Treatment of Knee Arthritis in Germany

Knee arthritis is a severely disabling disease. It is constantly progressing, causing chronic pain and disability. However, modern medicine can successfully cope with this pathology. You can undergo osteoarthritis treatment in Germany. For the treatment of the early stages of the disease, this country uses the latest methods in the field of cellular regenerative medicine. In the advanced stages of knee arthritis, joint replacement surgery is performed. Please use the Booking Health website to find out the cost of treatment of osteoarthritis in German hospitals.

Content

1. Conservative therapy
2. Surgeries for Iliotibial band syndrome and patellofemoral syndrome
3. Surgery for knee arthritis
4. Joint replacement surgery for osteoarthritis
5. Surgery and rehabilitation
6. Why is it worth undergoing treatment in Germany?
7. Treatment in Germany with Booking Health

Conservative therapy 

Most patients receive only conservative therapy in stages 1-2 of gonarthrosis. The main treatment methods are:

• Drug therapy. 
• Non-drug therapy. 
• Intra-articular injections. 

Drug treatment 

The most common class of medicines for drug therapy are nonsteroidal anti-inflammatory drugs. They reduce inflammation and relieve pain.

The dose of medicines for drug therapy, as well as the frequency of their intake, tend to be minimized. It is because anti-inflammatory drugs cause harm to the gastrointestinal tract. Approximately 1% of those undergoing therapy will be hospitalized because of severe bleeding.

In an early stage of arthrosis, drugs are taken only on demand, that is, after the onset of pain. It usually appears under short-term, intense exercise or at the end of the day. The pain disappears or diminishes after rest.

Periodically, joint inflammation occurs due to the development of reactive synovitis. During this period pain increases, and the patient has to take analgesics continuously. With the relief of synovitis, medicines can be canceled or reduced.

Non-drug procedures help to enhance the effect of nonsteroidal anti-inflammatory drugs. Sometimes local remedies with a warming effect can be used. In most patients, knees hurt less in warm temperatures, and more in cold, so warming the joint with a heating pad can help relieve pain.

Non-drug treatment 

In the case of osteoarthritis of the knee, non-drug methods are just as important, and perhaps more important, for relieving symptoms.

Therapeutic exercises are the only method with proven long-term therapeutic benefits. Exercises to strengthen the muscles of the lower leg, thigh, and buttocks help relieve stress on the knee and slow down joint degeneration.

Other non-drug treatments for knee osteoarthritis include: 

• Orthoses. 
• Kinesio taping. 
• Physiotherapy. 
• Massage. 
• Reflexotherapy. 

Shoes with shock-absorbing insoles, and a cane, help to relieve the knee. Refusal from intense physical exertion also helps.  Overweight patients are advised to lose weight.

Intra-articular injections 

Doctors mostly use hyaluronic acid injections for knee arthritis. These drugs are used as lubricants for the joints. They are called a synovial fluid prostheses. Hyaluronate reduces pain by reducing friction. It provides a good, long-term effect that lasts for several months. 

In developed countries, doctors are increasingly trying to treat knee osteoarthritis using regenerative medicine. The following substances can be injected into the knee:

• Platelet-rich plasma. 
• Mesenchymal stem cells. 

Platelet-rich plasma is prepared from the patient's blood. After taking blood, it is placed in a centrifuge, and excess cells are removed. As a result, the concentration of platelets per unit volume of fluid increases several times. Plasma is injected into the knee joint. About 1 million platelets are used per injection.

Platelets are blood cells responsible for blood clot formation and wound healing. They contain several growth factors, and most of them are released within the first hour after injection. These substances stimulate tissue regeneration.

The method of treating knee arthritis with stem cells is becoming more and more widespread abroad. They are most often obtained from adipose tissue, which is taken by liposuction. The tissue is then placed in a special apparatus that secretes the stromal vascular fraction. It is the mesenchymal stem cell source. The stromal vascular fraction is injected into the knee. The released stem cells not only provide the joint with growth factors, but they differentiate into chondrocytes (cartilage cells), ensuring tissue regeneration.

