Ahlbäck’s disease refers to a circulatory disorder in the knee joint. Typically, Ahlbäck’s disease occurs in women over the age of 60. Treatment includes physiotherapy in early stages and partial or total knee replacement in later stages.
What is Ahlbäck’s disease?
Ahlbäck disease is the term used to describe necrosis of the bone in the knee joint. Necrosis in the knee is identified by an area that does not have blood supply. Ahlbäck’s disease is not caused by an infection, but by a circulatory problem. Usually, patients with Ahlbäck’s disease are over 60 years old and female. Men can also be affected by the circulatory disorder. In exceptional cases, Ahlbäck’s disease can occur as early as the age of ten. If the disease occurs in people up to 20 years of age, usually only the cartilage of the knee is affected. Both mild and severe courses of Ahlbäck’s disease can occur. In the mild course of the disease, the patient notices bone loss or cartilage damage. If the course is severe, arthrosis develops in the knee joint. Severe knee necrosis can be accompanied by severe pain, which can be reduced by adequate therapy.
Causes
Ahlbäck disease can be caused by a variety of events. Some affected individuals have a blood flow disorder in the knee due to an accident. Blood vessels are injured after an accident, resulting in impaired blood flow. If the blood flow to the thigh is disturbed, there is a possibility of getting Ahlbäck’s disease. Likewise, taking certain medications can lead to Ahlbäck’s disease. If cortisone is taken for many years, there is a possibility of bone necrosis. The disease is also frequently associated with the long-term consumption of nicotine and alcohol. Often, diseases of the blood lead to the occurrence of Ahlbäck’s disease. In older patients, bone necrosis can also be triggered by incorrect loading of the legs. There are no other triggers for impaired blood flow in the knee.
Symptoms, complaints, and signs
Especially at the beginning of the disease, symptoms can be nonspecific. In the mild course of Ahlbäck’s disease, there is mild pain in the knee. A deep pain in the tissue is characteristic of the circulatory disorder in the knee. The knee of the affected person is usually not able to bear much weight. Therefore, many people with Ahlbäck’s disease limp when walking. In Ahlbäck’s disease, the pain is always more severe under stress than at rest. The disease is also often confused with damage to the meniscus or a lesion in the cartilage. Therefore, if the pain in the knee is severe, a specialist should be consulted as soon as possible. The specialist will check the knee joint for mobility and any swelling. Pressure pain is also characteristic of Ahlbäck’s disease. If the circulatory disorder in the knee is detected early, the discomfort and consequences of the disease can be reduced.
Diagnosis and course of the disease
Ahlbäck disease is diagnosed after an extensive physical examination. In addition to a stress test of the knee, imaging techniques are also used. The circulatory disorder in the knee is particularly well identified by X-ray. In the X-ray, the lightening of the affected bone is visually recognizable. As an alternative to X-rays, it is also possible to determine the disease with magnetic resonance imaging or scintigraphy. A blood test can confirm the suspicion of Ahlbäck’s disease. Typically, patients with impaired blood flow in the knee have a blood clotting abnormality in their blood work.
Complications
In most cases, Ahlbäck disease is not diagnosed directly because the symptoms are not particularly characteristic and thus do not speak directly to the disease itself. Those affected suffer primarily from pain in the knees. This not infrequently leads to restrictions in movement and furthermore to various limitations in the patient’s everyday life. The resilience of those affected decreases and depression and other psychological upsets occur if the pain continues to spread to other regions of the body. Swelling may also occur. Nocturnal pain leads to sleep disturbances. In many cases, the mobility of the knee is also significantly restricted and reduced.In the worst case, the reduced blood flow can also lead to tissue death. The symptoms of Ahlbäck’s disease can be relatively well limited and treated by means of exercise therapy. No particular complications occur, and the life expectancy of the patient is not reduced by the disease. In some cases, implants or prostheses are also necessary so that the patient’s movement can be restored.
When should you see a doctor?
The risk group for Ahlbäck disease includes, in particular, women in adulthood over the age of 60. They should consult a physician at the first irregularities, changes, or peculiarities of the general state of health and ask for clarification of the complaints. Pain in the knee that cannot be attributed to physical overexertion or the natural aging process are warning signs of the organism and must be examined and treated by a doctor. If the pain persists or increases in intensity, a doctor is needed. The use of a painkilling medication should be avoided until the patient has consulted the attending physician, as complications often arise that can be avoided. A sudden decrease in the usual physical performance, restrictions in the usual mobility as well as in everyday movements should be presented to a doctor. Pain on pressure or on touching the knee are considered signs of an existing health impairment and should therefore be examined medically. If the affected person notices a disturbance of the blood circulation and cold legs or feet occur, a visit to the doctor is necessary. In case of disturbances of the sensitivity at the knee, a tingling or numb feeling on the skin as well as a pale skin appearance, a doctor is needed to clarify the cause. Only with early diagnosis and treatment can there be a significant reduction in symptoms.
