ARTHROSIS - KNEE ARTHROSIS – GONARTHROSIS

The causes of knee arthrosis, also known as gonarthrosis, are very diverse and are influenced by various factors. It is the final stage of cartilage damage in which the bone is exposed. The most common cause is normal wear and tear, which affects everyone, whereby a hereditary component can be a determining factor. A malposition of the leg axis, chronic instability of the cruciate ligament, an accident, overweight and lack of activity can also promote the development of knee osteoarthritis.

The symptoms of knee osteoarthritis vary according to their degree. They begin with pain after resting, swelling and effusions in the joint. At an advanced stage, the affected joint suffers from so-called rest pain, a pain that occurs without any strain even during the night.

Arthrose

Depending on the individual stage of osteoarthritis of the knee, a wide variety of conservative and surgical therapies are available in order to achieve a pain-free situation and an improved range of motion.

NON-OPERATIVE THERAPY

The therapy of knee osteoarthritis depends not only on the respective stage, but also on the patient’s demands and lifestyle. Therefore, conservative therapy is about taking into account the personal situation of the affected person and reducing the factors that can be influenced from outside.

The drugs of first choice are drugs with strong pain and swelling relief, so-called non-steroidal anti-inflammatory drugs (NSAIDs) and Coxibe. Food supplements such as the combination of glucosamine and chondroitin sulphate have also been shown to have a positive effect on knee osteoarthritis. A decisive factor is that the patient regularly moves and consistently pursues physiotherapy in addition to medical care. The resulting increase in muscle strength and the mobilization of the joints are an essential component in improving the symptoms. We also use orthopaedic aids such as special tapes, bandages, splints and orthopaedic buffer heels to treat gonarthrosis.

In early stages of OA we also use orthbiologics such as: HYALURON, PRP, or STEAM CELLS

Among other things, hyaluronic acid is responsible for storing water and thus strengthening cartilage and making it more resistant. At the same time, it is known that cartilage damage has a low proportion of hyaluronic acid, which explains why the administration of high-molecular hyaluronic acid helps to build up and strengthen cartilage. Hyalurone/hyaluronic acid increases the viscosity of the synovial fluid, reduces joint stress and blocks phagocytosis, which leads to anti-inflammatory success. In addition, PRP blocks nitrogen oxides, which are associated with the development of osteoarthritis and represent a strain on the joint. Current studies show that cartilage therapy with hyaluronic acid can reduce pain by improving cartilage properties and even delay the onset of cartilage surgery. For us, hyaluronic acid is the first choice for early cartilage damage therapy in order to rebuild it adequately and avoid cartilage surgery.

We recommend the injection of hyaluronic acid for chronic, mild cartilage damage in one of the three knee compartments. We give 3 injections at intervals of approx. one week each. Good results can be achieved with mild arthrosis, and patients often return after 8-12 months for another series. In highly inflammatory cases or in patients who already have a “bone on bone” situation, the isolated hyaluronic acid injection is less successful. Here we recommend alternative biological procedures such as the combination of PRP and hyaluronic acid or the use of stem cells from the patient’s own body fat for cartilage damage treatment at the knee.

In PRP therapy, growth factors and exosomes are extracted from the patient’s own blood and degranulated after injection into the affected region, releasing various growth factors. These vascular, endothelial and insulin-like growth factors have enormous regenerative powers. More importantly, they can prevent inflammatory processes and their negative and toxic influence on cartilage. In addition, PRP treatment also reduces nitric oxide and thus oxidative stress on a joint. Furthermore, PRP therapy at the knee increases the effect of hyaluronic acid and reduces the metal proteinase, which is responsible for cartilage degradation.

This explains the healing potential and pain reduction in PRP and ACP therapy of cartilage damage and osteoarthritis. Since PRP is obtained from autologous blood and this therapy is based on the body’s own mechanisms, in contrast to cortisone therapy there are NO side effects.

Since it is known that hyaluronic acid also has a cartilage healing effect, we prefer the combination therapy of hyaluronic acid AND PRP. Depending on the extent of the cartilage damage, this therapy is injected 3-4 times into the affected joint. Between the individual injections at least 2 and not more than 10 days should pass in order to achieve an optimal result. After an injection, swelling can occur for a short time due to the increase in volume, but this is normally not painful and disappears very quickly on the same day. Relief or immobilization is not necessary.

