Ahlbäck's disease

Ahlbäck's disease refers to a circulatory disorder in the knee joint. Ahlbäck's disease usually occurs in women over the age of 60. Therapy includes physiotherapy at an early stage and a partial or full denture in later stages.

What is Ahlbäck's disease?

As Ahlbäck's disease is called bone necrosis in the knee joint. Knee necrosis is identified by a non-perfused area. Ahlbäck's disease is not triggered by an infection, but by a circulatory disorder.

As a rule, patients with Ahlbäck's disease are over 60 years old and female. Men can also be affected by the circulatory disorder. In exceptional cases, Ahlbäck's disease can occur from the age of ten. If people up to the age of 20 become ill, usually only the cartilage of the knee is affected.

With Ahlbäck's disease, both mild and severe courses can occur. In the mild course of the disease, the patient notices bone loss or cartilage damage. If the course is severe, osteoarthritis develops in the knee joint. Severe knee necrosis can be accompanied by severe pain, which can be reduced with adequate therapy.

causes

Ahlbäck's disease can be triggered by different events. Some people have suffered from a circulatory disorder in their knee as a result of an accident. Damage to blood vessels leads to circulatory disorders after an accident.

If the blood circulation in the thigh is disturbed, there is a possibility of Ahlbäck's disease. Ahlbäck's disease can also occur when certain medications are taken. With long-term use of cortisone, there is the possibility of bone necrosis.

The disease is also often associated with the constant consumption of nicotine and alcohol. Blood diseases often lead to the appearance of Ahlbäck's disease. In older patients, bone necrosis can also be triggered by improper stress on the legs. There are no other triggers for the circulatory disorder in the knee.

Symptoms, ailments & signs

Especially at the beginning of the disease, the symptoms can be unspecific. In the mild course of Ahlbäck's disease, there is slight pain in the knee. A deep pain in the tissue is characteristic of the circulatory disorder in the knee. The affected person's knee is usually not very resilient.

This is why many people with Ahlbäck's disease limp while running. With Ahlbäck's disease, the pain is always stronger under stress than at rest. The disease is often mistaken for damage to the meniscus or a lesion in the cartilage. A specialist should therefore be consulted as soon as possible if there is severe pain in the knee.

The specialist checks the knee joint for mobility and any swelling. Pressure pain is also characteristic of Ahlbäck's disease. If the circulatory disorder in the knee is recognized early, the symptoms and consequences of the disease can be reduced.

Diagnosis & course of disease

Ahlbäck's disease is diagnosed after an extensive physical examination. In addition to a stress test of the knee, imaging methods are also used. The circulatory disturbance in the knee can be seen particularly well through the X-ray.

During the X-ray, the lightening of the affected bone can be seen visually. As an alternative to X-rays, it is also possible to determine the disease with magnetic resonance imaging or scintigraphy. A blood test can confirm the suspicion of Ahlbäck's disease. Usually, patients with a circulatory disorder in the knee have a blood clotting disorder in the blood count.

Complications

In most cases, Ahlbäck's disease is not diagnosed directly, as the symptoms are not particularly characteristic and therefore do not speak directly for the disease itself. Those affected suffer primarily from pain in the knees. This often leads to restrictions in movement and also to various restrictions in the patient's everyday life.

The resilience of those affected decreases and it comes to depression and other psychological upsets, if the pain continues to spread to other regions of the body. Swelling can also occur. Nocturnal pain leads to sleep problems. In many cases, the mobility of the knee is significantly restricted and reduced. In the worst case, the reduced blood flow can lead to tissue death.

With exercise therapy, the symptoms of Ahlbäck's disease can be limited and treated relatively well. There are no particular complications, and the patient's life expectancy is not reduced by the disease. In some cases, implants or prostheses are also necessary in order to restore the patient's movement.

When should you go to the doctor?

The risk group for Ahlbäck's disease includes women in adulthood over 60 years. You should consult a doctor at the first irregularities, changes or peculiarities of the general state of health and ask for a clarification of the complaints. Pain in the knee that cannot be attributed to physical overexertion or the natural aging process are warning signs of the organism and must be examined and treated by a doctor. If the pain persists or increases in intensity, a doctor will be needed. You should refrain from taking painkillers until you have consulted the doctor in charge, as complications often arise that can be avoided.

A doctor should be presented with a sudden decrease in normal physical performance, limitations in normal mobility and everyday movement sequences. A pressure or touch pain on the knee are considered a sign of an existing health impairment and must therefore be examined medically.

If the person concerned perceives a disturbance of the blood circulation and it comes to cold legs or feet, a doctor's visit is necessary. In the case of disorders of the sensitivity of the knee, a tingling or numb feeling on the skin or a pale complexion, a doctor is required to clarify the cause. Symptoms can only be significantly reduced if the diagnosis and treatment is made early.

