Knee joint replacement / Knee endoprosthetics due to degenerative diseases of the knee joint (gonarthrosis)

• First symptom: fatigue after walking longer distances, yet no pain, but the wish for a break becomes more often.
• A feeling of fatigue after longer walks is often the first indication of an existing condition. There is no pain yet, but you are increasingly feeling the need to take a break.
• The progressing joint degeneration eventually causes a pulling sensation, a feeling of pressure, mild pain in the groin area, thighs or knee joints.
• In the next phase, you will experience pain while walking longer distances, walking on uneven ground or while climbing stairs.
• Pain after periods of inactivity is a typical symptom: When standing up after long sitting or when getting up in the morning, your first few steps are often painful and you always feel initial stiffness.
• At later stages, you may experience resting pain and/ or night pain.
• The more pain you experience, the more you will try to avoid painful movements. As a consequence, your muscles become tense and shorten as you adopt an unnatural posture, continuously bending your hip and causing the joint capsule and ligaments to shrink. Ultimately, the range of motion of your hip joint decreases and movement becomes painful.

• Lateral x-ray image of the knee joint
• Initially, the joint cartilage is worn down. This cartilage is not directly visible in X-ray images, but it can be seen as a dark seam between the bright osseous joint parts, referred to as joint space (= permeable to X-rays). Representing the extent of cartilage damage, this joint space becomes increasingly smaller, until the two bones are ultimately touching each other.
• With increasing joint stress, the bone tissue also responds by thickening in the areas of overloading. X-ray images then show sclerosis (thickening) as a bright band (= impermeable to X-rays). The under-loaded part of the bone rather appears to be more transparent than usual.
• Osteophytes (bone spurs) increasingly occur on the joint’s surface area.
• In the areas of overloading, a loss of blood supply arises, the bone tissue dies and small cysts (cavities) form. They frequently appear in pairs opposite to each other on neighbouring bone parts.

The first step is anamnesis, i.e. a systematic analysis of your case history. In this process, your current state of health, your living environment (e.g. occupational stress), your case history (e.g. internal-medical diseases), particular risk factors (e.g. allergies) as well as genetic (hereditary) risks are evaluated. The following questions are typical:

What are the symptoms, when did they start and how often do they appear?

What seems to cause the symptoms (physical exertion, sports)? Howe can they be alleviated?

Have you tried-self treatment (home remedies) and what did your physician prescribe (medication, physical therapy)?

Do you have any other conditions?
What medication do you take regularly?

During the thorough physical examination we ascertain and evaluate joint swellings, mobility, stability, pressure and pain during movement of the affected joint and the neighbouring joints, in addition to posture, misalignment of limbs and spine, nervous disorders, blood supply, height and weight.

The results usually yield a first diagnosis, which will then be confirmed, if necessary, using additional imaging techniques, and/or distinguished from similar signs and symptoms.

For basic diagnostics, usually three x-ray images are taken: one in front view, a side image and one of the patella in its sheath.
In case an axis measurement is required, the whole leg including the hip and ankle joints is displayed.

Magnetic resonance imaging
Magnetic Resonance Imaging (MRI or nuclear spin tomography; cross-sectional image using magnetic fields) measures the content of hydrogen atoms in different tissues, instead of working with x-rays. This imaging technique shows both bones and soft tissue such as cartilage, ligaments, muscles and tendons. At early and intermediate stages of a degenerative disease, it can be very helpful to accurately determine the extent of cartilage damage

Computer tomography
In some particular cases, computed tomography (CT, cross-sectional imaging technique using x-rays) is employed to complement conventional X-ray visualisation. CT generates a three-dimensional image of the hip joint, so that the joint can be precisely measured and, most importantly, misalignments can be determined.

Sonography
Sonography (ultrasound examination) of the knee joint is of secondary importance in the diagnostics of gonarthrosis. However, it allows for visualising the concomitant alterations of soft tissues, which cannot be seen in the x-ray image.

In case of pre-damaged knees, it is reasonable to use moving stairs or lifts. Exercising is certainly important but not on stairs!

The following preventive measures can help you to actively counteract the development of the disease or slow down its progression at an early stage.

Is your work mostly sedentary?

• Move your legs repeatedly!
• Stand up as often as possible and walk a few steps!

Do physical exercise!

• Cycling, swimming, Nordic walking and cross-country skiing are particularly suitable.
• Try to avoid stop-and-go sports such as tennis, table tennis, squash and badminton as well as most team sports such as handball, football, volleyball, etc.

Move your joints to their full extent!

• Do gymnastics on a regular basis!
• Exercise and stretch your muscles!
• Stretch shortened joint capsules and ligaments!

If you have a pre-existing condition, try to avoid heavy lifting!

• Every extra pound on your body puts additional pressure on your hip joint!
• Use a shopping cart rather than a shopping bag!
• When you are carrying loads, use an escalator or elevator.
• Take the load off your joints by using a walking stick!

Our treatment methods are always tailored to the individual patient and his particular case history – You will see that with our specialists you are in the right hands.

Physiotherapy:
Individualised physical therapy is combined with easy-to-understand instructions for self-treatment, to alleviate your discomfort, stabilise your cartilage and strengthen your muscles, helping you to significantly improve your mobility.

Balneotherapy (heat and cold) and physical therapy
Application of heat and cold; ultrasound and electrotherapy supplement the treatment. They effect the enhancement of blood circulation and thus an improvement of the joint nourishment.
(For the rest, see coxarthrosis)

Antiphlogistics (anti-inflammatory medication):
Anti-inflammatory therapies, also referred to as antiphlogistics, are our first choice for all medical conditions of the musculoskeletal system. In addition to their anti-swelling and anti-inflammatory effect, their active ingredients also relieve pain in different strengths. The side effects of these medications particularly affect the stomach and kidneys (e.g. Ibuprofen, Diclofenac, Indometacin).

Cartilage-building supplements:
Gelatines, Chondroitin sulfate and glucosamine sulfate are supplements with scientifically proven efficacy. However, treatment over a period of six to twelve weeks is necessary to achieve the desired effect.

Pure analgesics (pain medication):
Pure analgesics do no treat the cause of arthrosis. Although they relieve pain, they have no effect on the inflammatory processes in the body (examples: (e.g. Paracetamol, Metamizol, Tramadol).

Rehabilitation up to complete recovery

The goal is the patient’s complete recovery after surgery within the shortest possible period of time. Therefore, we select an as mild as possible surgery technique for each patient individually.

The patient is usually able to start with the physical therapy as early as on the date of the surgery. In case of normal recovery course as well as good health constitution, full weight may be placed upon the joint again after a few days and the patient is only dependent on two walking crutches only for about 6 weeks.

In order to ensure full recovery, we recommend that you undergo inpatient or outpatient rehabilitation after your stay at the hospital. We will be happy to assist you in choosing a facility and we will also take care of all the formalities with your insurance company.