Conservative orthopaedic treatment

Joint arthrosis

What is osteoarthrosis?

Osteoarthrosis is a degenerative, non-inflammatory joint disease characterized by damage to the articular cartilage, sclerotization (thickening) of the bone under the cartilage, changes in the joint capsule and, as a result, deformation and limitation of joint mobility. Osteoarthritis is accompanied by pain, which depends on a number of factors, such as the degree of damage to the joint, the load, the presence of effusion in the hips, the weather, and the time of year.

Why does osteoarthrosis occur?

Arthrosis occurs in a joint where the balance between the cartilage's reparative abilities and the degree of load (damage) on the articular cartilage has been disturbed. In the so-called primary cause, the cause may not be clear. In secondary arthrosis, it results from damage to the menisci and ligaments, traumatic damage to the cartilage or axial changes in the limb after a bone fracture. It is also due to inflammatory diseases (rheumatoid arthritis, bacterial arthritis), neuromuscular or metabolic diseases.

Risk factors:

Age: arthrosis is the most common chronic disease of the elderly (80% of people over 75 are affected).

Sex: women are affected more often.

Weight or overweight: an increase in load while maintaining reparative capacity is associated with a higher incidence of arthrosis.

Conditions after injuries to joints or adjacent bones.

Additional factors: genetic disposition, geographical influences.

Which joint can arthrosis affect?

Basically every joint. Most often, however, the large joints of the lower limbs - the hip and knee joints, the intervertebral joints of the spine, the small joints of the hand, the root joints of the thumb and foot, less often the ankles, shoulders, elbows or wrists.

Can arthrosis be cured?

The treatment of arthrosis is quite difficult, in fact it cannot be cured completely. In severe forms, it can be helped by replacing the affected joint with an artificial one. In milder forms, the course of the disease can be influenced by changing the load and physical activities, reducing weight and increasing the resistance and regenerative capacity of the cartilage by appropriate pharmacotherapy.

The treatment of osteoarthritis is summarized in the recommendations of OARSI- the international professional society for osteoarthritis. Basically, it is a combination of regimen measures, pharmacological and surgical treatment. Regimen measures include, for example, adequate physical activity. Even the affected joint needs a certain amount of stress to provide nutrition to the articular cartilage. Conversely, excessive loading leads to cartilage damage. In obese people, weight reduction is important. Preventive treatment of joint damage or limb deformities (treatment of damaged menisci and ligaments, traumatic cartilage lesions, treatment of axial limb deformities). Use of appropriate orthopaedic equipment and other measures.

Which drugs can be taken for osteoarthritis?

Chondroprotection: called SYSADOAs, or disease-modifying drugs. These include, for example, glucosamine or chodroitin sulfate, MSM (methylsulfonylmethane), collagen, hyaluronic acid.
The advantage of these drugs is their minimal side effects and the study-proven effects on arthrosis.
By increasing the supply in the diet, cartilage regeneration can be improved. An anti-inflammatory effect and a reduction in pain have also been described. They are mostly freely available.

Antireumatics: suitable in case of arthrosis decompensation (presence of swelling or effusion in the joint) or as an occasional analgesic. They may have side effects, most commonly on the gastrointestinal tract.

Pain-killers: they reduce pain in more severe forms of arthrosis, they do not affect the disease as such. These include, for example, Paralen, which according to the International Arthritis Society is the drug of first choice.

Injectables:

Application of growth factors, so-called autologous biological therapy: involves the activation of chondrocytes (cartilage cells) by growth factors. There is no clear evidence of its effectiveness or effect on the cause of the disease. However, it can be expected that in the near future this is where a major change in the treatment of this disease may occur. This treatment is not indicated for more severe forms of arthrosis and its disadvantage is the relatively high cost.

Hyaluronic acid application: intra-articular installation of this macromolecule improves the biochemical environment in the joint, which may lead to calming of arthrosis and stimulation of chondrocytes.

Corticosteroid application: when properly indicated, leads to calming of arthrosis, reduction of flow and prevention of effusion, which is subjectively perceived by a reduction in joint pain. If applied too frequently or incorrectly, it can, on the other hand, have a negative effect on the articular cartilage (injectable drugs must be administered by a doctor, preferably an orthopaedic surgeon).

Surgical treatment:

THR - total joint replacement: nowadays it is one of the most common and basic operations performed in orthopaedic departments. With the improvement of THP implants, surgical procedures and techniques, and last but not least, the intensification of rehabilitation, this type of surgery is displacing other surgeries (osteotomies and arthrodesis) and is performed even in younger patients. Further information can be found in the " patient information" folder.

UNI THR - unicompartmental joint replacement: ½ knee replacement: is indicated in case of damage to the inside or outside of the knee. This operation has a number of advantages (minimally invasive surgical approach, easier rehabilitation), but has relatively narrow indication criteria.

Other surgical procedures for osteoarthritis: ASK, osteotomies, arthrodesis.

Treatment of osteoarthrosis of the joints according to OARSI recommendations/International Osteoarthritis Society.

Nonpharmacological:

Combination of nonpharmacological treatment and pharmacotherapy

• Patient education, lifestyle modification.
• Regular telephone checks.
• Examination by a physiotherapist and exercise instruction.
• Regular exercise
• Weight reduction in obese people.
• Support aids (canes, crutches).
• Orthoses for joint instabilities.
• Medical shoes and orthopaedic insoles.
• Application of heat.
• TENS-transcutaneous electrical nerve stimulation.
• Acupuncture.

Pharmacotherapy:

• Paracetamol-paralen in doses up to 3g per day.
• Non-steroidal antirheumatic drugs - NSAIDs.
• Topical NSAIDs and capsaicin in knee arthrosis.
• Intra-articular injection of glucocorticoids.
• Intra-articular injection of hyaluronic acid.
• Glucosamine and chondroitin sulfate for pain relief.
• Glucosamine, chondroitin and diacerein-probable structural effect.
• Weak and moderate opioids.

Surgical treatment:

• Total joint replacement.
• Unicompartmental joint replacements.
• Osteotomy and preventive joint surgery.
• Joint lavage and arthroscopic treatment in gonarthrosis.
• Arthrodesis.