Zum Hauptinhalt springen

Kniegelenksarthrose

Zuletzt bearbeitet: Zuletzt revidiert:
Zuletzt revidiert von:
Definition:
Als Kniegelenksarthrose (Gonarthrose) bezeichnet man degenerative Veränderungen des Kniegelenks.
Häufigkeit:
Die radiologische Prävalenz einer Gonarthrose beträgt in Deutschland 23,8 %, jedoch sind davon nur 10–15 % symptomatisch.
Symptome:
Schmerzen, evtl. während der Nacht, evtl. Ruheschmerzen sowie Steifheit, die sich nach etwas Aktivität verbessert.
Befunde:
Evtl. geschwollenes Knie, Muskelatrophie, verringerte passive Beweglichkeit.
Diagnostik:
Klinische Untersuchung und Röntgen, evtl. MRT.
Therapie:
Abhängig von der Schwere der Schmerzen: körperliche Aktivität, Entlastung, Medikamente, Physiotherapie, Operation.
  • Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie e. V. (DGOOC). Leitlinie Gonarthrose. AWMF-Leitlinie Nr. 033-004. S2k, Stand 2017. www.awmf.org 
  • Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie e. V. (DGOOC). Leitlinie Indikation Knieendoprothese. AWMF-Leitlinie 033-052. S2k, Stand 2018. www.awmf.org 
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Knieschmerz bei Arthrosezeichen. AWMF-Leitlinie Nr.053-050. S1, Stand 2017. www.awmf.org 
  • American academy of orthopedic surgeons. Treatment of osteoarthritis of the knee. Stand 2013. www.aaos.org 
  • OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage 2014; 22: 363-88. www.oarsi.org 
  • EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. 2013. Ann Rheum Dis. www.eular.org 
  • American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. www.rheumatology.org 
  • Handlungsleitlinie Degenerative Gelenkerkrankungen aus Empfehlungen zur Therapie von degenerativen Gelenkerkrankungen. Arzneimittelkommission der deutschen Ärzteschaft, Arzneiverordnung in der Praxis, Sonderheft, 3. Auflage, November 2008. www.akdae.de 
  • Angemeldetes Leitlinienvorhaben, Registernummer 012-008. Endoprothese bei Gonarthrose. S1, Stand 2019.  www.awmf.org 
  • EPRD Deutsche Endoprothesenregister gGmbH. EPRD – Endoprothesenregister Deutschland. www.eprd.de 
  1. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet 2005; 365: 965-73. PubMed  
  2. Felson DT. Osteoartrhitis of the knee. N Engl J Med 2006; 354: 841-8. PubMed  
  3. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie e. V. (DGOOC). Leitlinie Gonarthrose. AWMF-Leitlinie Nr. 033 - 004, Stand 2017 www.awmf.org  
  4. Kellgren JH and Lawrence JS: Radiological assessment of osteoarthrosis. Annals of the Rheumatic Diseases 1957; 16: 494-501. PubMed  
  5. Robert Koch-Institut (Hrsg) (2013) Arthrose. Gesundheitsberichterstattung des Bundes. Heft 54. RKI, Berlin. www.rki.de  
  6. Gidwani S, Fairbank A. The orthopaedic approach to managing osteoarthritis of the knee. BMJ 2004; 329: 1220-4. PubMed  
  7. Andrianakos AA, Kontelis LK, Karamitsos DG, Aslanidis SI, Georgountzos AI, Kaziolas GO, Pantelidou KV, Vafiadou EV, Dantis PC. Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. The ESORDIG study. J Rheumatol. 2006; 33(12): 2507-13. PubMed  
  8. D’Ambrosia RD. Epidemiology of osteoarthritis. Orthopedics 2005; 28(2): 201–205. www.ncbi.nlm.nih.gov  
  9. OECD. Health at a Glance - Europe 2014. Knee replacement surgery 2012. www.keepeek.com  
  10. Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994; 84: 351-8. www.ncbi.nlm.nih.gov  
  11. Felson DT, McLaughlin S, Goggins J, et al. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med 2003; 139: 330-6. PubMed  
  12. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286: 188-95. PubMed  
  13. Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum 2001; 44: 1237-47. PubMed  
  14. McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 1992; 51: 844-9. PubMed  
  15. Felson DT, Chaisson CE, Hill CL, et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 2001; 134: 541-9. PubMed  
  16. Hill CL, Gale DR, Chaisson CE, et al. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol 2001; 28: 1330-7. PubMed  
  17. Hill CL, Gale DR, Chaisson CE, et al. Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without knee symptoms. Arthritis Rheum 2003; 48: 2836-44. PubMed  
  18. Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Arthritis Rheum 2004; 50: 1501-10. PubMed  
  19. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 2000; 27: 1513-7. PubMed  
  20. Handlungsleitlinie Degenerative Gelenkerkrankungen aus Empfehlungen zur Therapie von degenerativen Gelenkerkrankungen. Arzneimittelkommission der deutschen Ärzteschaft, Arzneiverordnung in der Praxis, Sonderheft, 3. Auflage, November 2008. www.akdae.de  
  21. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Arthritis Rheum 1986; 29: 1039-49. PubMed  
