Diagnosis of knee osteoarthritis - what to do?

What treatments are possible for knee osteoarthritis?

There are many different options, depending on the stage of osteoarthritis, the impairments (e.g. pain, mobility) and the individual needs and life situation. A basic distinction is made between conservative and surgical treatments.

Conservative treatments are normally started with the aim of reducing the impairments and slowing down the progression of osteoarthritis. Knee osteoarthritis cannot be cured. It is only possible to alleviate the symptoms and counteract further cartilage degradation.

What are conservative treatments and how effective are they?

Conservative treatments range from physiotherapy, chiropractic and osteopathy to medication, nutritional supplements and joint infiltrations.

In terms of medication, there are painkillers and anti-inflammatory drugs as well as cartilage-supporting substances. While painkillers should only be taken in the acute phase - they are addictive in the long term and are harmful to the digestive organs - cartilage-supporting substances such as glucosamine or chondroitin are suitable as long-term concomitant therapy.

Many patients say that the symptoms of osteoarthritis have improved as a result and that they feel a difference. Whether they really help has not been scientifically proven. Health insurance companies only cover certain preparations.

Which exercises are helpful for knee osteoarthritis?

Physiotherapy and other manual therapies are among the measures of first choice. There are a number of exercises that are helpful, although it is important to realise that even these will not eliminate the cause. However, with appropriate discipline, good results can be achieved by building strength, stability, gait training and reducing tension.

What is a joint infiltration?

An infiltration is an injection directly into the knee joint using a syringe. Proven substances include cortisone (inhibits inflammation and relieves pain), hyaluronic acid (reduces friction and improves mobility), autologous blood (promotes tissue healing and has an anti-inflammatory effect) and, more recently, cellular matrix (combination of autologous blood and hyaluronic acid).

The injections are administered in the practice and repeated at different intervals depending on the substance. Health insurance companies usually only cover cortisone, as the other substances are new treatments or are not effective for all patients.

What can you expect from these injections?

Most patients experience significantly less pain after a cortisone injection. However, the condition is usually only temporary. Due to the side effects of cortisone, I recommend a maximum of two to three injections. After that, alternative therapies should be considered.

The effect of hyaluronic acid and autologous blood varies from person to person. Some patients respond very well, others hardly notice any difference. A combination preparation is now available that has been proven to be more effective than a single dose. This is Cellular Matrix Therapy, which I have also had good experience with in my practice.

It is also used for cruciate ligament treatments and after knee operations to promote the healing process and reduce pain and swelling. Several injections are also possible and the treatment has few side effects.

How long can I control my symptoms with conservative methods?

That depends entirely on the individual situation. Basically, you're not doing anything wrong if you wait and try different treatments. It is quite normal that there are phases when things get better and others when you notice a deterioration. What matters are the symptoms and how they affect your quality of life.

How can I adapt my everyday life to reduce pain?

As a general rule, you should avoid physical activities that place a particular strain on the knee joint. This includes, for example, stop-and-go sports, long hikes down steep slopes or positions in a permanently bent position. If you have advanced osteoarthritis, you should always think carefully about how long and intensively you want to do a particular activity and prepare yourself accordingly.

It generally helps to reduce excess weight and exercise regularly. In some cases, aids or stabilising supports can also help. However, the latter should only be worn selectively as they otherwise weaken the muscles.

When is surgery indicated?

An operation is recommended if the pain and movement restrictions are so severe that the quality of life suffers massively: if you can no longer sleep at night, can no longer pursue your favourite hobbies or feel so insecure that you hardly do anything anymore; if you are dependent on taking painkillers permanently and these are already causing problems with your stomach, intestines, kidneys or liver.

It is also important that you have considered all other options beforehand and discussed the decision with those around you (family, partner, etc.).

How urgent is the operation or, to put it another way: will you be forgiving yourself if you wait a little longer?

