if the progression is not age-related, the resulting impairments can be significant.
What is patellar osteoarthritis?
Patellar osteoarthritis is wear and tear of the cartilage behind the kneecap. In addition to the aging process, this development can accelerate due to various causes. The cartilage becomes increasingly rough and cracked. The constantly necessary supply of nutrients to the cartilage tissue to ensure the healthy functionality of the knee joint is impaired. The body’s own production process for making synovial fluid decreases to such an extent that the cartilage layer behind the kneecap becomes narrower and more brittle. The elasticity of the cartilage tissue is increasingly lost. As a result, the affected person experiences pain that intensifies over time. The knee joint becomes increasingly stiff, which ultimately means that pain-free everyday mobility is no longer possible. Since the cartilage tissue is not supplied with blood, the therapeutic options are considered limited. Therefore, it is all the more important to reduce or eliminate existing risk factors within the scope of personal possibilities.
Causes
The causes of patellar osteoarthritis (retropatellar osteoarthritis) can vary. The trigger for wear and tear of the cartilage behind the kneecap may be a hereditary reduction in cartilage quality. Also congenital, the lateral retaining ligaments of the kneecap may be too short and cause a slight change in the position of the kneecap (patella). Excessive wear in the patella joint (femoropatellar joint) can also be caused by heavy loads such as heavy carrying, frequent kneeling (tiler), overweight or due to congenital leg malpositions. This results in excessive pressure of the kneecap on the femur, promoting wear and tear of the cartilaginous surface. Patellar osteoarthritis can also be caused by a hereditary deformity of the patella. A fracture of the patella or patellar lateralization can also be responsible for the development of the disease. This is a functional disorder of the patella in connection with a disturbed use of the gliding path. Treatment errors in meniscus or cruciate ligament injuries can cause a deficit in the necessary stabilization function related to the knee joint. In the long term, this can trigger arthrosis in this affected area. Ultimately, osteoarthritis of the kneecap can also occur as a result of inflammation of the knee joint.
Symptoms, complaints and signs
Initial symptoms that may indicate patellar osteoarthritis often present themselves as crunching noises when walking down stairs. The same phenomenon may present itself when standing up after sitting for a long period of time. If additional pain develops during this motion sequence, patellar osteoarthritis is the likely cause. Another sign of arthrosis is also an increase in pain sensation with additional loads (strain pain). If particular sensitivity occurs in wet and cold weather, this also indicates the presence of patellar arthrosis. Symptomatic is also the increased occurrence of pain at the beginning of movements or loads. After some time, the pain then decreases again. This typical course of the arthrosis disease is also called start-up pain. Over time, the pain intensifies and the movement restrictions increase. Eventually, stiffening of the knee joint occurs.
Diagnosis and course of the disease
Diagnosis initially includes a thorough physical examination and extensive questioning of the patient to find out any past medical history. Among other things, attention is paid to overweight and possible malpositions of the legs. In addition, the movement of the patella is assessed, particularly with regard to possible displacement in the sliding bearing. Imaging procedures such as ultrasound examinations and X-rays contribute to further clarification.In individual cases, magnetic resonance imaging may also be required. To exclude possible bacterial infections or rheumatic causes, a laboratory test can also be performed. If patellar osteoarthritis is diagnosed, therapy should be started immediately because of its progressive course. Otherwise, after the initial symptoms, the pain and movement restrictions increase unchecked. Without therapy, the affected person would have to deal with personally and professionally fatal consequences. In many cases, without professional treatment, surgery is the only option.
Complications
In most cases, patellar osteoarthritis occurs mainly at an older age of the patient. In this process, it can lead to various limitations and discomforts, significantly reducing the quality of life of the affected person. In most cases, there are difficulties or pain during ordinary activities in everyday life. Thus, climbing stairs is associated with pain for the affected person. This can occur under stress or in the form of pain at rest. Pain at rest can also lead to sleep problems at night. It is not uncommon for this to result in restricted mobility, so that the patient may be dependent on the help of other people in everyday life. Furthermore, patellar osteoarthritis can also lead to psychological discomfort or depression and thus significantly complicate the daily life of the affected person. Patellar osteoarthritis can be treated relatively well with the help of cortisone. This is injected directly into the knee of the affected person. As a rule, the symptoms disappear after the treatment. This may have to be repeated if the pain recurs. There are no further complications. Life expectancy is also not usually reduced by patellar osteoarthritis.
When should you see a doctor?
Patients with patellar osteoarthritis often have what is called anterior knee pain. This pain occurs primarily during physical exertion, for example, when standing up or descending stairs. Often, there is a distinct crunching sound during movements, reminiscent of a coffee grinder. In individual cases, the entire knee appears locked. Then the affected leg can only be moved to a limited extent or not at all. Inflammatory patellar osteoarthritis is manifested by palpable overheating and swelling in the area of the knee. The symptoms mentioned can occur in varying degrees depending on the stage in which the osteoarthritis is located. In the first stage, mild pain and occasional blockages occur. In the second stage, the arthrosis intensifies and places increasing strain on the affected person during physical activities. In the third stage, the affected leg can no longer be moved without pain. The kneecap repeatedly becomes inflamed, which can result in nerve pain and functional disorders of the leg. In the final stage, patellar osteoarthritis has affected the entire joint. The pain is permanent and the sufferer suffers from numerous accompanying symptoms, for example cramps, joint wear and malpositions. This results in irritability, personality changes, depressive moods and other mental illnesses.