  22. Dieppe P, Brandt K. What is important in treating osteoarthritis? Whom should we treat and when should we treat them? Rheum Dis Clin North Am 2003; 29: 687-716. PubMed  
  23. Walker-Bone K, Javaid K, Arden N, Cooper C. Medical management of osteoarthritis. BMJ 2000; 321: 936-40. British Medical Journal  
  24. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015 Jan 9;1:CD004376. The Cochrane Library  
  25. Superio-Cabusley E, Ward MM, Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis: a metaanalytic comparison with non-steroidal anti-inflammatory drug treatment. Artritis Care Res 1996;9:292-301. PubMed  
  26. Uthman OA, van der Windt DA, Jordan JL, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential and network meta-analysis. BMJ 2013; 347: f5555. BMJ (DOI)  
  27. Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD005523. onlinelibrary.wiley.com  
  28. de Rooij M, van der Leeden M, Cheung J, et al. Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017 ; 69(6): 807-816. pmid:27563831 PubMed  
  29. Bjordal JM, Klovning A, Ljunggren AE et al. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: a meta-analysis of randomised placebo-controlled trials. Eur J Pain 2006. www.ncbi.nlm.nih.gov  
  30. Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, Gaskell H, Moore RA. Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2017, Issue 5. Art. No.: CD008609. www.ncbi.nlm.nih.gov  
  31. Deyle GD, Henderson NE, Matekel RL, et al. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med 2000; 132:173-81. Annals of Internal Medicine  
  32. Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Annals of the Rheumatic Diseases 2013; 72(7): 1125-35. PubMed  
  33. American academy of orthopedic surgeons. Treatment of osteoarthritis of the knee. Stand 2013. www.aaos.org  
  34. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research 2012; 64(4): 465-74. pmid:22563589 PubMed  
  35. Guermazi A, Niu J, Hayashi D, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ 2012; 345: e5339. BMJ (DOI)  
  36. Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis 2007; 66: 433-9. PubMed  
  37. Christensen R, Bolvig J, Lund H, Bartels EM, Astrup AV, Hochberg MC, Singh JA, Lohmander S, Bliddal H, Juhl CB. Weight loss for overweight patients with knee or hip osteoarthritis (Protocol). Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD012526. DOI: 10.1002/14651858.CD012526. onlinelibrary.wiley.com  
  38. Jamtvedt G, Dahm KT, Christie A, et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther 2008; 88: 123-36. PubMed  
  39. Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: A systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol 2014; 66: 622–636. doi: 10.1002/art.38290 DOI  
  40. Amin S, Baker K, Niu J, et al. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum 2009; 60: 189-98. PubMed  
  41. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage 2014; 22: 363-88. doi:10.1016/j.joca.2014.01.003 DOI  
  42. Nathanael L, Feehan BS, Gary S, et al. The effectiveness of off-loading knee orthoses in the reduction of pain in medial compartment knee osteoarthritis. J Prosthet Orthot 2012; 24: 39-49. PubMed  
  43. Kirkley A, Webster-Bogaert S, Litchfield R, Amendola A, MacDonald S, McCalden R, et al. The effect of bracing on varus gonarthrosis. J Bone Joint Surg 1999; 81: 539-48. PubMed  
  44. Deutsche Gesellschaft für Orthopädie und Unfallchirurgie. Indikation Knieendoprothese. AWMF-Leitlinie 033-052. Stand 2018. www.awmf.org  
  45. Hinman RS, Crossley KM, McConnell J, Bennell K. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. BMJ 2003; 327: 135-8. PubMed  
  46. McAlindon TE, LaVaLLEY MP, Harvey WF, et al. Effect om intra-articular triamcinolone vs saline on knee cartilage volumen and pain in patients with knee osteoarthritis. A randomized clinical trial. JAMA 2017; 317: 1967-75. doi:10.1001/jama.2017.5283 DOI  
  47. Pincus T, Koch GG, Sokka T, et al. A randomized, double-blind, crossover clinical trial of diclofenac plus misoprostol versus acetaminophen in patients with osteoarthritis of the hip or knee. Arthritis Rheum 2001; 44: 1587-98. PubMed  
  48. Rother M, Conaghan PG. A randomized, double-blind, phase III trial in moderate osteoarthritis knee pain comparing topical ketoprofen gel with ketoprofen-free gel. JRheumatol 2013; 40: 1742-8. doi: 10.3899/jrheum.130192 DOI  
  49. Bjordal JM, Ljunggren AE, Klovning A, Slørdal L. Non-steroidal anti-inflammatory drugs, including coxibs, in osteoarthritic knee pain: a meta-analysis of randomised placebo-controlled trials. BMJ 2004; 329: 1317-20. British Medical Journal  
  50. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015; 350: h1225. doi:10.1136/bmj.h1225 DOI  
  51. Sinusas K. Osteoarthritis: diagnosis and treatment. Am Fam Physician 2012; 85: 49-56. American Family Physician  