An artificial knee joint is not usually an urgent matter. The symptoms have usually been present for some time and did not come on suddenly. Moreover, osteoarthritis is not a health-threatening disease. On the other hand, surgery should not be postponed if it has been decided that this is the only way to achieve the desired improvement. You should also not wait any longer if there are secondary problems (e.g. dependence on medication, malalignment) or a high risk of falling due to unsteady gait.

How long should I expect an improvement after the operation?

The healing phase after knee replacement surgery lasts around 6 weeks. During this time, you walk with sticks. Together with physiotherapy, a personalised training plan is drawn up so that you can quickly gain mobility and strength. Most patients are pain-free shortly after the operation.

What types of surgery are there?

This question can only be answered after a thorough assessment. This requires an examination and radiological clarification (magnetic resonance therapy). There are basically three types of surgery:

Joint-preserving surgery, known as arthroscopy. This is performed to smooth the cartilage and remove the torn meniscus. It is often the preliminary stage to the actual joint replacement.

Surface replacement: This is used when the joint needs to be partially or completely replaced because the joint surfaces have been destroyed.

Total joint prosthesis (revision prosthesis): It is used if the collateral ligaments no longer function, the bone quality is insufficient (osteoporosis) or there is a malalignment (knock-knee or bow-leg), or if a previously implanted artificial joint needs to be replaced.

Which method is the best?

I have specialised in the soft tissue-oriented method because it is minimally invasive and gentle and special attention can be paid to the collateral ligaments.

I also combine the soft tissue-orientated method with innovative technologies in the field of augmented reality (AR). Using AR glasses in the operating theatre, I can position the joint even more precisely and physiologically, which leads to better mobility, more stability and less pain in the operated joint.

The quality of the implants, their compatibility and the anchoring method are also top priorities for me.

How long does the operation and hospitalisation take?

The duration of the operation varies depending on the type of surgery, on average 1.5 to 2 hours. The hospital stay is usually 4 days.

What risks and complications are associated with the operation?

The insertion of an artificial joint is a routine procedure for experienced specialists. In most cases, the desired result can be achieved without any detours.

Every operation has general and specific risks, which I inform my patients about in advance. People react very differently to the same operation. The complication rate for a first operation is 1% and is therefore relatively low. The risk increases with each subsequent operation. A good state of health helps to minimise risks.

Infections can never be completely ruled out, which is why we attach great importance to special hygiene and safety standards, which we inform our patients about in advance.

How permanent is the operation? Should I expect to have another artificial joint?

An artificial joint replaces your natural joint and takes over its full function. However, it always remains a "foreign body" that is also subject to wear and tear. The ageing process continues even with an artificial joint and has an impact on stability. A lifespan of 10 to 15 years is assumed, although this period is likely to increase thanks to new technologies such as augmented reality.

How do I find the right doctor?

The choice of doctor is crucial and indeed not easy. I would advise everyone to get an initial impression on the internet and seek an opinion from at least two specialists. In addition to the personal impression, the following criteria should be taken into account:

• Expertise: does the doctor have the necessary experience? How many such operations has he already performed? Does he specialise in knee joints? What is his complication rate? How satisfied are his patients?
• Customised treatment: what treatment does the doctor offer me and does it make sense for me? Have I been well informed, including about alternatives and risks?
• Personalised care: can the doctor guarantee complete and personalised care? Does he take enough time for me?

We will be happy to put you in touch with patients so that you can talk to them and benefit from their experience. You can find testimonials from former patients here.

Book a consultation appointment

We would be happy to advise you in a personal consultation.

PD Dr Andreas L. Oberholzer is a recognised expert in knee complaints and has extensive experience in the field of artificial knee joints.

Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.

General Swiss insurance (basic health insurance) is sufficient for a consultation at our specialist centre. Any surgery with an inpatient stay will be performed at the Privatklinik Bethanien. This requires supplementary insurance (private, semi-private or flex) or partial assumption of costs by the patient.