To properly function again with osteoarthritis in the joints, guidance from the physiotherapist is required.

 

Movamento has a specialized orthopedic rehabilitation team of physiotherapists who have a lot of experience with the rehabilitation of osteoarthritis complaints. By orthopedic rehabilitation we mean improving the functioning of the body, when a problem, for excample in the knee or hip joint, occurs as a result of osteoarthritis. Rehabilitation can take place after surgery, but it can also be aimed at preventing surgery. A direct collaboration with the orthopedic surgeon and doctor is essential in order to achieve the best possible result.

Depending on your goals and rehabilitation plan, the rehabilitation team consist of a physical therapist, manual therapist and sports physiotherapist. In addition, we also work together with an occupational therapist and orthopedic shoemaker. We offer treatments that are aimed at returning to the desired activities, which go hand in hand with a higher quality of life. Activities such as cycling, climbing stairs or shopping are very important and a major limitation if these can no longer be carried out. The rehabilitation we offer can consist of physiotherapy treatments, training therapy and guidance in how to return to work or sport. In addition, we also give advise in how to use the body more evenly instead of in a pattern of ups and downs. Sometimes help is needed to emphasize what you are still able to do and to accept that some things are no longer that easy. Every problem is different and the duration and content of the rehabilitation can be adjusted accordingly. At Movamento we give the patient the time and attention that is needed, to help every individual at every level.

Personalized rehabilitation plan

Movamento has various specialists to offer a personalized rehabilitation plan. There are specialists in the shoulder, elbow, wrist and hand, but also in the knee, hip and ankle. Movamento stands for quality, therefore we invest a lot in internal training and education. In addition, we want to maintain a high quality of care through our interdisciplinary collaborations. If necessary, this allows us to be able switch quickly to, for example, a trauma surgeon or orthopedist.

Your goals are the main focus during the treatments and rehabilitation. Together with the specialists, you prepare a rehabilitation plan that matches your personal situation and goals.

 

Book an appointment

Do you want to book an appointment or do you have any questions? Fill in our contact form and we will contact you back as soon as possible. You can also reach us via the phone by calling 088 02 45 900.

 

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What is osteoarthritis?

With cartilage damage or wear (osteoarthritis), pain is usually the most important symptom. A phenomenon that often occures is starting stiffness or starting pain. This means that a joint such as the knee or hip must boot up after, for example, a long period of sitting or lying. In a later stadium this phenomenon can also occurs in rest and the pain can wake you up.

The joint may become swollen due to fluid entering. A well-known phenomenon with the knee joint is that it can “lock” (this is called closing complaints) because loose pieces of cartilage in the joint. This may be because the cartilage layers do not slide smoothly over each other anymore. In addition to these complaints, instability or creaking noises (crepetations) may also be present.

Cartilage is a structure in the body that cannot properly repair itself. This is because cartilage has no blood supply. Cartilage also has no nerve supply. This means it cannot register any pain. The pain that occurs after cartilage damage does not come directly from the cartilage damage itself, but from irritated structures around it, such as the mucosa and bone membrane. Instability may occure because the muscles relax reflexively when a pain stimulus is given from the knee. This phenomenon is often seen in a certain range of a movement or position of the knee.

 

When will osteoarthritis be operated?

In addition to the conservative treatment of the end stage of osteoarthritis, there are also surgical options. The success of an operation depends on a number of factors. The size of the cartilage damage and the severity of the damage is important. The present pain, body weight, any other abnormalities (such as O-legs, meniscus injury, instability of the knee) and the activity level of the patient are also taken in account. 

The goal of all cartilage treatments is to restore the function of the knee and reduce pain and swelling. A joint replacement surgery is a large procedure and is only done if other treatments will not give sufficient results. An important aspect is the very long and cautious rehabilitation with often longer periods (at least 6 weeks) of walking with crutches.

 

There are surgical techniques where the own knee is kept but there are also complete joint replacement techniques. An osteotomy is a joint maintenance technique and a prosthesis or endoprosthesis are joint replacement techniques. In addition, there are cartilage replacement operations or operations where the cartilage is treated.

 

The choice of an osteotomy or prosthesis depends on a number of factors:

  • Does the arthrosis occure in one or more compartments of the knee
  • Age (from 65 years and older a prosthesis is preferred)
  • The activity level (activities with more impact are less suitable for a prosthesis)
  • The patient’s wish (after an osteotomy, pain may still be present)
  • The preference and experience of the orthopedic surgeon

 

It is still possible to play a various amount of sports with a prosthesis. It is, for excample, possible to cycle, row or play tennis. Sports with a higher impact (for example running) are less suitable for a prosthesis.

 

 

Osteotomy

 

 

An axis-deviation can affect the wear of the knee. With an osteotomy, the axis of the leg is restored so that the weight is more placed on the healthy side of the knee. Before the operation, the mechanical load-axis (the line that runs from the center of the hip head to the center of the knee and the line from the center of the knee to the center of the ankle) is determined with an X-ray. The angle measured with this determines the size of the wedge used for the correction.

