Knee Arthrosis (gonarthrosis) and Rehab

Overview of knee osteoarthritis

Knee arthrosis (gonarthrosis) is a wear and tear in the knee. The typical complaints are pain when moving and later also at rest. Gonarthrosis is the most common form of osteoarthritis in USA. The wear shows up in the abrasion of the protective articular cartilage between two bones. There are even three bones in the knee joint, the femur, the shin and the kneecap. All bones are connected by joints, the shin and thigh are double.

Knee Osteoarthritis: General

Every year in USA, around 240 out of 100,000 inhabitants are diagnosed with osteoarthritis of the knee. The disease is therefore even more common than osteoarthritis of the hip joint. As it is a sign of wear, the risk of illness increases with age as expected. Men are typically affected earlier than women.

Many sufferers do not notice their gonarthrosis at first, others go to the doctor mainly for pain. The disease is usually diagnosed using imaging methods such as X-rays, computed tomography (CT) or magnetic resonance imaging (MRI). A typical narrowing of the joint space through the removal of cartilage confirms the doctor’s clinical suspicion here.

Knee osteoarthritis: Different forms

Since the knee has a rather complex structure, various forms of arthrosis can arise. The different joints between the three bones of the patella, tibia and thigh are called compartments in medicine. If only one compartment is affected by signs of wear, it is a unicompartmental gonarthrosis between the femur and tibia or between the femur and kneecap. If two compartments are affected (bicompartmental gonarthrosis), the femur and the tibia are involved. If all three compartments are affected, the orthopedist speaks of a pangon osteoarthritis or a tricompartmental gonarthrosis.

Medial and lateral gonarthrosis

Unilateral gonarthrosis can occur, particularly in the context of malaligned legs (bow or X legs). In the medial form, the zone of cartilage degradation lies in the inner part of the knee joint, and in lateral gonarthrosis, the wear is on the outside.

Activated gonarthrosis

If a knee joint that is pre-damaged by osteoarthritis becomes inflamed, doctors speak of activated gonarthrosis. The patient complains of a painful, reddened and overheated knee.

Knee arthrosis: appearance/symptoms

The main symptom of gonarthrosis is pain. Early signs of beginning joint wear are start-up pain, pain during exercise and fatigue pain. At rest, those affected have no problems at this point. With increasing cartilage breakdown, the symptoms also increase. Pain now exists even without stress and at night while sleeping, the muscles around the joint also hurt. Weather sensitivity and restricted movement can occur. In the pronounced final stage, the degradation process deforms the entire joint and the affected knee can become unstable.

Knee osteoarthritis: examinations and diagnosis

The orthopedist makes the diagnosis of gonarthrosis based on clinical examination results and images of the diseased joint. X-rays, magnetic resonance imaging (MRI) and computer tomography (CT) provide information about the width of the joint gap and thus indirectly about the thickness of the cartilage layer that covers the joint. The cartilage itself is not radiopaque and cannot be visualized on an X-ray or CT.

Patient questionnaire

Specialists use special questionnaires to decide when the right time to have surgery for gonarthrosis has come. Interesting points are for example:

  • How severe is your pain on a scale of 1 to 10?
  • How restricted is the function of your knee joint?
  • Do you feel that your gonarthrosis limits your quality of life?
  • Do you experience pain regularly at rest and at night?

Knee osteoarthritis: prevention, therapy and rehab

How to prevent gonarthrosis

Preventing gonarthrosis is only possible to a limited extent. Avoid being overweight and do knee-friendly sports such as water gymnastics and cycling. Consult an orthopedist if your legs are misaligned (X-legs or bow legs, for example). If joint wear has already started, physiotherapy exercises can stop the process by strengthening the muscles around the knee joint. The stress on the articular cartilage can thus be reduced.

Surgical therapy for gonarthrosis

If conservative therapy can no longer stop the progression of gonarthrosis, the treating orthopedist usually advises an artificial knee joint. If the cartilage in the knee joint is only worn on one side, a so-called medial slide can be used. The procedure is performed minimally invasively if the arthrosis is only moderately pronounced. After the operation, the sled functions as a spacer in the knee joint and thus takes over the task of the destroyed articular cartilage. A so-called surface replacement, which is used to preserve bone, works in a similar way. A full denture is the last stage of therapy. Orthopedic surgeons distinguish between cementless prostheses for younger patients who still have a stable bone structure and cemented prostheses for older patients, which cannot be easily replaced during the course. Depending on your needs, the prosthesis can be made of different materials. Which model is used for you depends on possible misalignments of your legs, the stability of your ligaments, your bone quality and any associated diseases. On average, the prosthesis must be replaced after approximately 15 years.

Your time in hospital

The surgery itself usually takes one to two hours. You will likely stay in the hospital for five days if there are no complications. The mobilization begins immediately after the new knee joint is inserted and continues immediately afterwards in the rehab. In addition to the doctors, your most important contact persons are specially trained physiotherapists.

Your time in rehab or follow-up treatment

Expect a stay of around three weeks, either inpatient or outpatient. At the beginning, you will move with two forearm crutches, according to the instructions of a physiotherapist. A motor motion track can also be used. You can quickly put more strain on the operated knee. Details here depend heavily on your general condition and the muscle strength of your legs. Look forward to a completely new feeling of movement. The time of chronic pain is now over and the pain in the operation also passes in the rehabilitation clinic under professional care. Concentrate on rebuilding the muscles of your knee and thus stabilizing the ligament. Most of the patients have pain-relieving posture, which they have often maintained for years, shortened ligaments, vision and muscles in the knee. This is where physiotherapy comes into play in rehab.

Every patient is an individual

In rehab there is time to create a very individual treatment plan for you and implement it every day. Orthopedists and physiotherapists (physiotherapists) form your treatment team together with occupational therapists and specialists in physical therapy. As the mobility of your knee improves, the therapy is constantly being adapted.

Physical applications

In order to get your knee back in shape quickly, you will receive various physical treatments that support the recovery process.

  • massages
  • lymphatic drainage
  • Fonts
  • electrotherapy
  • heat applications

Physiotherapy and occupational therapy

Physiotherapy and occupational and occupational therapy together have the goal of giving you back your flexibility in the knee joint and making you fit for everyday life again. They perform exercises to realign coordination and strength. The therapists will help you to improve any pre-existing bad posture and to gain a new body feeling. As soon as the surgical wound has healed, many rehabilitation clinics also offer physiotherapy in the water. Group therapy includes walks and similar movement training with other knee prosthesis wearers. An exchange of experiences motivates and improves the mental situation of the patients.

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