ENKnee osteoarthritis treatment in Germany moves in steps, from exercise to a replacement, and starts not with choosing an operation but with finding out what exactly is worn and how badly. Most people arrive with pain on the stairs, a knee stiff in the morning and swollen by evening, and a report saying «gonarthrosis», which is osteoarthritis of the knee: worn cartilage between thigh bone and shin bone.
This page covers the German plan: the steps before surgery, the operations that keep your own joint and the point where a replacement is genuinely on the table; the disease in general is covered on the page about osteoarthritis treatment in Germany. Decisions follow the images and the examination, not how many years the knee has hurt.
What is worn and how the stage is established
First, doctors establish which part is worn: the knee has three compartments, the inner, the outer and the one between kneecap and thigh bone, and osteoarthritis often affects only one of them. Bow legs overload the inner compartment, knock knees the outer one. The compartment affected decides everything that follows.
The stage is set on X-rays taken standing, under body weight, which show the real narrowing of the joint space; a clearly misaligned leg (varus or valgus) is imaged in full. MRI is used when the meniscus, ligaments or cartilage must be seen. Grading usually follows the Kellgren–Lawrence scale: grade I shows only early signs, grade II slight narrowing and small bony spurs (osteophytes), grade III pronounced spurs and clear narrowing; in grade IV the cartilage is almost gone and bone rubs on bone. Early grades are treated without surgery; in grades III and IV a replacement is seriously discussed, together with the symptoms and the compartment affected. X-ray grade and pain often do not match, and that is normal.
Several causes usually combine: ageing cartilage that repairs itself less well, excess weight, a misaligned leg overloading one half of the knee, old meniscus or ligament injuries or fractures near the joint, inflammatory joint disease and years of heavy loading; in Germany, knee osteoarthritis from long work on the knees is a recognised occupational disease. Patients can influence weight and thigh-muscle strength themselves, and German orthopaedic surgeons usually start the conversation there.
Before surgery is discussed, the doctor rules out look-alikes: inflammatory arthritis, such as psoriatic arthritis, which belongs with a rheumatologist; the aftermath of an old meniscus or ligament injury, when the knee locks or gives way; and a kneecap problem, with pain at the front. Different causes respond to different treatment.
What is done before surgery
A German orthopaedic surgeon first checks the basics: avoiding loads that make the knee hurt, such as kneeling and squatting; regular strength and mobility exercise for the thigh muscles with a physiotherapist; losing excess weight; a stick or crutches during a flare. Footwear changes, insoles and an unloading brace, which takes load off the worn half of the knee, are not for everyone: they help when the leg is misaligned, the knee unstable or exercise alone insufficient.
Medication only supports this base: painkillers and anti-inflammatories, starting with gels, are taken as a course, at the lowest effective dose and as briefly as possible. Injections are given on indication. A corticosteroid, a hormone-based anti-inflammatory, is injected for a flare with fluid in the joint or when other drugs fail; relief is temporary and high doses harm cartilage, so it is no long-term treatment. On hyaluronic acid the studies conflict, and the German guideline on knee osteoarthritis makes no recommendation either way. Platelet-rich plasma (PRP), made from the patient’s own blood, may be considered when other pain relief is unsuitable or has failed. Cell preparations sold as «stem cells» are not among the recommended treatments; study results are inconsistent. No injection rebuilds worn cartilage: injections ease pain and buy time for exercise.
The conservative stage ends when unloading, exercise and medication stop helping: pain at rest and at night, a joint losing movement, a short walk or a flight of stairs becoming an ordeal. Then an operation is discussed, starting with whether your own joint can be kept.
Operations that preserve your own joint
A corrective osteotomy changes the leg’s axis: the surgeon cuts the bone, usually the shin bone just below the knee, and fixes it at a new angle so that load shifts from the worn compartment to the healthy one. The typical candidate is a relatively young, active person with bow legs and inner-half wear only; the German guideline allows it up to Kellgren–Lawrence grade III.
