Zusammenfassung
Die Arthrose ist die häufigste Gelenkaffektion des Menschen. Frauen sind in etwa doppelt so häufig betroffen wie Männer. Es wird erwartet dass die Inzidenz und Prävalenz in den nächsten Jahren weiter deutlich ansteigen wird. In der Therapie sollten zunächst alle allgemeinen Maßnahmen ausgeschöpft werden. Hierzu zählen sowohl geeignete bzw. modifizierte Schuhe, Gehstöcke sowie weitere orthopädietechnische Verfahren. Wichtigster beeinflussbarer Risikofaktor ist das Körpergewicht, hier muss ebenso an die Eigenverantwortlichkeit des Patienten für die Progression seiner Erkrankung appelliert werden wie bei der körperlichen Aktivität. Physikalische Maßnahmen sollten die Therapie begleiten, obgleich für viele häufig zum Einsatz kommende Maßnahmen keine sehr gute Evidenz aus klinischen Studien vorliegt. Ähnliches gilt für die Akupunktur, die bei der Kniegelenksarthrose zum Einsatz kommen sollte, obgleich die Frage des Wirkmechanismus nicht geklärt ist. Die intraartikuläre Applikation von Corticoiden kann in Einzelfällen beim akut entzündeten Kniegelenk unter streng aseptischen Bedingungen zum Einsatz kommen. Abzulehnen sind Ultraschallwellentherapien, Magnetfeldtherapien, Diathermie und Stoßwellenbehandlungen. Umstellungsosteotomien kommen bei statischen Fehlbelastungen in Frage. Der definitive Gelenkersatz mittels Totalendoprothese ist eine im Hinblick auf Schmerzreduktion und Funktionsverbesserung gut belegte Intervention, sollte aber erst nach frustranem Ausschöpfen aller anderen Optionen in Erwägung gezogen werden. Ob hier minimalinvasive oder roboterassistierte Verfahren überlegen sind, lässt die derzeitige Datenlage nicht beantworten.
Abstract
Osteoarthritis is the most common joint affection in humans. Women are twice as often affected as men. Incidence and prevalence are expected to notably rise further within the next years. In therapy, all common methods should be used first. To those methods belong appropriate or modified shoes, walking sticks as well as other orthopaedic-technical methods. The most important risk factor to be influenced is body weight; here, the patient's personal responsibility for the progression of his disease has to be adressed as well as physical activity. Physical expedients should accompany the therapy, although there is no very good evidence from clinical studies for many often-used methods. The same applies to acupuncture, which should be used as therapy of osteoarthritis in the knee, although the issue of the functioning mechanism has not been clarified yet. Corticoids could be applicated intraarticularly under strictly aseptic conditions in single cases with an acutely inflamed knee. Ultrasound wave therapies, magnet field therapies, diathermy and shock wave therapies are to be rejected. Osteotomies could be used in static malfunctioning. Definite joint replacement with total endoprothesis is a well-documented intervention in regard to pain reduction and function improvement, but it should only be considered after all other options are tried without success. On the actual research basis, it can’t be stated if minimal invasive or robotic methods are superior.
Schlüsselwörter
Arthrose - Lebensstilberatung - operative Therapie
Key words
osteoarthritis - life style counselling - surgical interventions
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Korrespondenzadresse
PD Dr. T. Rosemann
Abteilung Allgemeinmedizin und Versorgungsforschung Universitätsklinikum Heidelberg
Vosstr. 2
69115
Heidelberg
Email: thomas.rosemann@med.uni-heidelberg.de
