Orthopedics-Online

Osteoarthritis therapy

How should osteoarthritis therapy be designed?

A causal therapy of osteoarthritisi.e. a therapy that addresses the cause of the arthrosis fixes there is not any.

Although a large number of "cartilage-building preparations" are offered, ranging from gelatine to herbal active ingredients which can contain a wide variety of things, so far there is no scientific proof of their effect (in relation to their cartilage-building effect). In particular, an influence on the progression of cartilage loss cannot be reliably demonstrated. For many preparations that claim this influence, studies are available that have been able to demonstrate a positive effect on osteoarthritis. This effect could then not be reproduced in other, independent control studies.

Read more on this topic: Cartilage build-up

Ultimately, the result is open. Too many things are still unanswered. Since most of the preparations on the market are relatively harmless, it is up to the experience of the doctor and the patient himself whether such a therapy should be adopted. The alternatives are at least limited and ostensibly aim at treating the symptoms, not at causal (causal) Osteoarthritis therapy.

However, various therapeutic measures can bring significant relief from the symptoms of osteoarthritis:

Physical therapy (heat, electricity, etc.) and physiotherapy (including maintaining strength and mobility) are often very effective.
Please also read: Knee school for osteoarthritis
Joint injections with flushing of the joint and instillation of cortisone preparations in inflammatory phases of osteoarthritis or the application of local anesthetics as pain therapy.
Administration of hyaluronic acid into the knee joint, which acts as "synovial fluid" and improves the quality of the existing cartilage.
Hyaluronic acid has a pain-relieving effect and improves mobility.
Orthopedic technology (hand stick, buffer heels, shoe outer and inner edge heights)
Painkillers: Anti-inflammatory preparations such as dicofenac or ibuprofen are particularly effective, but have the disadvantage that they attack the gastric mucosa. Combination with a "stomach protection preparation" (e.g. Pantozol®) can be useful for better tolerability. Alternatively, the so-called “COX 2 inhibitors” such as B. Celebrex or Arcoxia®, which are said to have a low complication rate for the dreaded gastric bleeding. In particularly severe cases, painkillers from the morphine group can be prescribed to relieve the symptoms.
Homeopathic Medicines:
Various homeopathic medicines can alleviate symptoms in osteoarthritis therapy.
You can find out more about this topic at: Osteoarthritis and Homeopathy

The aims of the therapy are above all to prevent the progression of osteoarthritis, alleviate the pain caused by the osteoarthritis and improve or maintain the restricted mobility. The pillars of therapy include general therapeutic measures, physical therapy, drug therapies, orthopedic technology and surgical measures.

Read more on the topic: X-ray stimulation

Appointment with ?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

Lumedis - orthopedic surgeons
Kaiserstrasse 14
60311 Frankfurt am Main

You can make an appointment here.
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
For more information about myself, see Lumedis - Orthopedists.

General measures

The general therapeutic measures for osteoarthritis mainly consist in reducing what may be present Obesityso that the previously damaged joints can be relieved. This is achieved through a Change of dietwhich in itself can also have a positive influence on the symptoms of osteoarthritis.

Please also read our topic: Diet for osteoarthritis

Furthermore, the loading and unloading of the joints should be in a reasonable ratio to each other. sportsthat put a particular strain on a certain joint group should be avoided. When choosing footwear, care should be taken to use shoes with soft heels. Joints should be warmed and protected from getting cold and wet. swim should be done in the form of crawl and back crawl and in thermal baths; regular aqua aerobics are also recommended.

Physical therapy

When treating osteoarthritis, it is recommended to perform regular physiotherapy exercises at regular intervals. Furthermore, the patient is informed about harmful movements and protective measures in the form of patient training. In the case of osteoarthritis without an inflammatory component, the application of heat can help (e.g. Ointments, plasters, red light, mud). In the case of activated osteoarthritis with a strong inflammatory component, cooling therapies are mainly induced, as well as electrical and ultrasound therapy.

Another component of physical therapy is muscle building and muscle training in order to protect and relieve the previously damaged joints. In addition, the patient should receive training on how to properly load the joints when walking.

Please also read: Strengthening exercises for knee osteoarthritis and knee osteoarthritis, which sport is advisable?

