The holistic concept for gonarthrosis therapy
Gonarthrosis is a common disease among adults with a high prevalence in the over 60s. The features: progressive destruction of the joint cartilage, including the joint structures such as ligaments, bones, synovial and fibrous joint capsules, as well as periarticular musculature. Clinically, the disease is presented with inflammatory and non-inflammatory phases. Only a percentage of patients with radiologically diagnosed changes notice disruption or pain.1
The chronic progression with no prospect of a cure requires there to be long-term trust in the doctor-patient relationship.
Guideline-compliant treatment of gonarthrosis pursuant to the Sk2 guidelines
The German Society of Orthopaedics and Orthopaedic Surgery (DGOOC), as the leading professional society, issued the S2k guidelines on gonarthrosis in January 2018.1 This contains key recommendations for therapy:
Each patient needs a tailored therapy plan. Patient-specific criteria should be taken into consideration when choosing the suitable conservative or surgical forms of therapy, for example:
- the degree of pain
- the activity level
- the mispositioning
- the age of the patient
- the extent of the arthrosis
Depending on the stage of the disease and the patient-specific factors, surgery should only be considered when conservative therapy cannot provide sufficient relief from pain and freedom of movement.
The medi gonarthrosis therapy concept is part of the conservative therapy measures listed in the S2k guidelines and comprises the following therapeutic phases:
Relief and stabilisation in conservative gonarthrosis therapy
Relief and stabilisation are important aspects in the conservative treatment of gonarthrosis. The attending physician can achieve both by using orthoses. Evidence shows a reduction in pain and functional improvements.1
Relief orthoses on the knee joint (unloader braces) work according to the 3-point principle.1
This means that using orthoses can lead to a varus or valgus correction of the leg axis. This relieves the overloaded compartment: Which in turn relieves the patient’s pain.
Pressure without orthoses
Pressure without orthoses
Pressure with orthoses
Pressure with orthoses: Protection provided by the 3-point principle
Knee adduction movement is significantly reduced by the orthoses
Medial gonarthrosis is the particular focus of the therapy. It develops when the adduction movement in the knee joint is increased.1 Numerous biomechanical studies have shown that knee adduction movement can be significantly reduced by orthotics.
In 2011, Müller-Rath and colleagues conducted a randomised clinical and gait analysis study using the medi M4s OA relief orthoses.2 Worn over a period of 16 weeks, the orthoses produced positive results for the patients:
- a significant reduction in the knee adduction movement
- improvement on the scale of how they felt
- a significant improvement of functional knee and pain scores (Tegner, Insall, Lequesne, WOMAC score, VAS)
Brace test before surgical corrective osteotomy
The valgus-producing high tibial osteotomy (HTO) is an established treatment option for varus gonarthrosis. A valgus-producing knee joint orthotic has a medial pressure relief effect similar to the HTO.
The study2showed that: The brace test with the M4s OA orthoses is well-suited for patients with borderline indications for a valgus-producing HTO. In the preoperational period, it provides the surgeon and patient with additional information on the expected postoperative clinical outcome and provides an assessment of the postoperative pain reduction.3
Patient-specific factors impact the regulation
When choosing the therapy measures and the corresponding aids, it makes sense to consider patient-specific criteria, such as their degree of pain, the severity of the arthrosis and range of movement.1
Advantages for you as a doctor if you treat patients with knee orthoses
- Indication-appropriate: 1,2
- Relief at the knee joint
- Pain reduction
- Functional improvement
- Tailored to the patient: a wide range of products, high-quality patient care
- Cost-effective: Knee orthoses are regulation-compliant and budget-neutral
|medi Soft OA light||medi Soft OA||M.4s OA comfort|
|Arthrosis grade||Grade 1-2||Grade 2-3||Grade 3-4|
1 S2k-Leitlinie Gonarthrose. AWMF-Registernummer 033 – 004; Stand 18.12.17. Published online at: www.awmf.org/leitlinien/detail/ll/033-004.html (Last accessed: 05.09.2018).
2 Müller-Rath R et al. Klinische und ganganalytische Untersuchung einer valgisierenden Kniegelenkentlastungsorthese in der Therapie der medialen Gonarthrose. Z Orthop Unfall 2011;149(2):160-165.
3 Minzlaff P et al. Valgus bracing in symptomatic varus malalignment for testing the expectable "unloading effect" following valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2015;23(7):1964-1970.