Aktuelle Traumatol 2007; 37(1): 3-15
DOI: 10.1055/s-2006-955864
Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Knorpelschaden und Gonarthrose, Teil III

Konservative Therapie und Nachbehandlung nach operativen EingriffenCartilage Lesions and Gonarthritis, Part IIIConservative Treatment and Rehabilitation after OperationsG. Spahn1
  • 1Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
22. Mai 2007 (online)

Zusammenfassung

Voraussetzung für den Erfolg einer konservativen und operativen Behandlung der Gonarthrose ist, dass der Patient den Charakter der Erkrankung versteht und in der Lage und Willens ist, seine Lebensweise darauf einzustellen. Neben dem ärztlichen Gespräch bieten hier Aufklärungsmaterialien und die Mitarbeit in Selbsthilfegruppen eine gute Hilfe. Die konservative Gonarthrosebehandlung umfasst im Wesentlichen 3 Säulen: medikamentöse Behandlung, Physiotherapie und die Versorgung mit Hilfsmitteln. Bei den Medikamenten handelt es sich in erster Linie um analgetisch-antiphlogistische Medikamente. Neben reinen Analgetika (Nichtopiat- und Opiatanalgetika) werden in der Regel NSAR (nichtsteroidale Antirheumatika) eingesetzt. Der Effekt der NSAR beruht auf der meist unselektiven Hemmung der Prostaglandinsynthese (Hemmung der Cyclooxygenase). Zu beachten ist dabei die nicht unerhebliche Nebenwirkungsrate, vor allem auf den Gastrointestinaltrakt. Obwohl die Behandlung mit Externa (NSAR-haltig bzw. auf phytotherapeutischer Basis) umstritten ist, bewirken diese Medikamente beim Patienten häufig eine deutliche Beschwerdelinderung. Weiterhin kommen SADOA (slow acting drugs in osteoarthritis) bzw. DMOAD (disease modifying osteoarthritis drugs) zum Einsatz. SADOA sind einerseits oral applizierbares D-Glucosaminsulfat, Vitamin E, Selen oder i. a. Hyaluronsäure. In Zukunft sind sicherlich Fortschritte in der Behandlung der Gonarthrosebehandlung durch DMOAD (z. B. Interleukinantagonisten, Gentherapie) zu erwarten. Für alle Behandlungen obligatorisch ist eine begleitende Physiotherapie. Dabei sind erlernte Übungsbehandlungen im Rahmen von Heimtrainingsprogrammen durch den Patienten konsequent durchzuführen. Zusätzlich können individuell auf die Bedürfnisse des Patienten abgestimmte Hilfsmittel wie Gehstützen, Bandagen, Schuhzurichtungen usw. häufig die Lebensqualität erheblich verbessern.

Abstract

Patients suffering from gonarthritis have to understand the character of this chronic disease. This is an important presupposition for success in conservative or operative treatment. The patient has to understand that gonarthritis mostly means long-life changes in lifestyle. The intensive talk with the physician but also information brochures as well as participation in self-care-groups can be helpfully. Conservative treatment of gonarthritis based on three main directions: drugs, physical therapy and supports. The mainly drugs which are used in treatment of gonarthritis have analgetic and antiphlogistic effects. Pure analgetic drugs (non-opiate or opiate analgetic) are seldom required. It is generally accepted that NSAID (non-steroidal anti-inflammatory drugs) are method of choice in arthritis therapy today. The mainly effect of NSAID is an inhibition of the prostaglandin synthesis by inhibition of the cyclooxigenase activity. Disadvantageously are side effects especially within the gastro-intestinal tract. No significantly effects produce topical drugs (containing NSAID or phytotherapeutics). But in some cases these externa effect a decrease of the patients complaints. Other drugs called as SADOA (slow acting drugs in osteoarthritis) or DMOAD (disease modyfying osteoarthritis drugs) can be usefull in gonarthitis treatment. SADOA are f. e. D-glucosamine-sulfate, vitamin E, selen or i. a. application of hyolonic acid. Surely in future better results are possible by using DMOAD (antagonists against interleukins or genetic therapy). Physical therapy is one of the most important parts of therapy in gonarthritis. Above all, the patients have to learn self-administrated home training programs for consequently daily use. Finally in same cases adjuvants (crutches, tapes, insoles) can be helpfully to improve the patients quality of life.