Medical therapy

Medicinal measures aim to reduce inflammation and pain in the joints. Drug therapy is mainly used for activated inflammatory arthritis.
Often used to treat pain Paracetamol used, drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation. It should be used for a limited time and only if there are acute periods of pain or inflammation. No NSAIDs should be combined and only one preparation should be used at a time. The dosage should be as low as possible. Always start with a low dose and increase if necessary if there is pain. Substances with a short half-life that work quickly should be used.
In parallel to the drug administration, the Kidney function examined and the integrity of the stomach checked beforehand. In elderly patients, the dose should be adjusted accordingly and the dose chosen should be even lower. To protect the stomach, a so-called Proton pump inhibitors can be used. In severe sales, a Cortisone preparation injected into the affected joint space. This also leads to an anti-inflammatory effect in the acute episode. An injection should only be given if the medication previously given has not worked.

Measures of orthopedic technology

There are numerous orthopedic aids that are supposed to help put the right strain on joints and make everyday movement sequences more physical. So there are special shoes and Roll-off aidsthat are intended to ensure this and can be adapted to the patient.

Operational measures

With advancing Osteoarthritis or in the case of therapy-resistant courses, often only one operative therapy measure the only alternative. This is mostly an artificial joint replacement. Most often come Knee endoprostheses (so-called Knee TEP) or hip TEP (Hip prosthesis), joint replacements of the shoulder joints have also been used for some time. Surgical treatments are now everyday routine interventions. (please refer: Surgery for knee osteoarthritis)
It must be noted, however, that after the corresponding interventions, a rehabilitation phase that sometimes lasts for weeks is necessary in order to restore the corresponding movements of the joints. Recently, further surgical procedures and approaches have been tested, but most of them are still in the trial phase. These include the cartilage cultivation and the Cartilage transplant.

In cartilage transplantation, a piece of articular cartilage is removed from an undamaged part of the joint at the open joint and inserted into the area whose cartilage has degenerated or has already disappeared. Then the joint is closed again, the one used cartilage should then grow in and form a new joint surface. Another technique is to grow cartilage outside the body. A piece of cartilage is also removed from the patient and grown outside of the body. As soon as a corresponding amount of cartilage has been newly formed, the cartilage is inserted in a second surgical session.
Then it is also waited for the cartilage to grow in. The prerequisite for the cartilage transplant procedure is that the joint is not to blame for the osteoarthritis or that the misalignment has been corrected. If a joint is further improperly loaded, the newly inserted cartilage will also degenerate again. The complaints then reappear. Furthermore, the procedures can only be used if there is only cartilage damage and the rest of the joint is still undamaged. In advanced stages, total joint replacement is the only treatment option.

Appointment with ?

I would be happy to advise you!

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You will find me:

Lumedis - orthopedic surgeons
Kaiserstrasse 14
60311 Frankfurt am Main

Osteoarthritis and Diet

The Causes of Osteoarthritis and the development of new treatment options have also focused on the topic in recent years nutrition directed. For example, unofficial guidelines and recommendations have been issued on how diet could go hand in hand with the development of osteoarthritis or how the course of osteoarthritis can be averted by changing one's diet.
Basis of the relationship between Diet and osteoarthritis is the guess that a Acid-base environment of the body, which is in the acidic area, could promote the development of osteoarthritis.
Therefore, it is primarily important to prevent the ingestion of foods that acidify the body.

Foods that pull the body's acid-base environment into the acidic area are:

red wine
animal fat
saturated fats, which include butter, cream, nuts, and oily fish
Vegetable fats that are hydrogenated
sausage
Pork and beef
acidifying fruits, such as citrus fruits
asparagus
tomatoes
pepper
black tea and coffee
Sweets
and
Alcohol.

Furthermore should be on Smoke can be dispensed with entirely.

However, foods that are recommended for osteoarthritis or that cause a Prevent osteoarthritis should be:

Salads
vegetables
non-acidic fruits
rice
Spelled products
potato
Marine fish
Rapeseed oil
Spelled oil
sesame oil
and
Lean milk products (skimmed milk, low-fat cheese, low-fat quark).

Drinking herbal tea is also recommended.

Of course, diet cannot completely prevent osteoarthritis. Nor can she heal them. At most it can have a supportive effect.
However, it should be noted critically that the theories are hardly or not scientifically proven.