  52. Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2003; 48: 370-7. PubMed  
  53. Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S. Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am 2003; 85-A: 1197-203. www.ncbi.nlm.nih.gov  
  54. Cepeda MS, Camargo F, Zea C, Valencia L. Tramadol for osteoarthritis: a systematic review and metaanalysis. J Rheumatol. 2007; 34: 543-55. PubMed  
  55. Pereira T V, Jüni P, Saadat P, Xing D, Yao L, Bobos P et al. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis BMJ 2022; 378 :e069722 doi:10.1136/bmj-2022-069722. www.bmj.com  
  56. Delanois RE, Etcheson JI, Sodhi N et al. Biologic Therapies for the Treatment of Knee Osteoarthritis. J Arthroplasty 2018. pmid:30612835 www.ncbi.nlm.nih.gov  
  57. Bennell KL, Hinman RS, Metcalf BR, et al. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Ann Rheum Dis 2005; 64: 906-12. PubMed  
  58. Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews 2010; 1: CD001977. doi:10.1002/14651858.CD001977.pub2 DOI  
  59. Siemieniuk RAC, Agoritsas T, Brignardelle-Peterseen R, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017. www.bmj.com  
  60. Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SMA, Verhaar JAN. Osteotomy for treating knee osteoarthritis. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD004019. DOI: 10.1002/14651858.CD004019.pub4. onlinelibrary.wiley.com  
  61. Naudie D, Bourne RB, Rorabeck CH, Bourne TJ. The install award. Survivorship of the high tibial valgus osteotomy. A 10- to -22-year follow up study. Clin Orthop 1999; 367: 18-27. PubMed  
  62. Billings A, Scott DF, Camargo MP, Hofmann AA. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg Am 2000; 82-A: 70-9. www.ncbi.nlm.nih.gov  
  63. Murray DW, Goodfellow JW, O'Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br 1998; 80-B: 983-9. www.ncbi.nlm.nih.gov  
  64. Svard UC, Price AJ. Oxford medial unicompartmental knee arthroplasty. A survival analysis of an independent series. J Bone Joint Surg Br 2001; 83-B: 191-4. www.ncbi.nlm.nih.gov  
  65. Brown A. The Oxford unicompartmental knee replacement for osteoarthritis. Issues Emerg Health Technol 2001; 23: 1-4. PubMed  
  66. Gidwani S, Tauro B, Whitehouse S, Newman JH. Do patients need to earn total knee arthroplasty? J Arthroplasty 2003; 18: 199-203. PubMed  
  67. Ritter MA, Berend ME, Meding JB, Keating EM, Faris PM, Crites B. Long-term follow-up of anatomic graduated components posterior cruciate-retaining total knee replacement. Clin Orthop 2001; 388: 51-7. PubMed  
  68. Khaw FM, Kirk LM, Gregg PJ. Survival analysis of cemented press-fit condylar total knee arthroplasty. J Arthroplasty 2001; 16: 161-7. PubMed  
  69. Jacobs W, Anderson P, Limbeek J, Wymenga A. Mobile bearing vs fixed bearing prosthesis for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis (Cochrane Review). In: The Cochrane Library, issue 2, 2004. The Cochrane Library  
  70. Kane RL, Saleh KJ, Wilt TJ, Bershadsky B, Cross WW III, MacDonald RM, et al. Total knee replacement. Rockville, MD: Agency for Healthcare Research and Quality, 2003. (Evidence report/technology assessment No 86.)
  71. Minns Lowe CJ, Barker KL, Dewey M, Sackley CM. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ 2007; 335: 812. British Medical Journal  
  72. Tria AJ Jr, Coon Tm. Minimal incision total knee arthroplasty: early experience. Clin Orthop 2003; 416: 185-90. PubMed  
  73. Møller AM, Villebro N, Pedersen T, et al. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359: 114-7. PubMed  
  74. Ajuied A, Wong F, Smith C, et al. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42(9):2242-52. PubMed  
  75. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA). Dortmund. Merkblätter und wissenschaftliche Begründungen zu den Berufskrankheiten der Anlage 1 zur Berufskrankheiten-Verordnung (BKV), zuletzt aktualisiert durch die Dritte Verordnung zur Änderung der Berufskrankheiten-Verordnung vom 22. Dezember 2014. Zugriff 24.1.2017. www.baua.de  
  76. DGVU Formtexte für Ärzte: Ärztliche Anzeige bei Verdacht auf eine Berufskrankheit. www.dguv.de  
  77. Mehrtens, G. Valentin, H. Schönberger, A. Arbeitsunfall und Berufskrankheit: rechtliche und medizinische Grundlagen für Gutachter, Sozialverwaltung S.878ff. Berlin: Erich Schmidt Verlag 9: Auflage, 2017.
  78. Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Knieschmerz bei Arthrosezeichen. AWMF-Leitlinie Nr.053-050, Stand 2017 www.awmf.org  
  • Lino Witte, Dr. med., Arzt in Weiterbildung, Innere Medizin, Frankfurt
  • Arild Aamodt, overlege/professor, Ortopedisk avdeling, Lovisenberg Sykehus, Oslo
  • Ingard Løge, spesialist allmennmedisin, universitetslektor, institutt for sammfunsmedisinske fag, NTNU, redaktør NEL