Literatur

  • 1 Adam M. Welche Wirkung haben Gelatine-Präparate? Therapie der Osteoarthrose.  Therapiewoche. 1991;  41 2456-2457
  • 2 Alfredson H, Lorentzon R. Superior results with continuous passive motion compared to active motion after periosteal transplantation. A retrospective study of human patella cartilage defect treatment.  Knee Surg Sports Traumatol Arthrosc. 1999;  7 232-238
  • 94 Alonso-Ruiz A, Perez-Ruiz F, Calabozo M, Saez F, Ignacio P J, Ruiz-Lucea E, Aretxabala I, Rios G. Efficacy of radiosynovectomy of the knee in rheumatoid arthritis: evaluation with magnetic resonance imaging.  Clin Rheumatol. 1998;  17 277-281
  • 3 Arend W P, Malyak M, Guthridge C J, Gabay C. Interleukin-1 receptor antagonist: role in biology.  Annu Rev Immunol. 1998;  16 27-55
  • 4 Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis.  CMAJ. 2005;  172 1039-1043
  • 5 Barclay T S, Tsourounis C, McCart G M. Glucosamine.  Ann Pharmacother. 1998;  32 574-579
  • 6 Bartz R L, Laudicina L. Osteoarthritis after sports knee injuries.  Clin Sports Med. 2005;  24 39-45
  • 7 Behrens F, Shepard N, Mitchell N. Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids.  J Bone Joint Surg [Am]. 1975;  57 70-76
  • 8 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee.  Cochrane Database Syst Rev. 2006;  CD005321
  • 9 Berman B M, Singh B B, Lao L, Langenberg P, Li H, Hadhazy V, Bareta J, Hochberg M. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee.  Rheumatology (Oxford). 1999;  38 346-354
  • 10 Bernau A, Heeg P. [Intraarticular punctures and injections: indications - prevention of infection - technique - complications].  Orthopäde. 2003;  32 548-569
  • 11 Bliddal H. Placement of intra-articular injections verified by mini air-arthrography.  Ann Rheum Dis. 1999;  58 641-643
  • 12 Boussina I, Lagier R, Ott H, Fallet G H. Osmium deposits detected by X-ray after synoviorthesis of the knee.  Scand J Rheumatol. 1976;  5 53-59
  • 13 Brand C, Snaddon J, Bailey M, Cicuttini F. Vitamin E is ineffective for symptomatic relief of knee osteoarthritis: a six month double blind, randomised, placebo controlled study.  Ann Rheum Dis. 2001;  60 946-949
  • 14 Brooks J J. The significance of double phenotypic patterns and markers in human sarcomas. A new model of mesenchymal differentiation.  Am J Pathol. 1986;  125 113-123
  • 15 Brouwer R W, Jakma T S, Verhagen A P, Verhaar J A, Bierma-Zeinstra S M. Braces and orthoses for treating osteoarthritis of the knee.  Cochrane Database Syst Rev. 2005;  CD004020
  • 16 Brouwer R W, van Raaij T M, Verhaar J A, Coene L N, Bierma-Zeinstra S M. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial.  Osteoarthritis Cartilage. 2006;  14 777-783
  • 17 Brune K, Hoffmann K. Pharmakologie des Schmerzes. Wörz R Differenzierte medikamentöse Schmerztherapie. München, Jena; Urban und Fischer 2001
  • 18 Buckwalter J A, Lane N E. Does participation in sports cause osteoarthritis?.  Iowa Orthop J. 1997;  17 80-89
  • 19 Bucsi L, Poor G. Efficacy and tolerability of oral chondroitin sulfate as a symptomatic slow-acting drug for osteoarthritis (SYSADOA) in the treatment of knee osteoarthritis.  Osteoarthritis Cartilage. 1998;  6 (Suppl A) 31-36
  • 20 Burks R, Daniel D, Losse G. The effect of continuous passive motion on anterior cruciate ligament reconstruction stability.  Am J Sports Med. 1984;  12 323-327
  • 21 Caplan A I. Review: mesenchymal stem cells: cell-based reconstructive therapy in orthopedics.  Tissue Eng. 2005;  11 1198-1211
  • 22 Cheing G L, Hui-Chan C W. Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone?.  Clin Rehabil. 2004;  18 487-497
