Diagnosis

Inspection (observation): Palpation (palpation): Functional test and pain test:

Evaluation of leg axis: muscle atrophy, leg length difference,
Gait pattern, knee swelling, skin changes
Overheating
Effusion, swelling, dancing patella
Crepitation, i.e. noticeable rubbing behind the kneecap
Patellar mobility
Patellar pain (soles – sign)
Pressure pain of the patella facets (pressure pain on the right and left side of the kneecap)
Pressure pain at the joint gap
Assessment of range of motion and movement pain, ligament stability
Meniscus sign – for the proof of damages in the area of the inner meniscus or outer meniscus

Necessary apparatus-based examination: X-ray of the knee joint in 2 planes Apparatus-based examination useful in individual cases:

X-ray functional images and special projections for surgery planning and evaluation of special forms of arthrosis
Sonography (ultrasound): Evaluation of knee joint effusion, Baker’s cyst
Magnetic resonance imaging of the knee: meniscus damage, damage to the cruciate ligament, osteonecrosis
Computer tomography: Fracture with cartilage step?
Skeleton – Scintigraphy: Inflammation?
Clinical-chemical laboratory for differential diagnostics = blood test: signs of inflammation?
Puncture with synovia analysis: rheumatism, gout, bacteria?

Which facts play an important role in the collection of the medical history?

Localization, functional impairment, duration, intensity, daily rhythm, radiation of pain
Resilience
Limp
Mobility
Entrapment, blockage, feeling of instability
Painless walking distance
Tendency to swell, complaints when going down stairs or uphill
Walking aids
Previous accidents
Instead of patella luxation (dislocation of the patella)
Previous knee joint diseases
Previous conservative or surgical treatment

Targeted exercises can make a major contribution to stabilizing the knee joint musculature and coordination skills as well as relieving the affected joint. Ask your physiotherapist for individual, suitable exercises.

In principle, selected exercise units should not be painful and should correspond to the possible range of motion of the knee arthrosis. Warm up for about 5-10 minutes before starting the exercises and then carry out the exercises calmly and in a controlled manner. After each exercise, a short stretching phase is recommended to prevent muscle and ligament shortening.

To achieve optimal training success, you should complete the exercises two to three times. Two simple examples can be:

Bridge: Lie on your back and put both legs up. Now lift your pelvis until only your shoulders are in contact with the floor.
Hold this position for 30 seconds and then lower your buttocks carefully. As a variation, one leg can be alternately released from the floor and stretched.
Hanging legs: Sit down carefully on a table top so that your legs hang freely in the air. Then move your legs alternately forward and backward.

The main focus of drug therapy for knee osteoarthritis is pain management.

At the beginning of the therapy, drugs such as ibuprofen, paracetamol, Voltaren® (diclofenac) or novamine sulfone (Novalgin®) are suitable. These drugs have a good pain-relieving effect, but if they are taken continuously, they can damage the stomach, kidneys and liver. To prevent inflammation of the mucous membranes of the stomach or gastric bleeding, a stomach acid blocker (proton pump inhibitor, pantoprazole) should be used as a supportive drug therapy, especially if taken over a long period of time.

In cases of advanced knee arthrosis and accompanying severe pain, stronger painkillers may have to be used. These may include opioids such as tramadol or tilidine. In the long term, drug therapy of knee arthrosis is only a symptom control and does not eliminate the trigger.

Permanent and regular intake of painkillers, especially ibuprofen etc. Physiotherapy and manual therapy are an important part of the therapy of knee arthrosis. Targeted physiotherapy exercises strengthen the muscular holding apparatus, stabilize the knee joint ligaments and promote the patient’s coordination.

During physiotherapy, patients are gradually introduced to the exercises or devices and ideally learn how to perform them at home. Especially in the case of knee arthrosis, aqua gymnastics, for example, is ideal because it relieves the joint. Many patients also suffer from lymph drainage disorders in the affected joint – the knee swells and becomes thick.

In manual therapy, special massage and wrapping techniques can provide relief and allow the lymph to drain away. In the case of knee joint arthrosis, surgery should only be performed on patients in whom all conservative therapeutic measures have been tried over a reasonable period of time and have not been able to bring about an improvement in symptoms. In principle, there are three different surgical procedures that can be considered: In the conversion operation, the physiological axes in the knee joints are restored in order to prevent the false and excessive loads in the joint caused by the knock-knees or bow legs, thus preventing the progression of arthrosis.

