Osteoarthritis
Osteoarthritis is a degenerative disease of the joints. It begins gradually and leads to the cartilage in the joint slowly breaking down.
This cartilage degradation leads to inflammation of the joint, resulting in joint effusion, pain and restricted movement. In the final stage of osteoarthritis, the pain is permanent and the mobility of the joint can be severely restricted.
The joints most commonly affected by osteoarthritis are the knees, hips, shoulders, fingers, elbows and feet. The spine is also affected somewhat less frequently.
How does osteoarthritis develop?
Osteoarthritis means wear and tear of the joint cartilage. Every person experiences normal wear and tear of the joint cartilage over the course of their life.
There are various causes for the gradual, mechanical wear and tear of the joint cartilage. On the one hand, there are genetic (familial) factors, obesity, poor eating habits, but also too much or too little exercise. The likelihood of osteoarthritis increases with age.
If you are overweight or have had an accident, the process can be accelerated. Strenuous sports (especially stop-and-go) and heavy physical labour also have an influence.
People who constantly and extremely overload their joints (e.g. competitive athletes) or those who have suffered injuries with damage to the joint are particularly at risk.
A causal cure is still not possible. Joint wear and tear can be slowed down somewhat by controlling weight and avoiding incorrect and excessive strain in sport or at work.
What stages of osteoarthritis are there?
Osteoarthritis is generally categorised into different stages:
- Stage 1: Cartilage becomes softer
- Stage 2: The cartilage surface becomes rougher and may have cracks
- Stage 3: The cartilage cracks go down to the bone
- Stage 4: The cartilage is completely worn away and the underlying bone is exposed (bony flap)
What symptoms does osteoarthritis cause?
Osteoarthritis often progresses gradually over several years. Over time, the joints affected by osteoarthritis are no longer covered with protective cartilage. In contrast to cartilage, bone has pain receptors and thus causes joint pain that is load-dependent and gradually becomes more severe.
The progression of osteoarthritis leads to typical undulating pain during exercise and later to constant pain at rest, especially at night. The pain-free intervals become shorter as the osteoarthritis progresses. This is accompanied by inflammation with swelling of the affected joint, restricted movement, shortening of the muscles and deformation of the joints with increasing misalignment and even complete restriction of mobility.
The more painful it becomes, the less you move the affected joint. This is a vicious circle, as movement is very important for blood circulation and cartilage regeneration.
How can osteoarthritis be prevented?
A healthy lifestyle with the right diet, the intake of specific restorative medication and exercise are essential and important for the prevention of osteoarthritis. When a joint is moved, the body produces a lubricating fluid known as synovial fluid. It acts as a lubricant and contains nutrients for the cartilage. Regular exercise and targeted training can build up the muscles around the joint, which stabilises it. Sport should therefore be practised for as long as possible.
Not all types of sport are equally suitable. Regular sports that are easy on the joints, such as swimming, water aerobics, cycling with low resistance or walking on flat terrain, are ideal. Targeted medical training therapies (physiotherapy, Pilates, amplitude training, etc.) can also be considered. Ball sports with rapid changes of direction and abrupt movements (stop-and-go) are not good and can even exacerbate the problem.
Unfortunately, it is still not possible to cure osteoarthritis, but the right treatment and therapy methods can greatly alleviate the pain and preserve the mobility of the affected joint for a long time. It is also very important to consult a specialist at an early stage. The sooner action is taken, the better the prospects for a life and movement that is as pain-free as possible.
How is osteoarthritis diagnosed?
Severe joint pain with associated disability or difficulty with everyday movements such as climbing stairs can be an indication of osteoarthritis.
After the specialist has personally questioned the patient about when and how the pain occurs, a comprehensive clinical examination of the affected joint follows to assess and localise pain, movement restrictions, anatomical differences and muscle strength. This is followed by a radiological examination of the affected joint.
If anything is unclear, an MRI (magnetic resonance imaging) can also be carried out to better assess the cartilage situation. Infiltration of the affected joint with an anaesthetic can also provide information about the cause.
Once all these examinations have been completed, the results are discussed with the patient and further steps are decided.
How can osteoarthritis be treated?
Treatment depends on the stage of osteoarthritis, the degree of suffering and the patient's needs
Conservative osteoarthritis therapies in the form of medication, pain gels, cartilage-protecting substances, injections/infiltrations and medical training therapy should be favoured whenever possible and appropriate.
If conservative treatment does not produce satisfactory results in the long term, surgical measures should be considered and a hip specialist consulted.
Conservative treatments
- Physiotherapy: Targeted and repetitive exercises improve coordination and increase endurance.