 

It depends on the anatomy and nature of the axis-deviation whether the osteotomy is performed above the knee (thigh) or below the knee (tibia). The osteotomy is more often performed in the tibia. To change the position of the tibia, the fibula is also sawn through (this is called a fibulotomy). Sometimes a small part of the fibula is removed. This is called a limited fibula resection. Because the fibula has been sawn through and is no longer fixed, the patient may experience, in the first weeks after the operation, abnormal movements in the fibula during the movements of the ankle and foot. Also some unpainful crepations might occure. This sensation will disappear after about 4 weeks.

 

Various techniques are known for performing an osteotomy. There is a closed wedge-technique, an open wedge-technique and a crescent-shaped osteotomy.

 

With a closed wedge-technique, the surgeon first takes a wedge-shaped triangle from the tibia or the upper leg and then closes the bone parts together again. This way, for example, an X-leg can be made of an O-leg, whereby the pressure points on the knee joint moves from the inside to the outside. For the fixation a staple, a plate and screws, fixation from outside or only plaster is used.

 

With an open wedge technique, a cut is made in the tibia or thigh. The bone surfaces are then moved apart until the correct corrected angle is reached. The part where there is now no bone is filled with bone from the pelvis comb or with artificial bone. This whole is fixed with a plate and screws.

With an open wedge-technique, a cut is made in the tibia or thigh. The bone surfaces are moved apart until the corrected angle is reached. The part where there is no bone now is filled with bone from the pelvis comb or with artificial bone. This is all fixed with a plate and screws.

An alternative method for an osteotomy that can be used for larger corrections is the crescent-shaped osteotomy. The bone is circular sawn through and the two bone parts are then rotated relative to each other until the correct position is reached. This method usually uses an external fixation.

 

Before the surgery the surgeon cannot give an absolute guarantee for a complete and pain-free function of the knee. In some cases, parts of the pain remain after the operation. On the other hand, it is a joint preservation operation.

 

A few days after the operation, it is normal for a blood shed to occure under skin. Due to gravity, this blood shed will lower down. Sometimes even to the foot. It is therefore important that the ankle and foot are properly moved. When a lot of tension in the calf muscle occures, a thrombosis must always be excluded.

 

The healing of the bone surfaces is basically the same as with a fracture and takes 6 to 10 weeks. Depending on the technique, plaster can be given.

After the operation, with a corner-stable plate, it is possible to move directly and partially or sometimes fully loaded. Usually it is wise to increase the load until 6 weeks after the operation.

 

Being overweight is a contraindication to osteotomy. When a patient is overweight, an osteotomy can eventually go from a painful O-leg to a painful X-leg. Of course the same applies for an X-leg to an O-leg.

 

 

Prosthesis

 

If it is not possible to perform an osteotomy or the predictability for a good result is too low, an (endo) prosthesis (artificial joint) is usually chosen. With this prosthesis rest pain or nocturnal pain, a reduction in the function of the knee and a decrease in the load-bearing capacity of the knee usually occures. It may also be that there is a different position (contracture). In this context, one may think of a extension limitation of the knee or an increasing deviation of the leg.

The damaged joint surfaces are replaced with a prosthesis. In addition to removing the painful part of the knee (the damaged joint surface), the axis of the leg is also restored and instability, if present, corrected.

 

Depending on the location of the osteoarthritis (presence in one or more compartments of the knee), a partial knee prosthesis or a total knee prosthesis is chosen. The joint between the kneecap and upper leg (patellofemoral joint), the inner (medial) part or the outer (lateral) part of the joint between the upper and lower leg can also be replaced separately. The patellofemoral prosthesis is only replaced if the compartments between the upper and lower leg are still in good condition. This is a hemiprosthesis.

Hemiprostheses have better results on the inside of the knee compared to the outside.

 

The damaged joint surfaces are sawn off and removed so the prosthesis fits precisely. If a total knee prosthesis is used, a metal cap is placed over the upper leg. In addition, a metal plate is placed on the lower leg. In between the plates, hard plastic (polyethylene) is placed, which forms the sliding and also the conductive surface. If necessary, the back of the kneecap will also be replaced with a new prosthesis. It depends on the type of prosthesis and the age of the patient whether the prosthesis is anchored with bone cement. It is common to anchor this way. The parts of the prosthesis are placed separately from each other and a good tape-device is needed for stability.

 

If there is a condition in both knees, surgery is often performed in a short period of time (3 months). This is because a relative extension arises of the operated leg. The length of the leg is not directly affected, but if, for example, an O-leg is corrected to a sero-degree angle, the leg will become relatively longer.

 

Postoperative prosthesis

After the operation, the patient will usually have little to no pain. Usually it is possible to strain the knee immediately after an operation. It is common to use crutches for a period of at least six weeks to spare the knee. Rehabilitation after an knee-prosthesis surgery takes on average three to six months. Just after one year there is a complete recovery. In the second year after the operation the knee function reaches its maximum because, at that time, the joint capsule is used to the prosthesis and the function restored. After surgery, a full extension of the knee is always pursued.

After ten years, more than 90% of the knee prostheses will still function properly. This applies to an older patient category. With younger patients, who demand more of their knee, the prosthesis have a shorter lifespan.