Arthroscopy (joint endoscopy, it can be performed open or closed), if necessary in combination with removal of damaged menisci (torn meniscus), cartilage fragments or the joint mucosa, cartilage smoothing, a so-called bioprosthesis (abrasion chondroplasty) or microfracturing.
A conversion operation (osteotomy), in which existing knock-knees or bow legs are corrected.
The implantation of an artificial knee joint, i.e. a knee prosthesis. Which technique is chosen depends on various factors, especially age, general condition, individual level of suffering and pain and the stage of the disease.

In arthroscopy, parts of cartilage are removed that have become detached in the course of the arthrosis and cause the complaints. The damaged cartilage layer is also strengthened.As a rule, this measure is only carried out on patients in whom the arthrosis is still in a relatively early stage and still has a layer of cartilage, albeit thin.

The advantage of this operation is that it enables the patient to put weight on the knee again relatively painlessly directly after the operation. However, if the arthrosis is more advanced, the cartilage layer is completely lost, at least in places, and there is exposed bone in the joint. Such “bone holes” can be filled up again with fibrous cartilage tissue.

In microfracturing, tiny holes are made in the bone and then covered with blood containing stem cells. Over time, these form new cartilage tissue that can now cover the joint surfaces and is almost as stable and resilient as the original cartilage. In abrasion chondroplasty, the entire upper bone layer is removed with a knife-like device.

This leads to bleeding into the joint, which ultimately triggers a healing process, which ultimately results in the formation of a cartilage replacement tissue, just like in microfracturing. These two techniques are preferable to the endoprosthesis, if one has the choice, because they regain a higher loading capacity of the knee and represent a repair process in the body in which nothing is implanted and therefore there is no risk of rejection or the need for another operation once the prosthesis has worn out. The knee joint replacement (= endoprosthesis) is therefore mainly carried out on older patients, who on the one hand usually do not put as much strain on their knee as younger people and on the other hand the limited durability of the artificial joint does not play such an important role.

Even in very severe cases of knee joint arthrosis in younger patients, an endoprosthesis can be inserted after a thorough weighing up of advantages and disadvantages. In addition to surgical therapy procedures, it is also possible to treat knee joint arthrosis without surgery. Which therapeutic procedure promises the best therapeutic success in an individual case depends on a number of different factors.

Individual factors such as age, profession, sports activities, weight, the extent of the arthrosis and the personal preferences of the patient influence the decision on the treatment method. In most cases, osteoarthritis of the knee joint is initially treated conservatively. Only if the conservative therapy remains unsuccessful is surgery the last option for treating knee joint arthrosis.

It is important to know that knee joint arthrosis cannot be treated causally. Neither conservative nor surgical procedures can treat the degenerative disease itself and reverse damage to the joint cartilage. All available treatment options aim to improve the symptoms and slow down the progression of the disease.

The most important measure of conservative therapy is the intake of pain and anti-inflammatory drugs (see: Drugs for knee arthrosis). In most cases, so-called NSAIDs are taken, which promise not only symptom relief but also an improvement in the local inflammatory reaction at the knee joint. Local measures involve injecting anti-inflammatory drugs or hyaluronic acid into the joint.

With this measure, an improvement in the symptoms of arthrosis can be achieved for a certain period of time. Alternative therapy options also include targeted physiotherapy, which can take up different treatment approaches. In addition to professional physiotherapy, which is usually useful in osteoarthritis, heat treatment, acupuncture, or stimulation of the nerve endings in the knee (TENS) can improve the typical symptoms.

Depending on the cause of the arthrosis, orthopedic measures can also help to minimize the progression of the disease and improve the symptoms. Especially the wearing of orthopedic insoles is often recommended in the therapy of osteoarthritis. There are various approaches to eliminate the symptoms of knee arthrosis and to prevent the progression of the disease.

Since knee joint arthrosis is a wear and tear disease of the articular cartilage, there are only limited possibilities to reach the site of pain.In addition to orally taken drugs or drugs injected into the joint, it is also possible to apply ointments to the knee. As a rule, these are ointments containing pain and anti-inflammatory substances such as Diclofenac. It should be noted, however, that the active ingredient contained in the ointments is not able to penetrate to the inside of the joint.

Instead, the active ingredient is distributed throughout the body, as it is when taken orally, and can reach the affected joint via the bloodstream. Progression or healing of knee arthrosis cannot be achieved by applying ointments. If symptoms persist, a physician should always be consulted, who can assess the individual joint damage and make a therapy recommendation.