Therapy of shoulder arthrosis

Osteoarthritis of the shoulder is treated conservatively whenever possible (especially in the early phase), i.e. without surgery. A combination of pain therapy and physiotherapy can have a positive influence on the progression of shoulder wear. This can often slow down osteoarthritis and alleviate shoulder discomfort.

Pain therapy is direct injections of pain-numbing medication (usually with the addition of cortisone) into the shoulder joint itself, into the shoulder capsule or the upper sliding space (between the head of the humerus and a bony protrusion of the shoulder roof). As a result, freedom from pain can often be achieved, and since the medication also has an anti-inflammatory effect, there is a reduction in the irritation (inflammation) in the shoulder joint.

Targeted physiotherapy to strengthen the shoulder muscles and correct possible bad postures in the upper sections of the spine can also support the healing process. Cold applications or X-ray stimulation can also prevent the progression of osteoarthritis in the shoulder in some cases.

In the case of advanced shoulder osteoarthritis, surgical therapy can be useful. The sliding space in the shoulder can be expanded, for example, and the shoulder muscles (rotator cuff) can be reconstructed. Relief or removal of parts of the shoulder joint can also be carried out.
In the case of very pronounced osteoarthritis of the shoulder, an artificial joint replacement should be considered in order to treat the pain in the long term and to improve the limited mobility of the shoulder. There are different shoulder joint prostheses (e.g. cap prosthesis, humerus head prosthesis, total shoulder prosthesis, inverse shoulder prosthesis) that can be used in advanced osteoarthritis.

Find out more about shoulder arthrosis at: Osteoarthritis of the shoulder

Therapy of knee osteoarthritis

A knee prosthesis may be necessary for severe osteoarthritis.

In the Knee osteoarthritis the first therapy goal is always one Pain reduction. With the help of medication, physiotherapy, Electrotherapy or X-rays can relieve knee pain caused by osteoarthritis.

Please also read: Strengthening exercises for knee osteoarthritis

In some cases you can also Cartilage preparations achieve an improvement in symptoms in the knee joint. Especially the one targeted muscle building can through Strengthening coordination and stability of the knee joint to alleviate the symptoms.

Only when everyone Conservative therapy options exhausted should be a operative therapy knee osteoarthritis should be considered. With smaller ones Meniscus- or Cartilage damage can a joint endoscopy (Arthroscopy) already enough to get the Osteoarthritis symptoms to alleviate. Also one Changeover operation, for malpositions like O- and Knock knees corrected can improve the statics of the knee joint.
In the case of very advanced osteoarthritis of the knee, is a artificial knee joint (Knee endoprosthesis) the option of choice. Usually only the top layer of the joint bone removed and the implant takes over the function of the joint cartilage (as a placeholder, so to speak). The current shelf life of artificial knee joints is between 8 to 15 years, then it must be renewed or replaced.

Therapy of hip arthrosis

The therapy options for hip arthrosis are very diverse. In the initial stages, anti-inflammatory and analgesic drugs are given. Weight reduction can also have a positive effect on the healing process, as each reduction of approx. 5 kilograms in weight reduces the risk of osteoarthritis by approx. 50 percent.
In addition, orthopedic shoes or insoles can help to change the load on the leg axis and thereby protect the joint.

The symptoms can also be alleviated by applying heat or cold. Hip osteoarthritis is treated particularly well with a lot of exercise and sporting activity, but little stress on the hip joint (e.g. swimming and cycling are ideal). The movement combats the osteoarthritis pain, stabilizes the cartilage and strengthens the muscles, which leads to a relief of the cartilage.

In advanced stages of the disease, surgical treatment of hip osteoarthritis must often be used. As part of a jointoscopy, causes of osteoarthritis such as limited cartilage damage can be eliminated. However, in some cases it may also be necessary to correct a misalignment by repositioning the hip joint, using a hip cap or completely replacing the hip joint.

Find out more about the here Therapy of hip arthrosis, X-ray stimulation

Therapy of hand osteoarthritis

The osteoarthritis in the hand is associated with a great deal of limitation for many patients, as simple activities such as eating or writing often become torture. It is therefore advisable to carry out adequate therapy for osteoarthritis in the hand. First of all, if the patient suffers from osteoarthritis, try to move his hand as much and as well as possible in order to prevent the osteoarthritis. This is primarily used for prophylaxis, but it is important to move your wrists properly. With the help of occupational therapy, the patient can learn which hand movements are good and which only put more stress on the joints and thus lead to aggravation.

