CONSERVATIVE OSTEOARTHRITIS THERAPY

Conservative osteoarthritis treatment in Mainz: Advanced therapies before joint replacement

Specialized treatment for osteoarthritis in the hip and knee

In the ENDOPROTHETICUM Rhein-Main, your orthopädischen specialty practice in Mainz, we offer under the leadership of Prof. Dr. med. Karl Philipp Kutzner comprehensive expertise not only in the field of joint replacement, but also in advanced conservative arthrotherapy. Our goal is to postpone surgical interventions as long as möglich and to maintain and improve your Lebensqualität through targeted, non‑surgical Maßnahmen. We understand that joint Verschleiß, especially the hip osteoarthritis and the knee osteoarthritis, can significantly affect daily life. Therefore we rely on proven and innovative treatment methods to relieve pain and optimise 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 major component of joint fluid and acts as a lubricant and shock absorber in the joint. In osteoarthritis, the concentration and quality of the body's own hyaluronic acid decrease, leading to increased friction and pain.

Through direct injection of high-purity Hyaluronic acid into the affected joint we can improve the gliding ability of the cartilage, inhibit inflammatory processes and significantly reduce pain. This treatment is especially effective in early to moderate knee osteoarthritis and hip osteoarthritis and can postpone 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 to relieve pain.
  • Autologous blood therapy (ACP): Use of autologous growth factors to promote regeneration and inhibit inflammation.
  • Physiotherapy and manual therapy: Targeted exercises to strengthen the musculature, improve mobility and stabilize the joints.
  • Medication 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 symptoms. It aims to control the symptoms and slow the progression of the disease. In particular for the hip osteoarthritis and the knee osteoarthritis can therapies such as the injection of Hyaluronic acid help to preserve 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


As the core element of arthrotherapy all guidelines consider the movement therapy as. The movement therapy can, depending on age, comorbidity, pain intensity and movement restrictions, include exercises for strengthening and mobilization, but it also serves to increase physical load capacity. In case of limitations of functional mobility, the guidelines recommend techniques of passive joint mobilization, which they also define as an element of movement therapy. In particular, physiotherapy is an essential component of treatment. Here patients learn exercises that they can, ideally, continue at home in self‑directed can continue.


Sportive activity, such as Cycling or Swimming, can reduce pain, improve mobility, increase joint metabolism as well as strengthen the surrounding musculature kräftigen 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


Infiltrations of the joint occur under controlled conditions, however a residual risk remains. Skin lesions can be carried into the joint, which can cause a joint infection can occur. The frequency for this is given in the literature as 1:10000. Also an allergic reaction, an Bleeding or damage to a thin nerve by the needle are possible in very rare cases.

Despite these risks, the joint infiltration in osteoarthritis is a useful 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 also briefly called cortisone, act strongly anti-inflammatory. Mit dem Einspritzen in das Gelenk kann das Kortison direkt auf die gereizte und entzündete Gelenkinnenhaut (Synovialis) einwirken. Diese Maßnahmen sollten so selten wie möglich durchgeführt werden. Zwar ist Kortison stark wirksam, es kann aber, insbesondere bei häufiger Anwendung, auch dem Gelenkknorpel schaden. Vor al­lem bei der aactivated osteoarthritis with swelling and effusion, an injection of cortisone into the joint is often very effective. In this case, a larger joint effusion can also be punctured. By withdrawing the effusion, the pressure inside the joint is reduced. However, the effect of the cortisone usually diminishes already after about 4 weeks.

   HYALURONIC ACID

Hyaluronsäure has been used for several decades in the symptomatic treatment of osteoarthritis of various joints. It is a naturally occurring substance in the joint. In particular, cartilage cells and the joint synovium produce Hyaluronsäure. The water-binding Hyaluronsäure and its polymers (long-chain molecules) keep the joint fluid viscous (thick). Thus Hyaluronsäure is the actual "lubricant" in the joint, supporting the glideability of the joint surfaces. In inflammation or after injuries or at older age, the availability of Hyaluronsäure in the joint decreases. By injecting Hyaluronsäure into the affected joint, the adverse effects of the missing Hyaluronsäure can be compensated again. The goal is to prevent or at least slow the joint wear that arises from 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

The treatment with autologous conditioned plasma (ACP) is a novel therapeutic method for treating wear‑related joint complaints. It is known that the Wgrowth factors various healing processes can be positively influenced. This insight forms the basis of ACP therapy. With highly concentrated growth factors in the blood (from platelets or blood platelets) can Healing and rebuilding processes in the damaged joint cartilage and tendon tissue can be stimulated. Early clinical results show significant improvements in pain progression and mobility.

For this, a blood draw is required. Through a special separation process using a centrifuge, the part of the blood that contains the body's own regenerative and arthritis‑inhibiting components is obtained. The resulting autologous solution is then injected directly into the affected joint. This is performed with a specially developed double syringe that ensures the highest patient safety. The ACP therapy is recommended for painful light to moderate arthroses (Arthrosis grades I‑III). In grade IV arthritis, the therapeutic effect is limited.