CONSERVATIVE ARTHRITIS THERAPY
Conservative osteoarthritis treatment in Mainz: Advanced therapies before joint replacement
Specialized treatment for osteoarthritis in the hip and knee
At ENDOPROTHETICUM Rhein-Main, your orthopedic specialist practice in Mainz, under the direction of Prof. Dr. med. Karl Philipp Kutzner, we offer comprehensive expertise not only in the field of joint replacement but also in advanced conservative osteoarthritis therapy. Our goal is to delay surgical interventions for as long as possible and maintain and improve your quality of life through targeted, non-surgical measures. We understand that joint wear, especially hip osteoarthritis and knee osteoarthritis, can significantly impact daily life. Therefore, we rely on proven and innovative treatment methods to alleviate pain and optimize joint function.
Hyaluronic acid: An effective weapon against joint pain
A central pillar of our conservative treatment strategy is injection therapy with hyaluronic acid. Hyaluronic acid is a natural main component of the synovial fluid and acts like a lubricant and shock absorber in the joint. In osteoarthritis, the concentration and quality of the body's own hyaluronic acid decreases, leading to increased friction and pain.
By directly injecting high-purity hyaluronic acid into the affected joint, we can improve the lubricity of the cartilage, inhibit inflammatory processes, and significantly reduce pain. This treatment is particularly effective for early to moderate knee osteoarthritis and hip osteoarthritis and can delay the need for joint replacement for a longer period.
Our conservative therapy approaches at a glance
- Injection therapy with hyaluronic acid: To restore joint lubrication and relieve pain.
- Autologous blood therapy (ACP): Utilization of the body's own growth factors to promote regeneration and inhibit inflammation.
- Physiotherapy and manual therapy: Targeted exercises to strengthen the muscles, improve mobility, and stabilize the joints.
- Medicinal therapy: Use of anti-inflammatory and pain-relieving medications for symptom control.
- Counseling on lifestyle changes: Professional recommendations regarding weight management and joint-friendly activities.
When is conservative therapy useful?
A conservative therapy is the first choice for patients with mild to moderate osteoarthritis complaints. It aims to control the symptoms and slow the progression of the disease. Especially in the case of hip osteoarthritis and knee osteoarthritis therapies such as the injection of hyaluronic acid can help to maintain joint function and significantly improve quality of life. Prof. Dr. Kutzner and his team analyze your individual findings precisely to create the optimal treatment plan for you.
Contact ENDOPROTHETICUM Rhein-Main in Mainz for comprehensive advice. We carefully examine which conservative options are available to you before considering a surgical intervention.
PHYSIOTHERAPY
All guidelines consider exercise therapy as a core element of osteoarthritis therapy. Exercise therapy can include exercises for strengthening and mobilization depending on age, comorbidity, pain intensity, and movement restrictions, but it also serves to increase physical resilience. For limitations in functional mobility, the guidelines recommend techniques of passive joint mobilization, which they also define as an element of exercise therapy. In particular, physical therapy is an essential building block of treatment. Here, patients learn exercises that they can continue at home in self-management
Sporting activity, such as cycling or swimming, can reduce pain, improve mobility, increase joint metabolism, and strengthen the surrounding muscles, and is also considered an important component of conservative therapy.
The decision on the type of sporting activity (hiking, cycling, golfing, tennis...) should be made on an individual basis, taking into account anatomical conditions (leg axes, accompanying pathologies) and the current pain and inflammatory response of osteoarthritis. Sport-related overloading should be avoided. In cases of acute joint pain and swelling, a temporary ban on sports may also be necessary.
ANTI-INFLAMMATORY
PAIN THERAPY
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that have analgesic, anti-inflammatory, and antipyretic effects. They are particularly effective for inflammation-related osteoarthritis pain.
Due to large inter-individual variations in bioavailability and half-life, the effect is variably pronounced in patients.
NSAIDs should not be used for long-term treatment, but only temporarily ("as needed") during periods of pain and until the inflammation subsides. The duration of treatment is not always predictable, but should be carried out until the inflammatory symptoms (such as swelling, pain, warmth) subside. The effect of NSAIDs occurs on average about 0.5-1 hour after intake, with tablets with delayed release (e.g. retard tablets) after about 1-3 hours.
