Gonarthrosis

Gonarthrosis: what’s that?

In medical jargon, osteoarthritis of the knee or knee arthrosis is described as gonarthrosis. It is an increasing wear of the joint cartilage which can also result in damage to the bone in late stages.
The knee joint consists of three bones: the thigh bone (femur), the shin (tibia) and the kneecap (patella). Different types of gonarthrosis are distinguished, depending on where the joint cartilage is degenerated.

Gonarthrosis types

• Medial gonarthrosis: If the degenerated cartilage is in the inner (medial) knee joint region (compartment), this is described as medial gonarthrosis. In case of additional varus malalignment, it is a so-called varus gonarthrosis.
  
  
• Lateral gonarthrosis: If the degenerated cartilage is in the outer (lateral) knee joint region (compartment), this is described as lateral gonarthrosis. In case of additional valgus malalignment, it is a so-called valgus gonarthrosis.
  
  
• Retropatellar arthrosis: If the degenerated cartilage is in the kneecap joint, that is to say more central, it is a retropatellar arthrosis.
  
  
• Pangonarthrosis: If all joint sections of the knee joint are affected, it is a pangonarthrosis.

Gonarthrosis is the most common form of arthrosis in Germany. However, no validated figures are available regarding its frequency. With increasing age, the likelihood of knee arthrosis rises. Up to the age of 45, men are more frequently affected, later on the other hand more women.

Gonarthrosis symptoms

A gonarthrosis does not automatically cause complaints. If they do not exist, it is described as an asymptomatic arthrosis. In case of symptomatic gonarthrosis, knee pain is often incurred, for example when climbing stairs or going downhill. Persistent pain may be incurred in advanced stages of the knee arthrosis. Moreover, the mobility of the knee joint is restricted and swellings may occur, which can also cause an uncertain gait. Several patients also describe weather-dependent knee pain which, for example, are increasingly incurred when the weather is cold or wet.

Gonarthrosis diagnosis

A tentative diagnosis can already be made based on the symptoms and the patient’s information (case history). Manual examination of the knee joint, i.e. testing the movement of the joint, can confirm this suspicion. The preliminary diagnosis can be confirmed by imaging procedures such as X-raying.

How can gonarthrosis be prevented?

Some possibilities exist which can contribute to the prevention of a gonarthrosis: these include regular exercise, strengthening the musculature, preferably with joint-friendly forms of sports such as swimming and cycling, avoiding overburdening, a normal bodyweight and a balanced diet.
After accidents, strict implementation of special exercises for the knee joint within the scope of remedial gymnastics or rehabilitation sport can make sense. Treatment with supports and braces provides further protection against overburdening and can, for example, be worn when working in stress situations or under acute pain.
Generally, it helps to support the joint via strong, supporting musculature and to mobilise it via targeted knee exercises.

What therapy options are available for gonarthrosis?

Depending on the stage of the arthrosis, conservative treatment methods or also an operation can be applied.

Conservative treatment

Normally, treatment starts with a combination of exercise therapy and physiotherapy and anti-inflammatory or analgesic medication. Moreover, also acupuncture, cold or heat treatment as well as joint relief via a knee joint support or brace such as the BORT StabiloGen® Eco can help. A balanced, healthy diet and the reduction of possibly existing excess weight also play an important role.

If these measures are not sufficient, cortisone can be administered into the joint once in case of acute inflammation. Hyaluronic acid or autologous conditioned plasma (ACP) – extracted from own blood – are available as an alternative.

Operative treatment

Without joint replacement: In cases with accompanying injury such as meniscus tears, an arthroscopy may make sense. Here, the cartilage surfaces of the joint can be smoothened out (debridement) and the joint rinsed (lavage). This may result in an improvement of the joint function.
If the joint cartilage has insufficient substance, corrective osteotomy may also make sense in some cases. During this operation, the relative position of the bones is corrected with the intention of relieving the joint surfaces in the region of the arthrotic changes.
In case of localised, above-all traumatically caused damage to the cartilage, cartilage transplantation may help.

With joint replacement: If the complaints cannot be sufficiently relieved via conservative measures or procedures to preserve the joint, an operation to replace the joint may make sense. For this purpose various types of prosthesis are available. If the gonarthrosis only affects a subregion of the knee joint (refer to “gonarthrosis types”), unicondylar prostheses (such as the HemiCAP® or hinge prostheses) can be used. If all sections of the knee joint are affected (pangonarthrosis), a knee TEP (total knee endoprosthesis) can be indicated. Also, more and more prostheses exist which only replace part of the joint, such as behind the kneecap and in the opposite thigh region.

Which treatment is used respectively depends on the individual patient’s history as well as the severity of the gonarthrosis and the patient’s psychological stress. Here, the physician and the patient decide jointly how the therapy plan can best be designed.