If the saddle thumb joint is affected, it often helps to have a doctor splint this joint. This is a very simple therapy for osteoarthritis of the thumb saddle joint, but at the same time a very effective and inexpensive one.

Another simple therapy for osteoarthritis in hand is rubbing in an analgesic gel or cream that contains non-steroidal anti-inflammatory drugs (NSAID) included, such as a Proff® pain cream. By massaging the joints and the pain-relieving effect, the patient usually has quick and good results and can move the hand reasonably well again. Especially in the early stages, the patient is also helped by taking pain reliever and / or anti-inflammatory drugs (non-steroidal anti-inflammatory drugs).

However, it is important to avoid direct injection of painkillers or anti-inflammatory drugs (anti-inflammatory drugs) into the affected joint in the hand, as this will only damage the joint more in the long term. Therapy with cortisone is also not recommended, as this only leads to an improvement in the short term and could also demolish the surrounding cartilage in the joint, which would only further promote the progression of the osteoarthritis and thus ultimately lead to more complications.

However, since drugs and gels are usually not sufficient therapy for osteoarthritis over a longer period of time, the patient should consider after some time whether he should try alternative healing methods. For example, heat applications help many patients and contain osteoarthritis over a longer period of time. Acupuncture also works very well as a therapy for many patients with osteoarthritis in the hand. In addition, there is also biostimulation with a soft laser and magnetic field therapy. However, these alternative healing methods are usually not recognized by the health insurance companies as therapy for osteoarthritis in the hand and therefore usually have to be paid out of pocket.

Radiosynoviorthesis is also a very effective therapy for osteoarthritis in the hand. Here, radioactively charged particles are injected directly into the wrist affected by osteoarthritis. These particles now inhibit the inflammatory process directly in the joint. In order not to damage the surrounding tissue by the radioactive particles, only short-range radioactive particles are used, which are then mainly distributed in the affected joint. In particular, the pain that occurs in the hand with osteoarthritis can be contained very well and over a longer period of time.

Depending on the severity of the osteoarthritis in the hand, the last possible therapy option is surgery. If the patient still has a joint space with inflammatory cells, arthroscopy can be used to attempt to remove only this part of the inflammatory area and thus reduce the patient's pain.

However, if the patient has an advanced stage of osteoarthritis in the hand, the doctor may have to completely cut the pain fibers in an operation so that they can no longer transmit the information "pain" to the brain. This therapy option should always be the last option and is also associated with certain risks. Nevertheless, the patient's freedom from pain is the top priority. If all other therapy options have been exhausted, the last resort is to cut the pain fibers as a therapy for advanced osteoarthritis.

Please also read: Treatment of finger osteoarthritis and surgery of finger osteoarthritis

Therapy of thumb osteoarthritis

A operative therapy of the Saddle thumb joint- Osteoarthritis is usually only necessary when strong pain simultaneously with one Impairment of the thumb function about a longer period exist and this not on conservative therapies speak to. In mild cases of osteoarthritis, one is often enough Relieving posture possibly with brief immobilization thumb to relieve pain.

Also can Anoint be applied and short term so-called rheumatic drugs be taken (e.g. Arcoxia®, Voltaren®, Ibuprofen®). In later stages of saddle joint arthrosis, especially in load-dependent complaints, can a rail (Orthosis) are worn when the joint is under stress in order to relieve the joint.
Cortisone injections in the joint can become a longer symptom relief lead, but due to the side effects (e.g. severe inflammation of the joint) not injected too often become.

Another therapy option is offered by a Treatment with leeches.
Should be a operative therapy for the thumb saddle joint arthrosis, this is usually the case large polygonal leg away (Trapezectomy). Of the Healing process After this operation is relatively tedious, the thumb can at the earliest after about three months can be used again normally. In rare cases a Artificial joint used, rehabilitation is much faster with this method (approx. six weeks). However, in most cases, over the years one does Loosening of the artificial joint in the bone, which is why a new operation with removal of the artificial joint replacement and subsequent trapezectomy is required.