Treatment & Therapy

Treatment of necrosis of the bone is carried out depending on the severity of the disease. There are several conservative treatments that can help with Ahlbäck's disease. As an immediate measure, specialists often recommend protecting the knee in question. Exercise therapy has also been established for many years.

Medication that can rebuild one's own bones is also often recommended. In the early stages there is also the possibility of stimulating healing through therapy with shock waves or oxygen. This can lead to the growth of new blood vessels in the bone. At an early stage, decompression of the medullary canal can help.

Here the doctor drills into the bone in question. The drilling stimulates the healing of the bone and the blood vessels can form anew. Another option is the use of bone substitutes. If Ahlbäck's disease is diagnosed at a late stage, implants are often the only treatment option.

The extent of the circulatory disorder is used as an indicator of a suitable therapy. The basic rule is that the smallest implant should always be used. This means that young people in particular are not limited in their movement. The surface of the knee joint can be reconstructed with an implant. A partial denture is necessary for a larger defect.

The integration of the partial denture is associated with little bone loss. This means that the loss of healthy bone is kept to a minimum. If a major defect was caused by Ahlbäck's disease, only a complete replacement of the knee joint can help. At every stage of the disease, pain-relieving drugs and shoe adjustments can also be used.

Outlook & forecast

No general statements can be made about the prognosis for patients with Ahlbäck's disease. It depends on the age of onset, the course and progress of the disease, and the chosen form of therapy. Without treatment, the prognosis is usually much worse. Nevertheless, spontaneous healing occasionally occurs during the development phase.

Despite the prospect of complete healing, the course of Ahlbäck's disease is generally protracted. A specific prognosis is difficult to assess, especially for young people affected. The conservative treatment of Ahlbäck's disease using hyperbaric oxygen therapy or shock wave therapy leads to the re-growth of blood vessels in the bones, especially in the early stages. This is how the disease heals naturally. The extent to which the affected bone can be stressed depends on the specific case. Many sufferers suffer from pain and certain restrictions even after Ahlbäck's disease has completely healed.

In the case of advanced disease, the insertion of implants is ultimately the most promising in both younger and older patients. Full mobility is no longer achieved with an artificial knee joint, but the disease can be completely cured in this way. The prognosis for standard prostheses is less favorable.

prevention

Various precautions can be taken to avoid circulatory disorders in the knee. Since incorrect loading can lead to Ahlbäck's disease, correct knee loading must be ensured.

Reducing excess weight is also a preventive measure. In principle, avoiding excessive alcohol consumption is recommended to prevent Ahlbäck's disease. The same applies to the consumption of nicotine. To prevent circulatory disorders in the knee, steroid doping should be avoided.

Aftercare

After successful treatment, Ahlbäck's disease requires intensive and lengthy aftercare. The specific measures to be taken depend on the form of therapy chosen. Spontaneous healing rarely occurs in the initial stages of the disease. In this case, regular medical check-ups and strict rest are necessary. After surgical treatment of the affected bone, it is particularly important not to put weight on the leg.

The healing of the surgical scar should also be monitored. Intensive follow-up care is necessary if implants or prostheses are used. In this case, the healing of the surgical wound is checked during an inpatient hospital stay. Afterwards, longer stays in a rehabilitation clinic are sometimes advisable. Depending on the private and professional situation of the patient, these stays can last several weeks or can also be outpatient.

In principle, follow-up treatment with intensive physiotherapy is necessary in the years after an operation. In addition, orthopedic check-ups are recommended at regular intervals. In the case of existing pain, there is also the possibility of a spa stay many years after the operation. In a few cases there are complications that require much more intensive follow-up measures.

You can do that yourself

In younger patients with a not yet too advanced stage of the disease Ahlbäck's disease, new cartilage tissue can form and the pain can decrease. If the disease does not develop any further, conservative therapy such as protecting the leg by supporting and not exercising or possibly adjusting the shoes in the event of a misalignment will help. Physiotherapeutic measures to strengthen the leg muscles and maintain the mobility of the knee joint are recommended. Bone-building drugs promote the ability to regenerate.

Surgical procedures are also used to preserve the joint when the disease has stopped, for example a relief hole, so that the bone tissue is stimulated to heal itself. A transplant of healthy bone tissue from another area of ​​the body is also a method of replacing the damaged tissue. Hyperbaric oxygen therapy can also be used as a support. Doctor and patient work together to develop an oxygen uptake program to promote healing.

In 80 percent of the diseases, however, the decline of the bone tissue progresses and, without treatment, leads to increasing pain and ultimately to knee osteoarthritis. In the case of a rather protracted healing process, the prognosis is positive when using an artificial joint. With the support of physiotherapy, the new knee joint is subjected to increasing stress in small steps until the patient can again participate in everyday life without any problems.