Surgeries for Iliotibial band syndrome and patellofemoral syndrome

In cases of iliotibial band syndrome (iliotibial tract syndrome), pain appears on the outside of the knee. It can develop after arthroplasty. It is more common in patients with hallux valgus. Whenever possible, doctors use conservative methods for treatment. If there is no effect, surgical intervention is performed: release of the iliotibial tract, transection, or application of small injuries with the tip of a scalpel. The surgery improves the stability of the knee joint.

Some patients develop patellofemoral pain syndrome after arthroplasty. It manifests itself as pain in the front of the knee. It is the area of contact of the patella with the femur. An operation is performed to solve the problem. Doctors restore the capsular and ligament balance in the patellofemoral joint. It is also possible to transect the nerves to eliminate pain (local patellar denervation).

Surgery for knee arthritis 

Doctors can perform four types of surgery for knee arthritis: 

• Arthroscopic interventions – joint lavage, cartilage resurfacing, removal of cartilaginous, and bone growths that are freely located in the synovial fluid of the body.
• Corrective surgery – removal of a part of the femur or tibia to restore the function of the limb, and its alignment.
• Knee replacement surgery – operation for knee replacement with an artificial endoprosthesis, is considered the main one in knee osteoarthritis.
• Removal of a joint without endoprosthetic – arthrodesis or resection arthroplasty. 

In developed countries, knee replacement with an endoprosthesis is always preferred for osteoarthritis. Other surgical procedures are rarely performed, as they have many disadvantages.

Arthroscopic interventions and corrective osteotomies are advisable to be performed only at stages 1-2 of knee arthritis. There is no evidence that these types of surgery help slow the progression of osteoarthritis. They do not make it possible to avoid or even delay knee replacement surgery. Patients receive the only symptomatic effect.

Joint removal without prosthetics is an extreme measure; in fact, a "desperate surgery" which leaves a person permanently disabled, but it can eliminate pain. In the future, the patient will not need additional treatment for knee arthritis. Such interventions are performed only for advanced arthrosis, if there are contraindications to endoprosthetics or if the patient refuses it.

When performing arthrodesis, the joint is connected without the possibility of flexion. The leg is always straight, so one can lean on it when walking with a cane, but the patient experiences inconveniences when sitting.

After a resection arthroplasty, the situation is reversed: the femur and tibia are no longer in contact. The knee bends easily, but one cannot lean on the leg. It is not so comfortable for a person to walk, but more comfort is provided when sitting compared to arthrodesis. This surgery is used in elderly patients who mostly lead a sedentary lifestyle.

Joint replacement surgery for osteoarthritis

Joint replacement surgery is considered the best option for knee arthritis treatment. In Germany, tens of thousands of such surgical procedures are performed every year. Although the cost of treatment is higher than when using conservative therapy or other operations, joint replacement surgery allows coping with even the most severe forms of osteoarthritis. In this case, the limb function can be fully restored.

To treat knee arthritis, doctors usually use total joint replacement surgery. It means that the joint is replaced totally, but not partially.

The artificial joints used for total joint replacement surgery are called three-pole endoprostheses. They come in three classes:

• Unbound. 
• Semi-bound. 
• Bound. 

In the case of osteoarthritis, it is preferable to use unbound endoprostheses. They allow preserving the patient's ligamentous apparatus, provide a better function of the joint after surgery, and wear out more slowly. When implanted, there is a lower risk that the patient will need a second surgical procedure in the future.

More severe cases of knee arthritis require the implantation of semi-bound prostheses. They can be used with the deviated axis of the limb and impaired joint stability when not all ligaments are functional. Semi-bound prostheses can be implanted with either replacement or posterior cruciate ligament preservation.

Artificial knee joints for primary joint replacement surgery can be with: 

• Mobile-bearing platform. 
• Fixed-bearing platform.

For knee arthritis treatment in young patients with high activity, preference is given to mobile-bearing platform endoprostheses. They provide better joint function through a combination of rotation and sliding. These types of endoprostheses are more resistant to stress and wear out slowly, even with an active lifestyle.

