Gonarthrosis

What is gonarthrosis?

In knee osteoarthritis, there is an imbalance between the load and resilience of the cartilage and bone structures in the knee. The articular cartilage becomes thinner, the ability to glide decreases, the synovial membrane (synovial membrane) can become inflamed and irritating effusion occurs. Osteoarthritis does not develop in the same way for everyone: phases with more symptoms alternate with more stable phases.

• The inner (medial), outer (lateral) and/or the patellofemoral part of the joint can be affected.
• Complaints do not always correlate with the x-ray image: even minor signs of wear can be painful - conversely, advanced wear can cause few symptoms.
• What is important is an individual, step-by-step treatment plan with a focus on exercise therapy, pain control and everyday adjustments.

Knee anatomy briefly explained

The knee joint connects the thigh (femur) and lower leg bones (tibia); the kneecap (patella) slides in the groove of the thigh. Articular surfaces are covered with hyaline cartilage, which enables low-friction movements. The synovial membrane produces synovial fluid to nourish the cartilage. Menisci serve as shock absorbers and load distributors; Ligaments stabilize the joint.

• Compartments: medial, lateral, patellofemoral
• Buffers: inner and outer meniscus
• Stabilizers: cruciate and collateral ligaments
• Supply: Synovia lubricates and nourishes the cartilage

Typical symptoms

• Pain on exertion and start-up, later also pain at rest
• Morning stiffness (usually <30 minutes)
• Swelling/irritation, feeling of warmth
• Crepitation (rubbing noises), occasionally “bending away”
• Decreased walking distance, problems going down stairs
• Sensitivity to the weather, varying intensity of symptoms

Warning signs that should be quickly clarified by a doctor: sudden severe swelling after trauma, feeling of being trapped (blockage), pronounced redness and overheating with fever, acute inability to bear weight, new severe calf pain/swelling (differential diagnosis including thrombosis or Baker's cyst rupture).

Causes and risk factors

Osteoarthritis occurs multifactorially. In addition to age, individual biomechanics, previous injuries and inflammatory processes play a role.

• Primary osteoarthritis: no clear trigger, often a combination of age, genetic disposition and lifestyle
• Secondary osteoarthritis: after meniscus/ligament injuries, axial misalignments (bowleg/knockleg), joint instability, cartilage damage, fractures
• Excess weight: increases the load on the knee joint and promotes inflammatory messengers
• Job/sport: kneeling/torsion activities, high impact load
• Patellar slippage and muscular imbalances
• Metabolic factors (e.g. diabetes), smoking, systemic inflammation

Course and stages

Osteoarthritis progresses in fits and starts. Early stages often show stress-dependent pain and irritating effusions; in middle stages, functional limitations increase; in advanced stages, axial deviations, bony attachments and deformities are possible. The good news: In many cases, the symptoms can be significantly alleviated through exercise therapy, weight management and anti-inflammatory strategies.

Diagnostics: this is how we proceed

• History: character of pain, initial pain, stress profile, previous injuries, tendency to swelling
• Clinical examination: axis, gait, mobility, tender points, signs of effusion, ligament stability, patellofemoral tests
• Imaging: X-ray while standing (leg axis, Rosenberg image if necessary), patella tangential image if necessary; Ultrasound to detect effusion/synovitis
• MRI: in case of unclear findings, atypical pain, planned joint-preserving surgery or to rule out other pathologies
• Laboratory/puncture: if inflammatory or crystal-induced arthritis is suspected

We will discuss the findings and significance with you clearly: Not every radiological sign requires invasive therapy. What matters is your symptoms and your goals in everyday life or sport.

Conservative therapy – foundation of treatment

First-line therapy is conservative. It combines education, exercise therapy, load control and medication options with the lowest possible rate of side effects.

Nutritional supplements (e.g. glucosamine/chondroitin, collagen) show inconsistent effects in studies. We provide evidence-based and individual advice, without promises of cure.

Injections and regenerative procedures

Infiltrations can complement conservative therapy if symptoms persist despite training, everyday adjustments and topical therapy. Selection and timing are made individually and after information about the benefits and risks.

• Cortisone injection: can briefly dampen an inflammatory attack (severe effusion, acute synovitis); more as a time-limited option
• Hyaluronic acid (“viscosupplementation”): aims for better lubrication and symptom relief for months; the effectiveness varies between individuals
• PRP (Platelet Rich Plasma): autologous blood product; Studies show better pain reduction than hyaluronic acid in mild-moderate osteoarthritis; not curative
• Combinations/series: possible in selected cases; Evaluation of the effect according to clearly defined goals
• Risks: temporary increase in pain, bruising, rarely infection or allergic reaction

Important: Injections do not replace active therapy. Exercise, weight control and consistent self-management make the biggest difference.

Joint preservation and surgical options

Our focus is on conservative measures. Surgical interventions are considered if the quality of life remains significantly impaired despite optimal non-surgical therapy and the findings and objectives match.

• Arthroscopy: usually not useful for pure arthrosis without mechanical blockage; indexed e.g. B. in free joint bodies or fixing meniscus tears
• Corrective osteotomy: in cases of significant bow or knock-knee position with one-sided arthrosis in order to normalize the load distribution
• Partial endoprosthesis (slide prosthesis): for isolated compartment arthrosis if appropriate indication
• Total endoprosthesis: Option for advanced, multicompartmental osteoarthritis with severe pain and loss of function

We provide independent advice and can provide a second opinion upon request. If an operation seems appropriate, we coordinate the referral to experienced partners and provide follow-up care.

Everyday life and self-management: 10 practical tips

prevention

• Muscle maintenance through regular strength and coordination training
• Weight control and balanced diet
• Early correction of axial and gait disorders, treatment of instabilities
• Technical training in sports with impact and twisting loads
• Consistent rehabilitation after knee injuries

Special forms and accompanying diseases

The localization influences symptoms and therapy accents. In patellofemoral osteoarthritis, front knee pain and problems walking down stairs are the main symptoms. Medial osteoarthritis is often associated with bow-legged tendencies, lateral with knock-knees. Irritable effusions (synovitis) and Baker's cysts occur as side effects.

• Patellofemoral osteoarthritis: focus on quadriceps/hip stabilization, patella tracking, taping/orthotics
• Degenerative meniscal lesions: usually conservative, arthroscopy only in cases of mechanical blockage
• Synovitis/irritable effusion: anti-inflammatory measures, if necessary puncture and injection

When should I seek medical advice?

• New, persistent knee pain for several weeks
• Significant swelling, feeling of blockage or instability
• Redness, overheating, fever or severe pain at rest
• Fall/trauma with subsequent inability to bear weight
• Increasing restrictions in everyday life despite self-measures

Treatment in our practice in Hamburg

We work in a guideline-oriented manner with a clear, step-by-step approach: thorough diagnostics, understandable explanation of findings, training and everyday plan, supplemented by targeted injections if necessary. We take your goals into account – whether walking with less pain, managing the stairs or returning safely to sport and work.

• Location: Dorotheenstraße 48, 22301 Hamburg
• Networking with qualified physiotherapists, bandagists and surgeons
• Second opinion for planned surgery
• Transparent information without promises of cure

Together we will develop a plan that suits your life situation - pragmatic, evidence-based and realistic.