  • 23 Chevalier X, Giraudeau B, Conrozier T, Marliere J, Kiefer P, Goupille P. Safety study of intraarticular injection of interleukin 1 receptor antagonist in patients with painful knee osteoarthritis: a multicenter study.  J Rheumatol. 2005;  32 1317-1323
  • 24 Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial.  Osteoarthritis Cartilage. 2005;  13 20-27
  • 25 Chrubasik S. Vitamin E for rheumatoid arthritis or osteoarthritis: low evidence of effectiveness.  Z Rheumatol. 2003;  62 491
  • 26 Chrubasik S. [Devil's claw extract as an example of the effectiveness of herbal analgesics].  Orthopäde. 2004;  33 804-808
  • 27 Creamer P. Intra-articular corticosteroid treatment in osteoarthritis.  Curr Opin Rheumatol. 1999;  11 417-421
  • 28 Crofford L J. COX‐1 and COX‐2 tissue expression: implications and predictions.  J Rheumatol. 1997;  49 (Suppl) 15-19
  • 29 Crofford L J. COX‐2 in synovial tissues.  Osteoarthritis Cartilage. 1999;  7 406-408
  • 30 Del V F, Filareto A, Spitalieri P, Sangiuolo F, Novelli G. Cellular genetic therapy.  Transplant Proc. 2005;  37 2657-2661
  • 31 Denis M, Moffet H, Caron F, Ouellet D, Paquet J, Nolet L. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial.  Phys Ther. 2006;  86 174-185
  • 32 Dennis D A, Komistek R D, Nadaud M C, Mahfouz M. Evaluation of off-loading braces for treatment of unicompartmental knee arthrosis.  J Arthroplasty. 2006;  21 2-8
  • 33 Deyle G D, Allison S C, Matekel R L, Ryder M G, Stang J M, Gohdes D D, Hutton J P, Henderson N E, Garber M B. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.  Phys Ther. 2005;  85 1301-1317
  • 34 Deyle G D, Henderson N E, Matekel R L, Ryder M G, Garber M B, Allison S C. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.  Ann Intern Med. 2000;  132 173-181
  • 35 Donovan P J, Gearhart J. The end of the beginning for pluripotent stem cells.  Nature. 2001;  414 92-97
  • 36 Engstrom B, Sperber A, Wredmark T. Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction.  Knee Surg Sports Traumatol Arthrosc. 1995;  3 18-20
  • 37 Ezzo J, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, Berman B. Acupuncture for osteoarthritis of the knee: a systematic review.  Arthritis Rheum. 2001;  44 819-825
  • 38 Fisher N M, Gresham G E, Abrams M, Hicks J, Horrigan D, Pendergast D R. Quantitative effects of physical therapy on muscular and functional performance in subjects with osteoarthritis of the knees.  Arch Phys Med Rehabil. 1993;  74 840-847
  • 39 Fitzgerald G K, Oatis C. Role of physical therapy in management of knee osteoarthritis.  Curr Opin Rheumatol. 2004;  16 143-147
  • 40 Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial.  J Rheumatol. 2001;  28 156-164
  • 41 Fredberg U, van Overeem H G, Bolvig L. Placement of intra-articular injections verified by ultrasonography and injected air as contrast medium.  Ann Rheum Dis. 2001;  60 542
  • 42 Gamarski J, Gamarski M. [Vitamin E as therapeutic coadjuvant in osteoarthritis.].  Hospital (Rio J). 1958;  54 209-216
  • 43 Grande D A, Mason J, Light E, Dines D. Stem cells as platforms for delivery of genes to enhance cartilage repair.  J Bone Joint Surg [Am]. 2003;  85 (Suppl 2) 111-116
  • 44 Grecomoro G, Piccione F, Letizia G. Therapeutic synergism between hyaluronic acid and dexamethasone in the intra-articular treatment of osteoarthritis of the knee: a preliminary open study.  Curr Med Res Opin. 1992;  13 49-55
  • 45 Grifka (Hrsg) J. Die Knieschule. Selbsthilfe bei Kniebeschwerden. Hamburg, Berlin; Rowohlt 2003
  • 46 Guo W S, Ma L, Li Z R. [Suppression of articular cartilage breakdown in osteoarthritis by interleukin-1 receptor antagonist using ex vivo gene therapy].  Zhonghua Yi Xue Za Zhi. 2004;  84 853-856
