Knee osteoarthritis (gonarthrosis)

Knee osteoarthritis is the progressive wear (arthrosis) of the knee joint. Such wear can be due to a predisposition, or may be the result of an illness or accident. Older people in particular are affected.


Types

Knee osteoarthritis takes two different forms: primary (due to predisposition) and secondary (acquired) osteoarthritis. In the case of the far more common primary osteoarthritis, everyday strain on the cartilage exceeds its stability. This primary knee osteoarthritis frequently occurs in more advanced adult age, so that about 75% of all people older than 50 years and around 90% of the over 70-year-olds suffer from corresponding joint changes.

Secondary osteoarthritis can be the result of an accident, for example in the case of a direct injury to the cartilage. Other causes include inflammation or also an internal illness such as rheumatism.

Many individuals are able to live with the diagnosis so that the ongoing treatment of joint wear is not required. The quality of life is impaired in only about 20% of the affected individuals.

Leading symptom

The most commonly named symptom of knee osteoarthritis is pain, which is felt in the knee joint especially when starting to walk or standing up. Pronounced pain therefore occurs primarily after phases of rest.

The more highly defined knee osteoarthritis already is, the more unpleasant the pain and sensations become. Friction noises (crepitus) and movements similar to gear wheels may occur, often in conjunction with rest pain or blocked joints. Only rarely does the affected individual feel entirely free of pain, resulting in limping.

Chronic irritation of the knee joint usually results in swelling with the accumulation of fluid in the joint.

The further knee osteoarthritis has progressed, the more pronounced the coarsening of the joint contour. A joint malposition also occurs regularly and becomes apparent over time.

Causes

The most frequent cause of knee osteoarthritis is previous damage to the meniscus.

Other causes for knee joint pain may be found in neighbouring joints. Wear, a malposition of the hip joint and splayfoot/flatfoot are significant risk factors for the onset of knee osteoarthritis.

Clinical examination

In the investigation of knee pain, the leg axis (knock knees or bow legs), the leg length and the gait pattern are primarily examined. Functional and pain tests are conducted as well, and imaging methods such as X-rays are used.

Therapy

Knee osteoarthritis therapy is initially conservative in most cases. Medications are administered, often in the form of injections into the joint. Physiotherapy also plays an important role with mobilising, muscle strengthening and muscle stretching measures. Physiotherapy is also performed for knee training and the stability of the knee is improved through coordination exercises.

In some severe cases however, an operation is unavoidable and constitutes the better alternative. Here one differentiates between joint preservation (e.g. changing the knee joint axis), joint stiffening and joint replacement operations. The least invasive procedure, an arthroscopy, is performed first so the doctor can better assess the progression of osteoarthritis.

Mobility without pain and improved walking ability are the primary objectives with both types of therapy.


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