- Medication: Painkillers and medication to support the cartilage
- Joint injections (cortisone, hyaluronic acid, autologous blood) to relieve pain or reduce inflammation and improve joint lubrication
- Orthopaedic insoles and supports
Surgical treatments
Joint-preserving surgery:
- Joint endoscopy (arthroscopy)
- Conversion (e.g. from bow leg to knock-knee)
Artificial hip joint (hip prosthesis):
- Partial: e.g. sled prosthesis
- Complete: e.g. soft tissue-orientated surface replacement or a total endoprosthesis (TEP)
Frequently asked questions
How quickly can osteoarthritis develop?
This depends on the cause of the osteoarthritis. Complaints caused by chronic cartilage wear, such as overloading, misalignment or natural ageing of the cartilage, for example, only occur after a certain period of time. This chronic cartilage wear can last for years and the symptoms of osteoarthritis (pain, restricted movement, unsteady gait) can increase exponentially over time. In contrast, cartilage wear is suddenly accelerated by joint infections, deposits or diseases (e.g. rheumatic) in the joint as well as accidents. This event destroys the joint cartilage very quickly, which ultimately leads to the well-known osteoarthritis pain and restricted movement.
Is osteoarthritis always painful?
No. The symptoms of osteoarthritis vary from person to person. For most people suffering from osteoarthritis of the joints, however, the main symptoms are pain due to strain and movement. For other people, the focus is on limited mobility due to osteoarthritis and unsteady gait.
Why is osteoarthritis pain different?
The pressure-stable articular cartilage protects the bone. A special characteristic of articular cartilage is that it has no blood vessels, lymph vessels or nerves. This is the reason why cartilage damage does not heal - namely because it has no blood vessels - and why the damage is not painful - namely because it has no nerves. Accordingly, we only feel osteoarthritis pain when the bone or the joint lining is attacked. The initial pain is caused by the breaking through of small bony interlockings of the bone surface (osteoarthritis stage IV). Stress pain is caused by pressure on the cartilaginous bone, which has many pain fibres. Mucosal inflammation pain is caused by the abrasion of bone and cartilage due to the rough surface. This pain is felt very differently depending on the size and location of the cartilage damage and by the person themselves.
How quickly does osteoarthritis worsen?
This varies from person to person and depends on how resilient the cartilage is, which in turn is genetically determined. In some people, the joint cartilage wears out more quickly than in others when subjected to the same load, as the cartilage is less stable for congenital (genetic) reasons. Chronic overloading of the cartilage leads to a slow increase in osteoarthritis symptoms. These can be barely noticeable for years at the beginning and then become significantly worse over time. On the other hand, accidents, incorrect movements or operations such as arthroscopy can significantly worsen osteoarthritis within a short period of time.
At what age is osteoarthritis normal?
Joint cartilage stops growing after puberty. This is when cartilage wear begins, which can be accelerated by overloading, obesity, misalignment, accidents and sports injuries. In addition, the natural ageing of the cartilage increases (loss of the cartilage's ability to bind water and therefore its elasticity), which leads to the cartilage being less resilient. As a result, cartilage wear and tear also increases with age. With increasing age, the joints are affected more and more frequently by signs of wear and tear. Osteoarthritis is therefore a typical disease of old age. The likelihood of developing osteoarthritis increases with age. Around two thirds of all people over 65 have arthritic joints.
Is it possible to develop osteoarthritis at a young age?
Yes, osteoarthritis can develop at a young age. However, osteoarthritis is very rare in young people before the age of 30 (less than 2%). As a rule, wear and tear of the joint cartilage (osteoarthritis) only occurs with increasing age. The causes of osteoarthritis at a young age include accidents, obesity, congenital malalignment of the bone, chronic overloading, sports injuries and joint diseases. Sports-related cartilage injuries in young people can usually be treated with autologous (own cartilage) cartilage therapy.
What accelerates osteoarthritis?
There are several factors that can accelerate osteoarthritis. Mechanical wear and tear of the joint cartilage is exacerbated by obesity, accidents, misalignment of the joint, sports that strain the joint or overloading through work or sport. On the other hand, joint infections, rheumatological diseases of the joint and deposits in the joint can damage the joint cartilage and thus promote osteoarthritis. In principle, any disease of the joint cartilage, the synovial membrane or the synovial fluid can accelerate osteoarthritis.
When is osteoarthritis at its worst?
Osteoarthritis means wear and tear of the joint cartilage. This progresses gradually at the beginning and the typical symptoms such as pain on start-up, pain on exertion, inflammatory pain as well as restricted movement and unsteadiness of the affected joint increase steadily and in waves. These symptoms can vary from person to person. If osteoarthritis is restricting your quality of life, it is time to have the affected joint (e.g. hip joint or knee joint) examined by a specialist and to seek advice on possible conservative (no surgery) and surgical therapies.
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Dr Andreas L. Oberholzer is a recognised expert in osteoarthritis and has many years of experience in the field of artificial knee and hip 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.
PD Dr Andreas L. Oberholzer
FMH specialist in orthopaedics and trauma surgery. Areas of specialisation: Knee, hip and foot surgery.