  • 47 Guo X, Wang C, Zhang Y, Xia R, Hu M, Duan C, Zhao Q, Dong L, Lu J, Qing S Y. Repair of large articular cartilage defects with implants of autologous mesenchymal stem cells seeded into beta-tricalcium phosphate in a sheep model.  Tissue Eng. 2004;  10 1818-1829
  • 48 Hassan B S, Mockett S, Doherty M. Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis.  Ann Rheum Dis. 2002;  61 24-28
  • 49 Hewitt B A, Refshauge K M, Kilbreath S L. Kinesthesia at the knee: the effect of osteoarthritis and bandage application.  Arthritis Rheum. 2002;  47 479-483
  • 50 Hicks J E, Perry M B, Gerber L H. Rehabilitation in the management of patients with osteoarthritis. Moskowitz RW, Howell DS, Altman RD, Buckwalter JA, Goldberg VM Osteoarthritis. Diagnosis and Medical/Surgical Management. Philadelphia, London, New York, St. Louis, Sydney, Toronto; WB Saunders 2001: 413-446
  • 51 Hinman R S, Crossley K M, McConnell J, Bennell K L. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial.  BMJ. 2003;  327 135
  • 52 Hinman R S, Crossley K M, McConnell J, Bennell K L. Does the application of tape influence quadriceps sensorimotor function in knee osteoarthritis?.  Rheumatology (Oxford). 2004;  43 331-336
  • 53 Huch K, Muller K A, Sturmer T, Brenner H, Puhl W, Gunther K P. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study.  Ann Rheum Dis. 2005;  64 1715-1720
  • 54 Ikeda T, Kubo T, Arai Y, Nakanishi T, Kobayashi K, Takahashi K, Imanishi J, Takigawa M, Hirasawa Y. Adenovirus mediated gene delivery to the joints of guinea pigs.  J Rheumatol. 1998;  25 1666-1673
  • 55 Im G I, Kim D Y, Shin J H, Hyun C W, Cho W H. Repair of cartilage defect in the rabbit with cultured mesenchymal stem cells from bone marrow.  J Bone Joint Surg [Br]. 2001;  83 289-294
  • 56 Jackson D W, Evans N A, Thomas B M. Accuracy of needle placement into the intra-articular space of the knee.  J Bone Joint Surg [Am]. 2002;  84 1522-1527
  • 57 Jacob R, Smith T, Prakasha B, Joannides T. Yttrium90 synovectomy in the management of chronic knee arthritis: a single institution experience.  Rheumatol Int. 2003;  23 216-220
  • 58 Jancewicz P, Dzienis W, Pietruczuk M, Skowronski J, Bielecki M. Osteochondral defects of the talus treated by mesenchymal stem cell implantation - early results.  Rocz Akad Med Bialymst. 2004;  49 (Suppl 1) 25-27
  • 59 Jerosch J, Heisel (Hrsg) J. Knieendoprothetik. Indikationen, Operationstechnik, Nachbehandlung, Begutachtung. Berlin, Heidelberg, New York, Barcelona, Budapest, Hongkong, London, Mailand, Paris, Singapur, Tokio; Springer 1999
  • 60 Jones A, Doherty M. Intra-articular corticosteroids are effective in osteoarthritis but there are no clinical predictors of response.  Ann Rheum Dis. 1996;  55 829-832
  • 61 Karinkanta S, Heinonen A, Sievanen H, Uusi-Rasi K, Kannus P. Factors predicting dynamic balance and quality of life in home-dwelling elderly women.  Gerontology. 2005;  51 116-121
  • 62 Karlsson J, Sjogren L S, Lohmander L S. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study.  Rheumatology (Oxford). 2002;  41 1240-1248
  • 63 Kawano T, Miura H, Mawatari T, Moro-Oka T, Nakanishi Y, Higaki H, Iwamoto Y. Mechanical effects of the intraarticular administration of high molecular weight hyaluronic acid plus phospholipid on synovial joint lubrication and prevention of articular cartilage degeneration in experimental osteoarthritis.  Arthritis Rheum. 2003;  48 1923-1929
  • 64 Kerrigan D C, Lelas J L, Goggins J, Merriman G J, Kaplan R J, Felson D T. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis.  Arch Phys Med Rehabil. 2002;  83 889-893
  • 65 Kim J M, Jeong J G, Ho S H, Hahn W, Park E J, Kim S, Yu S S, Lee Y W, Kim S. Protection against collagen-induced arthritis by intramuscular gene therapy with an expression plasmid for the interleukin-1 receptor antagonist.  Gene Ther. 2003;  10 1543-1550
