Since osteoarthritis cannot be cured, hip and knee joints often need to be replaced with artificial joints. A hospital stay of about two weeks is followed by an exercise program to rebuild muscle and practice using the new joint. An artificial joint can remain functional for up to 20 years.
Surgeries for gonarthrosis
The following surgical options are available for the surgical treatment of knee joint osteoarthritis:
- Knee arthroscopy
- Removal of the defective cartilage
- Leg axis correction
- Joint replacement
Knee joint endoscopy (arthroscopy).
Knee arthroscopy can be performed as an outpatient or inpatient procedure. A probe with a camera is inserted through a small incision in the skin. This transmits images from inside the joint to a screen. This allows the doctor to directly examine the joint and detect damage.
Removal of the defective cartilage
Often, the damaged cartilage is treated during the same surgery. For example, damaged meniscal tissue can be removed or cartilage tissue can be smoothed. In this way, a number of mechanical obstacles can be removed. There is also the procedure of drilling or abrading the defective cartilage area during arthroscopy. In this process, cartilage precursor cells enter the region of the defective cartilage tissue and can form so-called fibrocartilage. Fibrocartilage is a type of cartilage replacement produced naturally in the body.
Leg axis correction (near-joint osteotomies).
In younger patients up to the age of 50, if only the inner or outer joint area is affected by osteoarthritis when the leg axis is misaligned, correction of the axis defect close to the knee joint may also be an option. Bone realignment, also called osteotomy, straightens the legs and redistributes the load over the entire knee. This is intended to reduce the mechanical stress on the knee joint and thus delay the progression of osteoarthritis. First, the doctor saws out a wedge of bone during this procedure, then the bone is reconnected with a metal plate and screws. The metal parts must be removed again in another operation. Possible negative consequences are a difference in leg length, delayed bone healing with the development of a so-called false joint (pseudarthrosis) or an infection of the metal plate bearing. However, these complications are relatively rare and in approximately 80 percent of patients after leg axis correction, a good result is still found after ten years.
Joint replacement surgery
Joint replacement surgery means the use of prostheses: Here, the destroyed parts of the joint are removed and, if necessary, replaced by artificial joint parts, so-called endoprostheses, while correcting a malposition. Normally, the pain can be stopped in this way, and the function of the knee joint also improves. Such artificial joints can remain in the body for more than 15 years, but can also loosen after a few years, so the procedure is primarily suitable for older patients with severe gonarthrosis. In younger patients, it is recommended only if the only alternative would be knee fusion because of severe pain.
Possible future procedures
A problem with many previous surgical procedures is the lower load-bearing capacity compared with the original, healthy cartilage. Therefore, surgical procedures have been developed to cover the defect in the knee with healthy cartilage. However, these surgical techniques are not yet among the standard procedures for the treatment of osteoarthritis. These are osteochondral and autologous chondrocyte transplantation.
Osteochondral transplantation
Osteochondral transplantation, or cartilage-bone transplantation, is the transplantation of a healthy joint surface section into the area of a cartilage or cartilage-bone defect. In this procedure, the cartilage is transplanted along with a piece of the underlying bone. First, cartilage-bone cylinders are taken from the patient at low-load joint sites. In the area of cartilage damage, a slightly smaller cylinder is also removed.Now a kind of exchange takes place: The “healthy” cartilage-bone cylinder is clamped in the removal hole in the region of the cartilage damage, and the cylinder from the damaged cartilage zone replaces the removed healthy piece of tissue in the removal area. However, this technique can only treat defects up to approximately four square centimeters. If only very small, healthy cartilage-bone pieces are available, they are implanted in the form of a mosaic.
Autologous chondrocyte transplantation (ACT).
Another procedure is cartilage cell transplantation, also called autologous chondrocyte transplantation (ACT). ACT is a procedure used to treat cartilage injuries. For this purpose, the patient’s own cartilage cells (chondrocytes) are removed, multiplied in a nutrient solution and then reintroduced into the cartilage defect. A prerequisite for the use of autologous chondrocyte transplantation is intact cartilage in the area surrounding the defect (for example, in the area of the tibia) as well as on the opposite joint surface. The menisci should still have at least two-thirds of their original size. A biological age of about 50 years is considered the age limit. The aim of this procedure is to prevent secondary arthrosis. Disadvantages are the high costs, repeated surgical interventions and costly rehabilitation. The method is not yet suitable for the treatment of existing osteoarthritis.
What can be done preventively against knee joint osteoarthritis?
The following 4 tips can help you prevent knee joint osteoarthritis:
- Excess weight is a heavy burden on the joints in any case. Every kilo less also benefits the knee.
- Injuries to the knee joint due to sports accidents (for example, alpine skiing) should be avoided, in which you avoid any overexertion of the body. Because here are the main causes of sports accidents, which can also result in osteoarthritis once later.
- Exercise is important because it ultimately feeds the cartilage and keeps it supple. At the same time, you should always drink enough – two to three liters of fluid a day, preferably unsweetened, without alcohol and caffeine are ideal.
- One should wear flat shoes and stressful sports such as soccer, snowboarding or tennis not too intense. Instead of jogging, walking, aqua jogging and swimming are endurance sports that are easy on the joints.
