The causes of osteoarthritis of the kneecap are manifold and range from congenital malalignments to occupational or athletic overload. Often, they are also consequences of fractures of the kneecap. The largest group, however, is one with congenital patellar instability / patellar dislocation or trochlear dysplasia, which has not been treated adequately and has led to early osteoarthritis of the patella due to the resulting PF overload. Kneecap / patella osteoarthritis usually occurs in focally, and rather affects younger patients because of its origin. The treatment of patellar osteoarthritis is therefore to go under completely different aspects then in generalized knee osteoarthritis.
The conservative therapy of patella osteoarthritis depends not only on the stage of the disease, but also on the patient’s needs and the associated lifestyle habits. The aim of the treatment of patellar pain is to eliminate the inflammation and swelling in the joint. Here also medicines can be used at short notice.
A weight reduction is often the decisive factor. It is also important that the patient moves regularly and consistently performs physiotherapy and self-therapy. In this case, particular attention must be paid to the stretching of the individual structures in order to reduce the overload on the kneecap. Another possibility of therapy is the 3-time combination-injection with hyaluronic acid and PRP. At present, the most effective use of stem cells derived from the body fat is to normalize the Hoffa fat body.
TRANSFER OF THE TUBEROSITY
In the treatment of osteoarthritis of the knee by a transfer of the tuberosity, the distance between the patella and femur is increased and therefore the pressure on the kneecap reduced / normalised. By minimizing this pressure load, the pain can be alleviated. The inward and outward displacement of the patella guide is calculated to the nearest millimeter using our MRI and X-ray images to move the pressure both from the outside to the inside and from the kneecap. The displaced bone is secured with 2 screws.
This knee arthrosis procedure is performed stationary. Our patients are usually hospitalized for 2-3 days until they are discharged with a splint and crutches.
The relief period is 6 weeks and the diffraction is meanwhile increased gradually at intervals of 2 weeks from 30 °, 60 ° and 90 ° to a free mobility.
After a partial load during a 6-week healing period, you can increase the load quickly after an X-ray check. From this point on, driving is allowed again.
Muscular can be exercised throughout the time with the splint applied. Once the bone has healed safely, there are no restrictions
OUTER CAPSULE EXTENSION / LATERAL RELEASE
The external capsule extension is an intervention that should be used only in osteoarthritis of the patella and not in the instability. In order not to provoke instability in the desired pain reduction, we perform a much more sophisticated technique – the lateral elongation technique. In the outer capsule extension, the outer patellofemoral contact surface is relieved and shifted inwards. Here, the double-layered retinaculum is separated from each other in a filigree plastic intervention and adapted again in an advanced technique. Thus, an expansion and pressure relief, while the joint remains closed and instability is avoided
PARTIAL JOINT REPLACEMENT – MINI IMPLANT
When biological and relieving surgical procedures are exhausted, a mini-prosthesis is used in the patellar osteoarthritis,
The anatomically shaped WAVE and KAHUNA prosthesis developed by Prof. Schöttle and currently used internationally are joint replacements in which the anatomy can be adjusted in almost every detail with different curvatures corresponding to the trochlear surface. Since it is also the thinnest prosthesis on the market, bone loss is marginal and there are no problems with a supernatant and therefore increased pain-inducing pressure between the patella and thigh in this patellar osteoarthritis treatment.
Another advantage of this mini replacement is the fixation: it can be attached without cement by means of a screw in the underlying, healthy bone.
This characteristic and the very good results of this joint replacement in everyday life and in sports have led to this method being used in the treatment of patellar arthrosis in the younger patient in particular.
If a mini-prosthesis is no longer possible due to additional bony malpositions, then a slightly larger partial replacement comes into play.
Since we are dealing with the treatment of pain and osteoarthritis of the patellar joint, both clinically and radiologically and in the context of navigation, we are well aware of all the subtleties that must be considered in order to offer our patients, who are in this case quite promising, a promising solution to offer.
Like all divisor sets, this is done in a hospital stay.
Already after 4 days a transfer to a stationary rehabilitation facility is possible. After a partial joint replacement, the use of crutches with a partial load over a period of 2 weeks is necessary. Thereafter, according to the pain syndrome can be loaded quickly, so that after discharge from rehabilitation walking without crutches should be easily possible.
Depending on your professional activity, even slight physical activities are possible after 4 weeks.
As soon as you do not need crutches you can drive again.
After a secure healing and the regaining of a good musculature also sporting activities such as skiing, golfing or playing tennis in an appropriate measure painless possible.