  • 66 Kirschner P. [CPM - Continuous Passive Motion: treatment of injured or operated knee-joints using passive movement. A meta-analysis of current literature].  Unfallchirurg. 2004;  107 328-340
  • 67 Kriegshauser L A, Bryan R S. Early motion with cast-brace after modified Coventry high tibial osteotomy.  Clin Orthop Relat Res. 1985;  168-172
  • 68 Lane N E, Thompson J M. Management of osteoarthritis in the primary-care setting: an evidence-based approach to treatment.  Am J Med. 1997;  103 25S-30S
  • 69 Lavernia C J, Sierra R J, Gomez-Marin O. Smoking and joint replacement: resource consumption and short-term outcome.  Clin Orthop Relat Res. 1999;  172-180
  • 70 Lindqvist U, Tolmachev V, Kairemo K, Astrom G, Jonsson E, Lundqvist H. Elimination of stabilised hyaluronan from the knee joint in healthy men.  Clin Pharmacokinet. 2002;  41 603-613
  • 71 Locher H, Strohmeier M, Wolber K. Orthopädische Schmerztherapie. Wirth CJ, Bischoff HP Praxis der Orthopädie. Band I: Konservative Orthopädie. Stuttgart, New York; Thieme 2001: 181-205
  • 72 Löffler G. Stoffwechsel von Triglycerinen und Fettsäuren. Löffler G, Petrides PE Biochemie und Pathobiochemie. Berlin, Heidelberg, New York, Hongkong, London, Mailand, Paris, Tokyo; Springer 2003: 753-788
  • 73 Luc M, Pham T, Chagnaud C, Lafforgue P, Legre V. Placement of intra-articular injection verified by the backflow technique.  Osteoarthritis Cartilage. 2006;  14 714-716
  • 74 Madry H, Kohn D. [Conservative treatment of knee osteoarthritis].  Unfallchirurg. 2004;  107 689-699
  • 76 Maillefert J F, Hudry C, Baron G, Kieffert P, Bourgeois P, Lechevalier D, Coutaux A, Dougados M. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study.  Osteoarthritis Cartilage. 2001;  9 738-745
  • 77 Makin M, Robin G. Radioactive colloidal gold in the treatment of chronic synovial effusions.  Proc R Soc Med. 1968;  61 908-910
  • 78 Matheson A J, Perry C M. Glucosamine: a review of its use in the management of osteoarthritis.  Drugs Aging. 2003;  20 1041-1060
  • 79 Mayer M E. Physical therapy and exercise in osteoarthritis of the knee.  Ann Intern Med. 2000;  132 923
  • 80 McInnes J, Larson M G, Daltroy L H, Brown T, Fossel A H, Eaton H M, Shulman-Kirwan B, Steindorf S, Poss R, Liang M H. A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty.  JAMA. 1992;  268 1423-1428
  • 81 Mohomed N N. Manual physical therapy and exercise improved function in osteoarthritis of the knee.  J Bone Joint Surg [Am]. 2000;  82 1324
  • 82 Mohr (Hrsg) W. Gelenkpathologie. Berlin, Heidelberg, New York; Springer 2000
  • 83 Moore R A, Tramer M R, Carroll D, Wiffen P J, McQuay H J. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs.  BMJ. 1998;  316 333-338
  • 84 Morelli V, Naquin C, Weaver V. Alternative therapies for traditional disease states: osteoarthritis.  Am Fam Physician. 2003;  67 339-344
  • 85 Moskowitz R W. Hyaluronic acid supplementation.  Curr Rheumatol Rep. 2000;  2 466-471
  • 86 Mottonen M, Pantio M, Nevalainen T. Effects of osmium tetroxide on the rabbit knee joint normal synovial membrane.  Acta Rheumatol Scand. 1970;  16 121-129
  • 87 Mullaji A B, Shahane M N. Continuous passive motion for prevention and rehabilitation of knee stiffness (a clinical evaluation).  J Postgrad Med. 1989;  35 204-208
  • 88 Nagaya H, Ymagata T, Ymagata S, Iyoda K, Ito H, Hasegawa Y, Iwata H. Examination of synovial fluid and serum hyaluronidase activity as a joint marker in rheumatoid arthritis and osteoarthritis patients (by zymography).  Ann Rheum Dis. 1999;  58 186-188
