Rheumatic, bacterial and degenerative knee arthritis
The rheumatoid arthritis (joint inflammation) can affect one or more joints.
It leads to swelling and inflammation of the synovial membrane, which lines the entire joint capsule inside. Other causes of inflammation of the synovial membrane are the bacterial and the abrasion-caused arthritis and the change (metaplasia) of the synovial membrane itself.
Joint fluid (synovial fluid) is, especially in the aggressive rheumatoid arthritis, adversely affected due to the inflammation in its composition, which leads to damage and later also to the destruction of the articular cartilage. The symptoms of rheumatic gonarthritis (knee joints inflammation) are manifested in swelling, pain during exercise and at rest, and a growing movement restriction.
The diagnosis is primarily reached by a study of the blood and synovial fluid.
Under bacterial infection, in addition to heat and redness of the joint, other general symptoms such as fever and fatigue occur, proven by the examination of the knee joint fluid.
The abrasion-caused joint irritation also shows joint effusion and pain, but presents widely varying symptoms (see sections cartilage damage and osteoarthritis).
1. The actual rheumatoid arthritis should initially be treated medically conservatively for several months, under consultation by the treating rheumatologist.
In case of failure of therapy a so-called arthroscopic "early synovectomy” treatment (removal of the inflamed synovial membrane) should not take too long to begin with, to prevent serious damage to the articular cartilage or even a complete joint destruction.
Compared to the previous (and still available) open surgery, arthroscopic synovectomy offers great advantages with respect to the conservation of important capsular ligamentous structures. Since a wide-scale arthrotomy is dispensed with, the risk of arthrofibrosis (joint callosity, joint stiffness) will be banned.
The decision for early surgery is therefore easier today. The exposure of the patient and the postoperative pain is low and the rehabilitation process is rapid. The hospital stay consists of only a few days.
2. The bacterial knee arthritis needs an immediate arthroscopic surgical procedure, namely the synovectomy (removal of the synovial membrane) and requires a hospital stay of at least three weeks. In addition, high doses of antibiotics are applied.
3. The abrasion-caused knee irritation can often be treated successfully conservatively. The arthroscopic surgery procedures are similar to those of a "debridement" - see section cartilage damage and osteoarthritis.
Immediately after surgery, the physical therapy begins on a motorized knee splint (CPM).
2 days after the operation, getting up is possible after removal of the drainage.
Ability to work
This question as well as any requests for sporting purposes are dependent on the nature and extent of the internal knee damage, they should be discussed beforehand with us.
In general, the earlier the surgery is performed, the greater the chance of success.
Since the introduction of arthroscopic synovectomy, and high-frequency surgery, in which an almost blood-free selective removal of the inflamed synovial membrane is possible, the chance of success is 80 to 90 percent.
The complication rate is very low and corresponds to that of the other arthroscopic procedures.
Less a complication, but rather a consequence of rheumatoid arthritis is the occasional recurrence of inflammatory synovial membrane after some time.
Because of the small surgical pain, patients "like" to decide for a repetition of the arthroscopic procedure.