Knee Osteoarthritis

Knee Osteoarthritis

Diseases that disrupt the articular cartilage (osteoarthritis, calcification), meniscus injuries, tears or ruptures in the intra-articular ligaments (anterior cruciate ligament or lateral ligament tears), inflammation of the intra-articular membrane (synovitis), and abnormal knee movements with kneecap bone protrusion are the most common causes of knee pain in adult patients.

Osteoarthritis of the knee joint can occur naturally with aging or as a result of various rheumatic diseases (rheumatoid arthritis, for example), deterioration of the articular cartilage after trauma (post-traumatic arthritis), and the death of intra-bone cells in the bones that form the joint for a variety of reasons (osteonecrosis).

Signs and symptoms of osteoarthritis

Usually the pain starts gradually and increases over time. Sometimes sudden attacks of pain may also occur. Stiffness and swelling may be seen in the joint. Patients have difficulty in bending and fully extending the knee. Joint range of motion decreases. Pain and swelling complaints usually increase after prolonged immobilization.

Walking, squatting and climbing stairs are the movements that increase the pain the most. Pain in the knee is usually expressed as weakness in the joint and an inner ache. Sometimes there may be a locking of the knee and a sound or crunching sensation with the pain.

In joint examination, the localization of pain and the amount of joint range of motion are taken into consideration. In radiologic examinations, if possible, comparative direct x-rays of both knees by pressing are sufficient for diagnosis. If necessary, knee MRI examination may be requested to determine the amount of cartilage loss and to obtain more information about the condition of the meniscus and ligaments.

Treatment

In patients with osteoarthritis in the early stages, lifestyle changes, exercise, the use of canes or crutches to facilitate load distribution and other assistive methods can be used.

As a drug treatment, general painkillers (paracetamol, etc.) and non-steroidal anti-inflammatory drugs (aspirin, ibuprufen, etodolac, etc.) are used temporarily for pain control in acute pain attacks, in the presence of synovitis or when the patient does not want surgical treatment. Long-term chronic use of these drugs is known to cause liver, kidney and stomach diseases.

Non-pharmacologic nutritional supplements (glaucosamine and chondroitin) may be given to slow down cartilage breakdown in early osteoarthritis.

Intra-articular injections are mostly used in moderate osteoarthritis when there is no acute attack and the pain is partially under control. In our clinic, both hyaluronic acid, which is the intra-articular fluid of the knee, and platelet-rich plasma (PIP), which is obtained after centrifugation of blood taken from the patient at high speed, are injected into the joint. Intra-articular steroid injections are recommended for very advanced stages and for patients who are medically unable to undergo surgery.

Alternative adjunctive treatment methods

The first of the auxiliary treatments is successfully applied by anesthesiologists specialized in pain and acupuncture in our clinic in early and mid-stage patients.

Surgical treatment options

Surgical treatment options for arthritis in the knee joint can be summarized as arthroscopic cleaning of the deteriorated cartilage and washing of joint-disrupting fluids in the joint, reshaping of the bones if there is a malalignment between the thigh and tibia in the knee joint, half or full knee prosthesis surgeries and cartilage transfer according to the amount of cartilage deteriorated. The method of surgical treatment varies according to the stage of the disease.

Arthroscopic cleaning

In patients with early-stage arthritis, arthroscopic cleaning of the inside of the knee is particularly useful in patients who experience a mechanical snapping sensation.

Osteotomy surgeries to correct malalignment

The knee joint consists of two main areas: the inner and the outer part. Osteoarthritis starts from the inner part, which is the most heavily loaded part. Over time, the wear of the cartilage causes more load on the inner part of the knee and the disease progresses rapidly in this way. In patients with mid-stage arthritis, where there is not much angulation, the center of gravity can be shifted back to the middle part of the knee by reshaping the bones. This reduces the existing complaints and slows down the progression of the disease.

Prosthesis surgery

Prosthetic surgery should be considered in patients with advanced osteoarthritis if their complaints cannot be controlled with other treatment options. Generally, these patients have to take painkillers all the time, their daily living comfort is impaired due to knee pain, and they have difficulty walking and doing their daily tasks.

In relatively early stage patients where only the inner part of the knee joint is affected, prostheses called half-type prostheses (unicondylar) may be preferred. Thus, the complaints of the patients are eliminated with a smaller surgery compared to a full joint prosthesis and the time of full joint prosthesis application can be postponed to later stages.

Knee replacement surgeries are preferred more by patients and surgeons because they allow joint movement very early, the patient can load and walk the day after surgery and rehabilitation is easier. Both half and full knee replacements are successfully performed in our clinic.