NSAIDs have a considerable potential for side effects, which occur especially in older age and at higher dosages. In particular, they can damage the stomach, kidneys, and cardiovascular system with long-term use.
Systemic COX-2 inhibitors are a special form of NSAIDs that can significantly reduce side effects, particularly in the gastrointestinal tract.
NSAIDs can be combined well with Metamizol (Novalgin, Novaminsulfon) for severe pain. However, the exact mechanism of action of Metamizol is not yet known.
Paracetamol shows no clinically significant pain-relieving effect in patients with osteoarthritis. Numerous studies have come to this conclusion.
Patients with osteoarthritis should also be treated very cautiously with opiates. These are pure painkillers and do not work against the inflammation in the joints. The benefit of these painkillers is therefore low and is associated with a high risk of side effects. They also contain a significant potential for addiction.
The various substance groups of pain therapy are used individually, with benefits and side effects always being weighed.
INFILTRATION THERAPY
Joint infiltrations are performed under sterile conditions, but there remains a residual risk. Skin germs can be introduced into the joint, potentially causing a joint infection . The frequency of this is reported in the literature as 1:10,000. An allergic reaction, a bleeding
Despite these risks, joint infiltration in osteoarthritis is a sensible measure. The administered
Medications work directly in the joint and sometimes have a long-lasting effect. The frequent
Gastric problems from anti-inflammatory tablets do not occur.
CORTISONE
Glucocorticoids, often referred to as cortisone, have a strong
anti-inflammatory effect. When injected into the joint, cortisone can directly affect the irritated and inflamed synovial membrane (synovialis). These measures should be performed as infrequently as possible. Although cortisone is highly effective, it can also damage the articular cartilage, especially with frequent use. Particularly in cases of activated osteoarthritis
with swelling and effusion, an injection of cortisone into the joint is often very effective. In this process, a tense joint effusion can also be aspirated. By removing the effusion, the pressure inside the joint is reduced. However, the effect of cortisone typically diminishes significantly after approximately 4 weeks.
HYALURONIC ACID
Hyaluronic acid has been used for several decades in the symptomatic treatment of arthrosis of various joints. It is a substance that occurs naturally in the joint. Hyaluronic acid is primarily formed by cartilage cells and the synovial membrane. The water-binding hyaluronic acid and its polymers (long-chain compounds) keep the synovial fluid viscous (thick). Thus, hyaluronic acid is the actual "lubricant" in the joint, supporting the gliding ability of the joint surfaces. In cases of inflammation or after injuries, or in older age, the availability of hyaluronic acid in the joint decreases. By injecting hyaluronic acid into the affected joint, the adverse consequences of the missing hyaluronic acid can be compensated. The goal is to prevent or at least slow down the joint wear caused by the increased friction of the joint surfaces.
Despite a large number of scientific studies, the effectiveness of this form of therapy is still controversial in the literature. However, newer and high-quality meta-analyses describe a clinically relevant pain inhibition. Therapy with hyaluronic acid is widespread, but it is not yet covered by statutory health insurance.
ACP / PRP
Treatment with autologous conditioned plasma (ACP) represents a novel treatment method for therapy of wear-related joint complaints. It is known that the growth factors contained in human blood can positively influence various healing processes. The ACP therapy is based on this knowledge. Using highly concentrated growth factors in the blood (from thrombocytes or blood platelets), healing and reconstruction processes in the damaged articular cartilage and tendon tissue can be stimulated. Initial clinical results show significant improvements in pain progression and mobility.
For this, a blood sample is required. Through a special separation process using a centrifuge, the part of the blood that contains the body's own regenerative and anti-arthritic components is obtained. The thus obtained autologous solution is then injected directly into the affected joint. This is done using a specially developed double syringe, which ensures the highest patient safety. The ACP therapy is recommended for painful mild to moderate osteoarthritis (osteoarthritis grade I-III). However, in osteoarthritis grade IV, the therapeutic effect is low.
