Knee osteoarthritis

Medical Information

Synonym:

Osteoarthritis

Definition:

Degenerative joint disease associated with wear, use, and aging, affecting the musculoskeletal system. It is characterized by the degenerative destruction of cartilage and damage to adjacent structures, such as bone, muscles, joint capsule, and ligaments.

Etiology:

Damage to articular cartilage with preserved mobility, related to "wear and tear," caused by a mismatch between the applied load and the joint's weight-bearing capacity.

Pathogenesis:

Overload with subsequent matrix degradation (reversible in early stages, then irreversible over the course of the disease). Accompanying synovitis, onset of joint incongruity, and loss of cartilage substance.

Classification:

• Kellgren and Lawrence classification

• OARSI

• Classification according to Altmann – differentiation between primary and secondary osteoarthritis

Clinical History:

• Gradual onset

• Pain and loss of function

• Exertional pain

Diagnosis:

• X-ray

• Magnetic Resonance Imaging (MRI)

• Laboratory diagnostics

Differential Diagnoses:

• Rheumatic arthritis

• Infectious arthritis

Therapy:

• Physiotherapy and physical treatments

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Injections

• Surgical therapies:

  • Arthroplasty

• Shock wave therapy (ESWT)

Hypothesis and Therapeutic Strategy:

The objective of treatment is to reduce pain and improve function to achieve individual relief and, if necessary, delay endoprosthetic treatment.

• Lee and Han report an improvement in function and a reduction in pain.

• Wang et al. describe the prevention and treatment of osteoarthritis in an animal model using rat knees.

• Chen et al., in a comparative study between ESWT and ultrasound in patients with knee osteoarthritis, achieved a reduction in pain in the group treated with ESWT and an improvement in range of motion (ROM) and the Lequesne index.

• Lee et al. show a positive effect of ESWT on pain and function.

Symptoms and range of motion may be positively influenced by:

• Reduction of nitric oxide (NO)

• Increased expression of growth factors such as vWF, VEGF, BMP-2, and osteocalcin

• Suppression of metalloproteinases (MMP-1 and MMP-3)

Aftercare:

• Free movement

• Avoidance of overload

Important:

The ESWT must be performed personally by a qualified and expert physician.

Currently, ESWT for osteoarthritis cannot be formally included in therapeutic recommendations due to a lack of sufficient data. Nevertheless, a recommendation for use in early stages of osteoarthritis can be identified, especially in cases of rhizarthrosis and gonarthrosis. Treatment should be oriented according to the location of the discomfort (bone/cartilage, synovial, capsule, or other accompanying structures).

Thiele, R., Marx, S. Case presentation of arthroscopically controlled therapy of osteochondrosis dissecans using ESWT. Arthroscopy 16 (7 2003), 266-271.

Dahlberg J1, Fitch G, Evans RB, McClure SR, Conzemius M.; The evaluation of extracorporeal shockwave therapy in naturally occurring osteoarthritis of the stifle joint in dogs.Vet Comp Orthop Traumatol. 2005;18(3):147-52.

Ochiai N1, Ohtori S, Sasho T, Nakagawa K, Takahashi K, Takahashi N, Murata R, Takahashi K, Moriya H, Wada Y, Saisu T.; Extracorporeal shock wave therapy improves motor dysfunction and pain originating from knee osteoarthritis in rats. Osteoarthritis Cartilage. 2007 Sep;15(9):1093-6. epub 2007 Apr 26.