Surgery for gonarthrosis
Since osteoarthritis is not curable, hip and knee joints must often be replaced by artificial joints. After a two-week hospital stay, a training program follows, in which the muscle is rebuilt and the handling of the new joint is practiced. An artificial joint can remain functional for up to 20 years.
Knee joint reflection (arthroscopy)
The knee joint mirroring can be performed on an outpatient or inpatient basis. About a small skin incision while a probe with camera is introduced. This transfers images from the interior of the joint to a screen. So the doctor can examine the joint directly and detect damage.
Often the damaged cartilage is treated during the same operation. For example, damaged meniscal tissue can be removed or cartilage tissue smoothed. In this way, a number of mechanical obstacles can be eliminated.
There is also the process of tapping or grinding the damaged cartilage during articulation. Cartilage precursor cells enter the region of the defective cartilage tissue and can form so-called fibrocartilages. Fibrocartilage is a kind of endogenous cartilage replacement.
However, according to information provided by the Techniker-Krankenkasse (TK) "the lower load capacity compared to the original, healthy cartilage is problematic." Therefore, surgical procedures have been developed to re-cover the defect with healthy cartilage. "The surgical techniques currently available are not standard procedures for the treatment of osteoarthritis. Therefore, the following procedures are currently only performed in a few clinics. These are cartilage-bone transplantation and autologous chondrocyte transplantation (ACT). "
In cartilage-bone transplantation, cartilage-bone cylinders are removed from the patient at low-load joint sites. In the area of cartilage damage, one also takes a slightly smaller cylinder.
Now a kind of exchange takes place: The "healthy" cartilage-bone cylinder is clamped in the region of the cartilage damage in the withdrawal hole, the cylinder from the damaged cartilage zone replaces the removed healthy tissue piece in the removal area.
However, only defects of up to four square centimeters can be treated with this technique. If only very small, healthy cartilage-bone pieces are available, these are implanted in the form of a mosaic. The first results of this surgical method are promising.
Cartilage cell transplantation (Autologous Chondrocyte Transplantation):
Another method is the body's own cartilage cell transplantation (Autologous Chondrocyte Transplantation). In this case, articular cartilage is removed during a joint mirroring outside the main load zone, for example in the tibial region.
The recovered cartilage cells are propagated in the laboratory. Now the patient is operated again, the cartilage cells are introduced. The cartilage cells are then injected under a flap of periosteum which is sutured over the defect.
There is also the possibility to coat with collagen cartilage cells via a collagen tissue. This fleece is then sewn into the defect. Thus, defects of three to ten square centimeters can be treated.
The prerequisite for the use of autologous chondrocyte transplantation is an intact cartilage in the vicinity of the defect and on the opposite articular surface. The menisci should have at least two-thirds of their original size. The age limit is considered to be a biological age of about 50 years.
Disadvantages of this method are the high costs, repeated surgical interventions and a complex rehabilitation. So far this procedure is only carried out in the context of case studies at university centers. According to the TK, studies on long-term results are not yet available.
Leg axis correction (articular osteotomies):
If, in younger patients up to the age of 50, a misalignment of the leg axis affects only the inner or outer joint area of an arthrosis, the correction of the axis defect close to the knee can also be considered. This is to reduce the mechanical stress on the knee joint and thus delay the progression of osteoarthritis.
First, the doctor saws out a bone wedge, then the bone is rejoined with a metal plate and screws. Possible consequences: a leg length difference, a delayed bone healing with development of a so-called false joint (pseudarthrosis) or an infection of the metal plate bearing. However, these complications are relatively rare, and in about 80 percent of patients after Beinachsenkorrektur found even after ten years, a good result.
The metal parts must be removed again in another operation. Joint replacement surgery means the use of prostheses: Here, the destroyed joint parts are removed and, if necessary, with the correction of a malposition replaced by artificial joint parts, so-called endoprostheses. Normally, this helps to bring the pain to a standstill, and the function of the knee joint also improves.
Such artificial joints may remain in the body for more than 15 years, but may loosen up after a few years, so the procedure is primarily suitable for older patients with severe gonarthrosis. In younger patients, it is only recommended if, due to severe pain, alternatively only a knee joint stiffening would be an option.
What can be done preventively?
- Obesity is in any case a heavy burden on the joints. Every kilo less is good for the knee.
- Injuries of the knee joint due to sports accidents (eg alpine skiing) should be avoided by avoiding any overexertion of the body. For here are the main causes of sports accidents, which may later even have an arthrosis result.
- Exercise is important because it ultimately nourishes the cartilage and keeps it supple. You should always drink enough - two to three liters of fluid a day, unsweetened if possible, without alcohol and caffeine are ideal.
- You should wear flat shoes and do not exercise stressful sports such as football, snowboarding or tennis too intense. Instead of jogging, walking, aquajogging and swimming are joint-friendly endurance sports.