Furthermore, due to the complex interaction between the Hoffa body, inflammation, degeneration and remodelling processes, we rely on stem cell therapy derived from our own fatty tissue for cartilage therapy at the knee. Since 2013, Prof. Schoettle has had extensive knowledge about the use of adult stem cells and their precursors in orthopaedics. In Munich, we currently use a procedure that has already been used in more than 10,000 cases worldwide for the treatment of gonarthrosis and is also accepted by the FDA.

Stem cells are the firemen and at the same time the repair centre of our body and become active when they are attracted by dying cells or inflammations. They not only have a maximum anti-inflammatory effect, but also the possibility to multiply themselves and differentiate into the damaged tissue and thus achieve regeneration. They can also form new blood vessels to nourish the dead cartilage and support regeneration. When stem cells from the same “family” are brought into an affected area, they have a multimodal effect because they inhibit inflammation, ensure nutrition through the formation of new blood vessels and can replicate the affected tissue.

And since Prof. Schoettle’s method uses the body’s own fat, there are no side effects.

The procedure can be performed either in isolation or in combination with other procedures. Under light anaesthesia, 60-100 cc of fat are extracted from the abdomen, mechanically processed with the cells contained in the fat and applied to the affected region under light anaesthesia after almost an hour. Our patients can leave the clinic immediately afterwards. In the liposuction region, an abdominal belt should be worn for 48 hours. We also recommend the use of crutches for 2 weeks in order to fully develop cartilage healing. No sporting activities should be carried out during this time.

Inform yourself about these possibilities during our special consultation hours.

PARTIAL REPLACEMENT

If the time of a knee osteoetomy has been missed or is no longer possible due to bone situation or the age of the patient, a partial replacement has to be considered.

Prof. Schoettle pays great attention to the choice of individual options, as we are rather reluctant to use total knee arthroplasties if possible, and look for the more patient-friendly variant of the partial replacement.

In this comparatively gentler and less painful partial prosthesis procedure, in which only the inner or outer part of the knee joint is replaced, all ligaments of the knee joint are completely preserved. The partial replacement is used according to the individual ligament tension, whereby a restoration of the original range of motion can be achieved very quickly.

This procedure is performed in an inpatient stay. Already after 5 days a transfer to an inpatient rehabilitation facility is possible. After an UKA, the use of crutches with a partial load over a period of 2 weeks is necessary. Afterwards, the pain syndrome can be quickly treated, so that walking without crutches should be possible without any problems after discharge from rehabilitation.

Depending on your professional activity, light physical activities are also possible after 4 weeks.

As soon as you no longer need crutches, you can drive again.

After a secure healing and the recovery of a good muscle structure, sports activities such as skiing, golfing or playing tennis are also painlessly possible to an appropriate extent.

Arthrose
Arthrose

TOTAL REPLACEMENT OF THE KNEE JOINT - TKA

In the case of advanced knee osteoarthritis, in which all parts of the joint are affected, a total knee replacement is used. Using a TKA, leg axis defects, leg length differences and the function of permanently damaged ligaments are addressed all in the same procedure. Since the anatomy not only differs significantly between women and men, but also within the same gender, an individual knee prosthesis system must be calculated and adapted for each patient. The methods we use to calculate the corresponding joint replacement ensure that the existing anatomy is taken over while taking the optimal function into account. When implanting total knee prostheses, Prof. Schoettle pays a high attention to using a surgical technique, taking all these reflections into account. Thanks to his highly specialized knowledge of the kneecap, we are also able to prevent the kneecap problems that frequently occur after TKA. In contrast to other procedures, this and local pain therapy allow us to move freely at an early stage, so that mobilization can begin the day after the surgery.

The procedure takes place on an inpatient basis for secure wound healing, intensive physiotherapy and good pain therapy. After just under a week, you can be discharged to an inpatient post-operative treatment / rehabilitation facility according to your wishes and consultation with us.

While the crutches can be taken off after approx. 4 weeks, a normal gait pattern should be regained after a period of approximately 3 months. You can resume light activities approx. 6 weeks after the surgery and should be able to be active again from approx. 3 months after the surgery.

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Prof. Dr. med. Philip Schoettle
KNEE AND HEALTH INSTITUTE
Sprechzeiten Montag bis Freitag nach Vereinbarung

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