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.
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.