Treatment and therapy
The cartilage mass, which is not supplied with blood, cannot be healed after damage. Only a delay in the development of the disease and an alleviation of the symptoms can be achieved. If pain is present, treatment with analgesics is initially possible. These also have an anti-inflammatory effect. In the case of severe pain and already pronounced movement restrictions, cortisone can also be injected directly into the affected knee. However, a cure cannot be achieved by this. Due to the known side effects of cortisone, permanent treatment with this substance should be avoided. An injection of hyaluronic acid into the knee joint to slow down the development of the disease and to relieve discomfort is more appropriate. Strengthening the thigh muscles to relieve strain during movement is also helpful. If the destruction of the cartilage mass is already too advanced, surgical measures can be taken as a last resort. In order to precisely determine the clinical picture, a joint endoscopy (arthroscopy) is performed in addition to the findings from the imaging examination procedures. During this procedure, tissue that has already been damaged can be removed and cartilage can be smoothed.Depending on the findings, implantation of a kneecap, a complete knee joint or specific joint parts can be performed. To stimulate the body’s own defense function, the upper bone layer can also be scraped off. This creates a hemorrhage. This is intended to initiate an increased immune system response for repair in the affected area. Unnecessary further cartilage damage can be prevented by an arthrosis-appropriate everyday behavior. A change in diet is also an option for the holistic therapy of osteoarthritis. Reducing body weight in the case of obesity also promises to reduce the impairments.
Outlook and prognosis
The prognosis of patellar osteoarthritis is unfavorable. It is a chronic disease with a progressive course. If no further medical care is sought, the symptoms can be expected to increase. The cartilage tissue is not sufficiently supplied with blood and is ultimately continuously worn away. This results in a restriction of knee movement. In addition, the physical resilience of the affected person decreases and the quality of life diminishes. In a treatment, the progress of the disease is delayed by various measures. Pain is alleviated by administering medication, and targeted training can be used to modify general movement patterns. Nevertheless, a cure is not achieved in this way. In an advanced stage of the disease and after all other therapeutic options have been exhausted, surgery is performed. The knee joint is replaced and replaced by an implant. The operation is associated with various risks and side effects. In addition, the healing and recovery process takes several months. Interventions are particularly difficult for patients at an advanced age or in a weakened state of health of the affected person. Although a reduction of the symptoms is achieved by this intervention, a reduced general resilience is still to be expected. Occupational or sporting activities may have to be restructured. Without an implant, the affected person is dependent on walking aids or a wheelchair.
Prevention
A number of things can be done to prevent patellar osteoarthritis with regard to the causes of its development. In the case of permanent overload due to frequent kneeling, as in the case of tilers, the protection offered by knee pads is a good idea. Carrying heavy loads can be learned, as with many athletic movements, to avoid excessive pressure on the knee. Strengthening the thigh muscles to reduce the effects of overuse is also helpful. Excess weight also represents an avoidable burden. In addition, a balanced diet rich in vital substances combined with the practice of gentle sports form a beneficial framework for the prevention of patellar osteoarthritis.
Aftercare
Patellar osteoarthritis is not curable according to current scientific knowledge. It is chronic; an increase in symptoms can be expected if the signs are not observed. Therefore, follow-up care cannot pursue the goal of preventing recurrence. Instead, it aims to prevent complications and strengthen the patient’s daily life in the form of continuous treatment. The treating physician arranges regular examinations with his patient, depending on the intensity of the complaint. In these examinations, the current status is determined. Imaging procedures such as X-rays and ultrasound scans allow conclusions to be drawn about the progress of the arthrosis. Alleviating the symptoms is not just the doctor’s responsibility; the patient must also take action. The latter can in fact contribute a great deal to a symptom-free life. Strengthening the muscles, for example, has been shown to lead to a reduction in symptoms. Daily exercises should definitely be done at home. A physiotherapist can initially present suitable training sessions. Cycling is considered useful because the joint is moved without great strain. But also the professional everyday life should be reflected. Indeed, some patellar arthrosis results from overuse in physically demanding occupations. Patients achieve relief from the signs by wearing knee pads and proper lifting and carrying procedures.
Here’s what you can do yourself
When diagnosed with osteoarthritis of the kneecap, it is helpful to review and, if necessary, reorganize your daily routine.Lifting and carrying heavy loads, for example, can be one of those tasks that can ideally be outsourced or otherwise organized. This is especially true if it involves climbing stairs. Work that must be performed in a stooped or kneeling position should also be delegated to other people, if possible. Additional weight and pressure on the affected kneecap not only leads to pain, but can also accelerate wear and tear, causing the overall situation to worsen. As a rule of thumb, as soon as pain occurs, care should be taken to take it easy. Osteoarthritis is basically irreparable, since damage has already occurred to the cartilage, but this cartilage does not heal or regenerate itself. However, the progression of the disease can be stopped or slowed down. The affected person can contribute a great deal to the preservation of cartilage mass through targeted nutrition, often by changing years of eating habits. First and foremost, certain foods should be avoided altogether, for example fatty red meat, as well as an excess of meat in general. With the use of oils should be changed to cold-pressed oils such as olive oil. As a matter of principle, convenience foods should be avoided. Other foods, on the other hand, should be consumed preferentially: Millet promotes cartilage regeneration, and plenty of vegetables and fruit are equally beneficial. However, the patient should always ensure a healthy and balanced diet in order to avoid a one-sided diet. Nutritional supplements can positively influence the change.