  • 89 Namiki O, Toyoshima H, Morisaki N. Therapeutic effect of intra-articular injection of high molecular weight hyaluronic acid on osteoarthritis of the knee.  Int J Clin Pharmacol Ther Toxicol. 1982;  20 501-507
  • 90 Neustadt D H. Intra-articular therapy. Moskowitz RW, Howell DS, Altman RD, Buckwalter JA, Goldberg VM Osteoarthritis. Diagnosis and Medical/Surgical Management. Philadelphia, London, New York, St. Louis, Sydney, Toronto; WB Saunders 2001: 393-411
  • 91 Nissila M. Absence of increased frequency of degenerative joint changes after osmic acid injections.  Scand J Rheumatol. 1978;  7 81-84
  • 92 Nissila M. Use of osmic acid in the topical treatment of exudative synovitis of the knee joint.  Scand J Rheumatol. 1979;  29 (Suppl) 1-25
  • 93 O'Duffy E K, Clunie G P, Lui D, Edwards J C, Ell P J. Double blind glucocorticoid controlled trial of samarium-153 particulate hydroxyapatite radiation synovectomy for chronic knee synovitis.  Ann Rheum Dis. 1999;  58 554-558
  • 95 Pelletier J P, Caron J P, Evans C, Robbins P D, Georgescu H I, Jovanovic D, Fernandes J C, Martel-Pelletier J. In vivo suppression of early experimental osteoarthritis by interleukin-1 receptor antagonist using gene therapy.  Arthritis Rheum. 1997;  40 1012-1019
  • 97 Pham T, Maillefert J F, Hudry C, Kieffert P, Bourgeois P, Lechevalier D, Dougados M. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A two-year prospective randomized controlled study.  Osteoarthritis Cartilage. 2004;  12 46-55
  • 98 Reginster J Y, Bruyere O, Fraikin G, Henrotin Y. Current concepts in the therapeutic management of osteoarthritis with glucosamine.  Bull Hosp Jt Dis. 2005;  63 31-36
  • 99 Reginster J Y, Deroisy R, Rovati L C, Lee R L, Lejeune E, Bruyere O, Giacovelli G, Henrotin Y, Dacre J E, Gossett C. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial.  Lancet. 2001;  357 251-256
  • 100 Richmond J C, Gladstone J, MacGillivray J. Continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: comparison of short- versus long-term use.  Arthroscopy. 1991;  7 39-44
  • 101 Richter W. Stammzellen in der Knorpelforschung.  Akt Traumatol. 2005;  35 249-254
  • 102 Salter R B. The physiologic basis of continuous passive motion for articular cartilage healing and regeneration.  Hand Clin. 1994;  10 211-219
  • 103 Sandell L J, Hering T M. Biochemistry and molecular and cell biology of articular cartilage in osteoarthritis. Moskowitz RW, Howell DS, Altman RD, Buckwalter JA, Goldberg VM Osteoarthritis. Diagnosis and Medical/Surgical Management. Philadelphia, London, New York, St. Louis, Sydney, Toronto; WB Saunders 2001: 115-143
  • 104 Sasaki T, Yasuda K. Clinical evaluation of the treatment of osteoarthritic knees using a newly designed wedged insole.  Clin Orthop Relat Res. 1987;  181-187
  • 105 Schultz W, Gobel D. Articular cartilage regeneration of the knee joint after proximal tibial valgus osteotomy: a prospective study of different intra- and extra-articular operative techniques.  Knee Surg Sports Traumatol Arthrosc. 1999;  7 29-36
  • 106 Self B P, Greenwald R M, Pflaster D S. A biomechanical analysis of a medial unloading brace for osteoarthritis in the knee.  Arthritis Care Res. 2000;  13 191-197
  • 107 Spahn G, Klinger H M, Kirschbaum S. [The effect of adjuvants (bandage or compression stocking) in the rehabilitation of patients after arthroscopic débridement].  Akt Traumatol. 2005;  35 17-21
  • 108 Spector T D, Harris P A, Hart D J, Cicuttini F M, Nandra D, Etherington J, Wolman R L, Doyle D V. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls.  Arthritis Rheum. 1996;  39 988-995
  • 109 Steinmeyer J. Pharmacological basis for the therapy of pain and inflammation with nonsteroidal anti-inflammatory drugs.  Arthritis Res. 2000;  2 379-385