Arthroscopy, keyhole surgery with a camera, helps when osteoarthritis comes with a separate mechanical problem, such as a torn meniscus flap or a loose fragment that locks the knee. An arthroscopic «clean-out» alone, washing the joint and trimming frayed cartilage, does not treat osteoarthritis: the German guideline advises against it, and statutory health insurance covers arthroscopy here only after an injury, for a locked knee or for a meniscus problem. More on arthroscopy in Germany.
Cartilage repair, with the patient’s own cartilage cells grown in a laboratory or a bone-and-cartilage plug taken from elsewhere in the joint, is meant for a limited defect, usually after an injury in a young person, with normal or corrected leg alignment. Advanced osteoarthritis is the main contraindication, and the German guideline makes no recommendation on it for lack of evidence.
When a replacement is the answer
A replacement means one of two decisions. A unicompartmental, or partial, implant replaces only the worn half and keeps the cruciate ligaments and healthy compartments; the German guideline recommends it for advanced wear confined to the inner compartment. A total knee replacement is needed when both compartments are worn; the anterior cruciate ligament is then almost always removed.
When choosing a hospital, ask how many such operations it performs a year: the German guideline links higher numbers with better results, and Germany sets a binding annual minimum for knee replacements. Ask about EndoCert, Germany’s certification for joint replacement centres, about navigation or robot-assisted systems, which in the guideline’s assessment do not by themselves improve function, and about a revision programme. Among the orthopaedic hospitals in Germany are Helios ENDO-Klinik Hamburg, a specialist hospital for joints and spine that also revises knee and hip implants, and Asklepios Orthopaedic Hospital Bad Abbach, an orthopaedics and rheumatology hospital that replaces knees and transplants cartilage cells. In Munich, Rechts der Isar Hospital (TUM) runs EndoTUM, a certified maximum-care joint replacement centre led by Professor Rüdiger von Eisenhart-Rothe, who also directs orthopaedics and sports orthopaedics there.
Rehabilitation in Germany is planned in advance: a course in a rehabilitation clinic or day centre usually follows straight after the hospital stay. For people insured in Germany, hospital social services arrange it before discharge; patients from abroad should agree the place before surgery. More on orthopaedic rehabilitation in Germany.
Frequently asked questions
How is knee osteoarthritis treated?
In steps. At every stage the base is thigh-muscle exercise, unloading the knee and losing excess weight; medication and injections ease pain for a while. If one half is worn because the leg is misaligned, an osteotomy is possible. Arthroscopy is only for a separate meniscus problem or a locked knee. When pain persists despite this, a partial or total replacement is discussed.
Can knee osteoarthritis be stopped without an operation?
Worn cartilage cannot be restored, but pain can often be reduced and wear slowed. The German guideline links every reduction of excess weight with less pain, better mobility and slower progression. Tailored exercise also reduces pain and improves function, and the longer someone keeps it up, the greater the benefit. An operation is discussed when these measures stop helping.
When is an osteotomy better than a replacement?
When wear is confined to one half of the knee because the leg is misaligned, typically in a relatively young, active person with bow legs and inner-compartment wear no worse than Kellgren–Lawrence grade III. The aim is to extend the life of the patient’s own joint. Older people with more advanced wear in one compartment are more often suited to a partial replacement.
How AlenMed arranges treatment
Work starts with a remote review of images and records, which shows whether a trip is needed. We match the hospital to the stage and the worn compartment, send the request, obtain the official cost estimate (Kostenvoranschlag), arrange the visa invitation and provide a medical interpreter at consultations. Conservative care, meaning consultations, imaging, physiotherapy and injections, is charged under the German fee schedule GOÄ; an operation follows the hospital’s estimate for surgery, implant, inpatient stay and rehabilitation where needed. For a benchmark, see the cost of knee replacement.
Patients take home a written plan and, after surgery, the operation report, instructions on loading the knee and follow-up dates.
This material is for information only and is not an offer. The extent of treatment is decided by the doctor at an in-person consultation.
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