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Konservative Therapie der Gonarthrose

Conservative therapy of osteoarthritis

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Zusammenfassung

Die Gonarthrose ist eine degenerative Erkrankung des Kniegelenks, die durch einen fortschreitenden, irreversiblen Verlust an hyalinem Gelenkknorpel mit Umbau des subchondralen Knochens gekennzeichnet ist. Symptome sind je nach Stadium Morgensteifigkeit, belastungsabhängige Schmerzen bis hin zum Ruheschmerz mit Bewegungseinschränkung und Ergussbildung. Um operative Eingriffe hinauszuzögern oder zu vermeiden, können die Symptome durch eine Reihe konservativer Maßnahmen behandelt werden, wie Gewichtsabnahme, regelmäßiges Bewegungstraining, verschiedene Formen der physikalischen und physiotherapeutischen Behandlung, manuelle Therapie sowie Verwendung orthopädischer Hilfsmittel. Zusätzlich können begleitend nichtsteroidale Antirheumatika sowie intraartikuläre Glukokortikoide angewendet werden. Chondroprotektive Substanzen wie Glukosamin und Chondroitinsulfat sowie intraartikulär applizierte Hyaluronsäure bewirken eine zeitlich begrenzte Linderung der Symptomatik. Ihre therapeutische Wirksamkeit wird aber weiterhin diskutiert.

Abstract

Osteoarthritis of the knee is a degenerative joint disease with progressive degradation of articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking and joint effusion depending on the stage of the disease. In an effort to delay major surgery, patients with knee osteoarthritis are offered a variety of nonsurgical modalities, such as weight loss, exercise, physiotherapy, bracing, orthoses, nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular viscosupplementation or corticosteroid injection. In general, the goals of these therapeutic options are to decrease pain and improve function. Some of these modalities may also have a disease-modifying effect by altering the mechanical environment of the knee. Chondroprotective substances, such as lucosamine, chondroitin sulphate and hyaluronic acid are safe and provide short-term symptomatic relief while the therapeutic effects remain uncertain.

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Abbreviations

AVK:

Arterielle Verschlusskrankheit

COX:

Cyclooxygenase

EGF:

„Epidermal growth factor“

GERAC :

„German acupuncture trials“

GIT:

Gastrointestinaltrakt

IGF:

„Insulin-like growth factor“

IL:

Interleukin

KHK:

Koronare Herzkrankheit

MMP:

Matrixmetalloproteinase

MSC:

Mesenchymale Stammzelle

MTT:

Medizinische Trainingstherapie

NO:

Stickoxid

NSAR:

Nichtsteroidale Antirheumatika

PRP:

Plättchenreiches Plasma

RNA:

Ribonukleinsäure

TENS:

Transkutane elektrische Nervenstimulation

TGF:

„Transforming growth factor“

TNF:

Tumornekrosefaktor

VEGF:

„Vascular endothelial growth factor“

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Authors and Affiliations

  1. Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland

    P. Diehl, P.C. Kreuz & T. Tischer

  2. Orthopädiezentrum München Ost, Münchner Straße 14, 85540, Haar/München, Deutschland

    P. Diehl

  3. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    L. Gerdesmeyer, J. Schauwecker & H. Gollwitzer

  4. Sektion onkologische und rheumatologische Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    L. Gerdesmeyer

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  1. P. Diehl
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Correspondence to P. Diehl.

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Diehl, P., Gerdesmeyer, L., Schauwecker, J. et al. Konservative Therapie der Gonarthrose. Orthopäde 42, 125–139 (2013). https://doi.org/10.1007/s00132-012-2016-6

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  • DOI: https://doi.org/10.1007/s00132-012-2016-6

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