Treatment and therapy
Treatment of necrosis of the bone depends on the severity of the disease. There are several conservative treatment methods that help with Ahlbäck’s disease. As an immediate measure, specialists often recommend resting the affected knee. Exercise therapy has also been established for many years. Likewise, medications that can rebuild the patient’s own bone are often recommended. In the early stages, there is also the possibility of stimulating healing through therapy with shock waves or oxygen. This can lead to the ingrowth of new blood vessels in the bone. At an early stage, decompression of the medullary cavity can help. In this procedure, the doctor drills into the affected bone. Drilling stimulates the healing of the bone and allows the blood vessels to form anew. Another option is the use of bone substitutes. If Ahlbäck’s disease is diagnosed at a late stage, implants are often the only treatment option. In this case, the extent of the circulatory disorder is used as an indicator of a suitable therapy. The basic rule is that the smallest implant should always be used. This means that young people in particular are less restricted in their movements. An implant can reconstruct the surface of the knee joint. In case of a larger defect, a partial prosthesis is necessary. The integration of the partial prosthesis is associated with a small loss of bone. This means that any loss of healthy bone is kept to a minimum. If a large defect has been caused by Ahlbäck’s disease, only a complete replacement of the knee joint can help. At any stage of the disease, pain-relieving medications can also be used, as well as shoe modifications.
Outlook and prognosis
No general statements can be made about the prognosis in patients with Ahlbäck disease. It depends on the age of onset of the disease, the course and progress of the disease, and the selected form of therapy. Without treatment, the prognosis is usually significantly worse. Nevertheless, spontaneous cures occasionally occur during the development phase. Despite the prospect of complete healing, the course of Ahlbäck’s disease is basically protracted. A concrete prognosis is difficult to assess, especially in young patients. The conservative treatment of Ahlbäck’s disease by means of hyperbaric oxygen therapy or shock wave therapy leads to the regrowth of blood vessels in the bones, especially in the early stages. In this way, the disease heals naturally.The extent to which the affected bone can be loaded depends on the specific case. Many patients suffer from pain and certain limitations even after complete healing of Ahlbäck’s disease. In advanced courses, the insertion of implants is ultimately the most promising option for both younger and older sufferers. Although full mobility is no longer achieved with an artificial knee joint, the disease can be completely cured in this way. The prognosis is less favorable with standard prostheses.
Prevention
Various precautions can be taken to prevent the circulation disorder in the knee from occurring. Since incorrect weight-bearing can lead to Ahlbäck’s disease, care should be taken to ensure correct knee weight-bearing. Reducing excess weight also counts as a preventive measure. In principle, abstaining from excessive alcohol consumption is recommended for the prevention of Ahlbäck’s disease. The same applies to the consumption of nicotine. Steroid doping should be avoided to prevent circulatory disturbance in the knee.
Aftercare
After successful treatment, intensive and prolonged aftercare is necessary for Ahlbäck’s disease. The specific measures to be taken depend on the form of therapy chosen. Spontaneous healing rarely occurs in the initial stages of the disease. In this case, regular medical check-ups and strict rest are necessary. After surgical treatment of the affected bone, it is especially important not to put any weight on the leg. The healing of the surgical scar should also be monitored. Intensive aftercare is necessary if implants or prostheses are inserted. In this case, the healing of the surgical wound is checked during an inpatient hospital stay. Subsequently, longer stays in a rehabilitation clinic are sometimes advisable. Depending on the patient’s private and professional situation, these stays may last several weeks or may be on an outpatient basis. In principle, follow-up treatment with intensive physiotherapy is necessary in the years following surgery. Orthopedic examinations are also recommended at regular intervals. If pain persists, there is also the possibility of a stay at a health resort for many years after the operation. In a few cases, complications occur that require much more intensive follow-up care.
What you can do yourself
In younger patients with a stage of Ahlbäck’s disease that is not too advanced, new cartilage tissue may form and a decrease in pain may occur. If the disease does not develop further, conservative therapy such as sparing the leg by supporting it and refraining from sports or possibly adjusting shoes if the leg is out of position will help. Physiotherapeutic measures to strengthen the leg muscles and to maintain the mobility of the knee joint are recommended. Bone-building drugs promote the ability to regenerate. Surgical procedures are also used to preserve the joint when the disease has stopped, such as relief drilling; this stimulates the bone tissue to heal itself. A transplantation of healthy bone tissue from another area of the body is also a method of replacing the destroyed tissue. Hyperbaric oxygen therapy can also be used as a supportive measure. The physician and patient work together to develop a program of oxygen intake to promote healing. However, in 80 percent of conditions, the destruction of bone tissue progresses and, without treatment, leads to increasing pain and ultimately knee osteoarthritis. Although the healing process is quite lengthy, the prognosis is positive when an artificial joint is used. With the support of physiotherapy, the new knee joint is subjected to increasing loads in small steps until the patient can once again participate in everyday life without any problems.