  • 111 Steinmeyer J. [Drug therapy of arthrosis].  Orthopäde. 2001;  30 856-865
  • 112 Strand V, Conaghan P G, Lohmander L S, Koutsoukos A D, Hurley F L, Bird H, Brooks P, Day R, Puhl W, Band P A. An integrated analysis of five double-blind, randomized controlled trials evaluating the safety and efficacy of a hyaluronan product for intra-articular injection in osteoarthritis of the knee.  Osteoarthritis Cartilage. 2006;  14 859-866
  • 113 Takeda W, Wessel J. Acupuncture for the treatment of pain of osteoarthritic knees.  Arthritis Care Res. 1994;  7 118-122
  • 114 Taylor W J, Corkill M M, Rajapaske C N. A retrospective review of yttrium-90 synovectomy in the treatment of knee arthritis.  Br J Rheumatol. 1997;  36 1100-1105
  • 115 Tillu A, Tillu S, Vowler S. Effect of acupuncture on knee function in advanced osteoarthritis of the knee: a prospective, non-randomised controlled study.  Acupunct Med. 2002;  20 19-21
  • 116 Tukmachi E, Jubb R, Dempsey E, Jones P. The effect of acupuncture on the symptoms of knee osteoarthritis - an open randomised controlled study.  Acupunct Med. 2004;  22 14-22
  • 117 van de Loo F A, van den Berg W B. Gene therapy for rheumatoid arthritis. Lessons from animal models, including studies on interleukin-4, interleukin-10, and interleukin-1 receptor antagonist as potential disease modulators.  Rheum Dis Clin North Am. 2002;  28 127-149
  • 118 Van Soesbergen R M, Hoefnagel C A, Marcuse H R, Dijkstra P F, Bernelot Moens H J. Radiosynoviorthesis of the knee: a doubleblind trial of 1 versus 5 mCi Gold-198.  Clin Rheumatol. 1988;  7 224-230
  • 119 van O M, Sont J K, van Laar J M. Superior effect of arthroscopic lavage compared with needle aspiration in the treatment of inflammatory arthritis of the knee.  Rheumatology (Oxford). 2003;  42 102-107
  • 120 Vane J. Towards a better aspirin.  Nature. 1994;  367 215-216
  • 121 Vane J R, Botting R M. The mechanism of action of aspirin.  Thromb Res. 2003;  110 255-258
  • 122 Wagner P. Anpassungsfähig: Wie sich die Risiken einer Einnahme von Antirheumatika im Laufe der Zeit „verändern“.  Arzneiverordnung in der Praxis. 2005;  32 43-58
  • 123 White-O'Connor B, Sobal J, Muncie Jr H L. Dietary habits, weight history, and vitamin supplement use in elderly osteoarthritis patients.  J Am Diet Assoc. 1989;  89 378-382
  • 124 Wilder F V, Hall B J, Barrett J P. Smoking and osteoarthritis: is there an association? The Clearwater Osteoarthritis Study.  Osteoarthritis Cartilage. 2003;  11 29-35
  • 125 Williams J M, Moran M, Thonar E J, Salter R B. Continuous passive motion stimulates repair of rabbit knee articular cartilage after matrix proteoglycan loss.  Clin Orthop Relat Res. 1994;  252-262
  • 126 Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther H U, Melchart D, Willich S N. Acupuncture in patients with osteoarthritis of the knee: a randomised trial.  Lancet. 2005;  366 136-143
  • 127 Yurtkuran M, Kocagil T. TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee.  Am J Acupunct. 1999;  27 133-140
  • 128 Zaslav K R, Dugas J R. Nonoperative treatment. Cole BJ, Malek MM Articular Cartilage Lesions. A Practical Guide to Assessment and Treatment. New York, Berlin, Heidelberg, Hong Kong, London, Milan, Paris, Tokyo; Springer 2004: 23-34
  • 129 Zorn B. [Antiarthritis effect of the Harpagophytum root; preliminary report].  Z Rheumaforsch. 1958;  17 134-138
  • 130 Zuber T J. Knee joint aspiration and injection.  Am Fam Physician. 2002;  66 1497-1500

Dr. med. Gunter Spahn

Praxisklinik für Unfallchirurgie und Orthopädie

Sophienstraße 16

99817 Eisenach

Telefon: 0 36 91/7 35 00

Fax: 0 36 91/73 50 11

eMail: spahn@pk-eisenach.de