(Joint abrasion, joint deformity, joint wear)
If due to degenerative cartilage degradation processes the cartilage layer gets so damaged that the natural adaptation and repair mechanisms get exhausted, there is a decompensation (decay) of the whole joint.
The cartilage wears increasingly, and soon bare bones show without any cartilage covering ("Moon" - lunar landscape). As a result, it then comes to bone abrasion.
As a defense mechanism the joint now tries to enlarge the lost or even destroyed surface of pressure intake by growing bones again (by osteophytes - spurs).
These osteophytes usually fail to do their job, on the contrary, they continue to interfere with the biomechanics of the joint only.
Depending on its severity, the osteoarthritis is primarily characterized by reduced capacity, pain during exercise and rest, and heated swelling and the stiffening of joints.
Typically there are also strong changes in the appearance of symptoms: phases with relative freedom from symptoms to inflammatory attacks (activated osteoarthritis).
The causes of arthritis are extremely varied:
Family disease, obesity, permanent overload, metabolic disorders such as diabetes, deformities of the foot and leg alignment, rheumatoid and other inflammatory diseases, accidents which affect the joint, hormonal, and unknown factors should be mentioned.
The arthritis treatment is at the beginning a cartilage treatment.
Stage I incorporates all the measures that are non-invasive, ie do not penetrate the intact skin and do not hurt.
Physical therapy: ultrasound, iontophoresis, Stereodynator, laser irradiation, massage.
Physiotherapy: physiotherapy, stretching exercises, co-contraction, isometry.
Chondroprotective: dietary supplements that contain ample doses of glucosamine and Chonroitinsulfat such as Remobil. These components are installed in the articular cartilage and improve its lubricating abilities.
Bandages: It is possible to get stability by direct pressure on the affected joint but they primarily increase the pre-load of the muscles by stimulation of skin receptors. Not to be underestimated is the heat that is a bandage brings. All this reduces pain and improves the functioning.
Insoles: Special biomechanical insoles normalize the foot load and hence the power insertion into joints such as the ankle, knee, hip and spine.
All these measures are designed to take inflammations and irritations out of the joint and allow for normal sliding again.
In addition, hyaluronic acid injections into the affected joint. Hyaluronic acid lubricates the joint and is also a natural component of the joint cartilage. 5 injections at an interval of one week are required. Some studies point to total cartilage repair. Initially, it is sometimes absolutely necessary to give anti-inflammatory injections before (cortisone, Xyloneural).
If the many possibilities of conservative therapy do not lead to the desired success, the arthroscopic debridement (stage III) is carried out.
In this stage the arthritis treatment progresses to a treatment of the bone under the cartilage.
As in the treatment of cartilage damage, the goal in osteoarthritis treatment is to create a stimulus reduction (reducing inflammation) in the joints and stimulate reparation processes.
The removal of torn meniscus parts, dead pieces of articular cartilage, cartilage abrasion material and inflamed synovial membrane parts (partial synovektomy) also have anti-irritation and anti-inflammatory effects. The removal of an excessive amount of grown bone strips and bone spurs (osteophytes) reduces friction.
The aim of arthroscopic treatment of osteoarthritis and the osteotomy is to prevent the onset of the "unloved" artificial joint by preserving the own knee or postponing it at least as much as possible.
Endogenous reparation processes can be stimulated by the so-called abrasion. The abrasion is a milling of the exposed cartilage-less bone ("Moon Landscape").
Only the top dead bordering lamella is milled (about 2 mm) to expose blood vessels. The stability and carrying capacity of the joint are not reduced thereby. By exposing the blood vessels, the growth of replacement cartilage is stimulated.
The growth of this cartilage takes approximately two to three months, full curing and maturation will take approximately one year, after that the replacement cartilage is somewhat able to take over the characteristics and functions of the natural articular cartilage. It remains, however, a replacement cartilage (fibrocartilage), not hyaline cartilage. Mostly a successful conversion to the hyaline or hyaline-like cartilage does not occur, so that the replacement cartilage falls victim to a more or less rapid wear.
Arthroscopic treatment of osteoarthritis using the example of the knee joint: The dead, exposed bone layer is removed by abrasion to stimulate the body's own recovery processes.
The debridement and abrasion can be performed on the knee, shoulder, ankle, elbow, wrist, and also at the hip.
Most often this treatment is offered for the knee.
Treatment using the example of the knee joint.
1. Gelenktoilette (Reinigung und Gleitflächenglättung) ohne Abrasion:<br></br>Immediately after surgery decongestant actions, therapeutic exercises to increase muscle strength and passive extension and flexion of the leg on a knee motorized CPM (CPM) are undertaken. Walking possible after the surgery, rest for four to six weeks.
2. Gelenktoilette mit Abrasion:<br></br> This therapy requires a consistent rest of the operated knee joint for six weeks (two forearm crutches) and partial loading for another month (one forearm crutch support). The motto for the abrasion is: Move (stimulating the growth of cartilage replacement), but do not strain, because too early pressure on the abraded cartilage surface would destroy the cartilage replacement. The postoperative therapeutic exercises must therefore be carried out carefully and by avoiding pain and swelling. Usually a rapid cure can not be expected, the healing process takes, depending on the extent of the abrasion, from six months to a year.
Should a stronger axis deviation in terms of an O or X-leg be the case, with persistent complaints, then an axis correction may be necessary (see section knee / osteotomy).
Axis changes are useful on the knee, ankle and hip.
Ability to work
A sick leave period of about three weeks must be expected in case of office activities, provided that the patient can continue his work with two forearm crutches.
Depending on whether a debridement was performed with or without abrasion, hard physical work can, if at all, be done only after a period of six months to a year.
Swimming and cycling can be usually done after two or three months.
Other sports must always be discussed beforehand with us. What is definitely needed is a proper muscle function.
Compared to the often depressing situation, the abrasion arthroplasty (as the full name of this operation) can achieve amazing results. About a year after the surgery 80 percent of patients report a significant relief from pain and a threefold increase in their personal walking distance.
The proportion of patients requiring subsequent axis correction of the knee joint (osteotomy) is at 10 percent.
Since the introduction of the new methods for the repair of cartilage damage and osteoarthritis (described below), the abrasion arthroplasty has fallen out of favour - I think wrongly. It is true that they can only produce replacement cartilages, which can wear out early again - but that is not a must! Again and again we see amazing long-term success with this procedure. In addition, the new methods lack long-term experiences and they are not affordable for everyone.
The treatment of the shoulder, elbow and wrist simply consists of therapeutic exercise and rest for 6 weeks. Ankle and hip are treated similarly to the knee joint.
New methods of surgical osteoarthritis treatment, treatment of cartilage defects
These methods were inititally developed to treat small defects, but also to cover all cartilage thickness defects (for example, after an accident), just as a patch can. These were young patients with otherwise perfectly healthy knees. Through the cartilage healing, it was sought to avoid a later osteoarthritis (abrasion). After recording good to excellent results, larger defects were treated and later also worn knee joints (osteoarthritis).
Meanwhile, however, with regard to the healing of large defects and particularly osteoarthritis, a certain disillusionment has occured. Unfortunately, osteoarthritis is still not curable by these methods.
These methods are used mainly on the knee, but also at the ankle and hip.
Please read the chapter "knee / joint abrasion".
Example of a successful cartilage repair: Full cartilage defect on the patella sliding bearing.
After coverage with a cultivated cartilage, the defect is completely filled and the patient pain-free.