Mobile-bearing platform artificial joints may be implanted in elderly patients as well. They are unstable to stress, and not as functional, but they provide better knee stability.

For arthroplasty in severe cases, including revision (repeated) knee replacement surgery, totally bound prostheses are used. They replace the entire joint along with the ligaments. The basic types of such endoprostheses include:

• Rotating-hinge endoprostheses – are basic, as they provide more range of motion.
• Hinged endoprostheses – allow only for flexion and extension of the knee.

Bound prostheses have a shorter service life than unbound ones.

Surgery and rehabilitation 

Knee replacement surgery is performed under general or spinal anesthesia. It lasts 1.5-2 hours.

The doctor removes tissue around the thigh, tibia, and patella. He implants the components of the artificial joint into the joint. They are implanted under the guidance of computer navigation, which ensures perfectly accurate placement of the endoprosthesis.

Rehabilitation after surgery for knee arthritis begins as early as possible. The patient gets out of bed on the day of surgery or the next day. Lying in bed, he does the exercises. Physical therapy and passive joint working out can be used to increase joint mobility. The main goal of the early phase of rehabilitation is to combat swelling, and inflammation, improve blood circulation, and normalize wound healing.

After 2-3 weeks, the patient continues to recover in a rehabilitation center. The main method of rehabilitation is physical exercise. A person is doing physical exercises under the supervision of specialists on fitness equipment. Some centers use robot-assisted systems. Training takes place in gyms and the pool, while physiotherapy is used in parallel.

It takes 3-4 months to fully recover after knee arthritis treatment. According to the rehabilitation results, a person gets rid of pain and restores gait, balance, joint stability, and limb support. The maximum amplitude of all movements is achieved. As a result, the patient can return to active life, significantly improving its quality.

Why is it worth undergoing treatment in Germany?

You can undergo treatment for knee arthritis in Germany. This country has an advanced level of medicine. The surgical procedures are safe for your health and give reliable long-term results. 

Here are several reasons why you should seek medical help in one of the German hospitals: 

• Placement of the endoprosthesis using computer-assisted navigation provides the best functional effect and reduces the risk of aseptic loosening of the endoprosthesis.
• The use of high-quality prostheses can last for decades. Most patients will not need a second prosthesis replacement surgery.
• The early start of rehabilitation activities helps reduce the risk of complications and shortens the length of hospital stay.
• Affordable cost of treatment: it is lower than in other developed countries.
• Full rehabilitation after discharge from the hospital will allow you to completely get rid of pain and return to an active lifestyle, restore gait, and household and professional skills.

Treatment in Germany with Booking Health

To undergo treatment of knee arthritis in Germany, use the services of Booking Health. On our website, you can get information about the cost of treatment in different German hospitals, compare prices, and book a medical care program on favorable terms.

Please, contact Booking Health specialists to travel to Germany for treatment. Here's what we will do for you: 

• We will choose the best orthopedic clinic whose doctors specialize in knee arthritis treatment.
• We will help you overcome the language barrier and establish communication with the German hospital and your attending physician.
• We will reduce the waiting time for the start of the medical care program and book a doctor's appointment on the most suitable dates for you.
• We will reduce the price. The cost of treatment in Germany will decrease due to the lack of additional coefficients for foreign patients.
• We will take care of all organizational issues: documents for entering the country, transfer from the airport, hotel, interpreter, etc.
• We will prepare a medical care program and translate medical documents into German. You do not have to repeat the diagnostic procedures that you have already had.
• We will provide communication with the hospital after the treatment completion in Germany.
• Whenever required, we will organize additional diagnostic tests, treatment in Germany, or rehabilitation. 
• We will buy medications abroad and send them to your native country. 
• We will help you keep in touch with the hospital after the end of treatment in Germany.

Booking Health makes treatment in Germany easier, faster, and cheaper. We will fully organize your trip, and you will only have to focus on restoring your health.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Journal of Orthopaedic Surgery and Research

Articles for Orthopaedic Practice - Orthogate

MedicineNet