WHAT IS GONARTROSIS?
Gonarthrosis is the name given to the loss of cartilage in the knee joint. It is known as calcification among the public, but it is not an accumulation as it is thought, on the contrary, there is a loss.
The word arthrosis means arthro (joint)and oz (disease) and its Turkish equivalent is joint disease. Gonarthrosis is arthrosis of the knee joint. Arthrosis of the hip joint is called coxarthrosis, and arthrosis of the spinal joints is called spondyloarthrosis.
- Are there types of gonarthrosis? Is all gonarthrosis the same?
In general, arthrosis is of two types: Primary and secondary (secondary). In primary arthrosis, the cause of arthrosis is not clear. Reasons such as genetic factors, obesity, general joint laxity and aging are often blamed. In secondary arthrosis, the cause of the event is usually intra-articular fracture caused by trauma, treated or untreated meniscus and anterior cruciate ligament tears, previous infection, congenital anomalies and rheumatoid arthritis and similar inflammatory joint diseases. In patients with general arthrosis, the first initial site of arthrosis is often the finger joints and spine. Complaints in the knee area begin later, but it is usually knee joint arthrosis that causes the patient to consult a physician.
Gonarthrosis can occur at early and late ages. The type of gonarthrosis seen at an early age is often secondary and may progress more rapidly, causing the patient to undergo surgical intervention at an early age. Primary gonarthrosis usually begins in the 50s and progresses slowly, requiring surgical treatment at much older ages.
The degree of gonarthrosis is different in each patient. The stage of gonarthrosis can be determined based on examination findings and radiological findings. Treatment is decided according to this stage.
- How is gonarthrosis diagnosed? What are the symptoms?
Primary gonarthrosis is a slowly progressive disease. It usually begins in the 50s with a poorly localized pain, often in both knees. Pain, which often occurs when going up and down stairs and squatting, may also occur in more ordinary daily activities in later ages. At older ages Due to aging and muscle weakness, wasting occurs in the muscles above the knee and walking becomes difficult. Over time, inversion in both legs occurs (genu varum) and daily activities become difficult. There may also be increased knee joint fluid, that is, swelling. This swelling rarely causes additional complaints in patients. In case of very advanced gonarthrosis, the patient may be confined to crutches or a wheelchair.
The diagnosis of gonarthrosis can be made by physical examination, but radiological methods are also needed to confirm the diagnosis. In the radiological diagnosis of gonarthrosis, whether primary or secondary, x-rays must first be taken. Anteroposterior and lateral radiographs are taken as standard; Taking the anteroposterior radiograph during loading, that is, while the patient is standing, better shows the severity of gonarthrosis. Anteroposterior radiographs show that the inner joint space is narrowed and even completely closed in advanced cases. In addition, bone protrusions (osteophytes) and whitening of the bone under the cartilage (subchondral sclerosis), indicating cartilage loss, are observed on the non-loaded surfaces of the femur and tibia bones that form the joint. Similar images appear in the kneecap bone.
- Should MRI be requested in gonarthrosis?
Magnetic resonance imaging (MRI ) Examination is not necessary in gonarthrosis with a normal course. However, in a patient who has been known to have knee pain due to gonarthrosis for a long time, an MRI may be requested if the pain increases with or without minimal trauma. However, this type of patient should first be evaluated with x-rays.
In the above-mentioned patient group, edema can be detected in the bones forming the joint on MRI. This condition, called bone marrow edema, can disappear over time with good rest. However, if it is delayed, it may take a long time and even bone death (osteonecrosis) may develop. Osteonecrosis can be detected by MRI, and MR is of great benefit in this type of patient.
Also, meniscus tears accompanying gonarthrosis can be detected with MRI. However, the accuracy of MRI in meniscus tears in people over 50 years of age is lower than in younger patients. menisci Since the heart begins to degenerate with age, like other organs, it may appear torn on MRI and may be reported as such by the radiologist.
- Gonarthrosis is a preventable disease. Is it?
Primary gonarthrosis is a disease that can be delayed and is not preventable. The cause is often genetic factors. This genetic factor does not have to be passed down from the parents; It may also be passed on from a relative from earlier generations. It can often be seen that one of the siblings gets the disease and the other does not.
Some things need to be taken into consideration in order to delay or prevent the disease. Today, obesity is a very important cause, especially for knee and spine arthrosis. Therefore, paying attention to diet and not gaining weight helps protect against gonarthrosis. Another protection factor is exercise. Exercise, which is necessary for the human body in every respect, is also indispensable for knee joints. Having strong leg and hip muscles can protect and even prevent gonarthrosis. Although the radiological images are the same, it is observed that gonarthrosis progresses slowly and the need for surgery is less in people who are underweight and have strong leg muscles, compared to people who are overweight and have weak leg muscles. For this reason, it is very useful to make leg exercises a habit from an early age.
- Is gonarthrosis more common in athletes and does it start earlier?
Athletes, and especially professional ones, use their knee joints more frequently and more demandingly due to their work and are more exposed to trauma during competitions. During these traumas, intra-knee structures, especially the meniscus and cruciate ligaments, may be injured. This situation can lead to premature wear of the knees and therefore gonarthrosis, which can lead to the end of the athlete's sports life. In older years, when arthroscopy was not yet in use, the treatment of these injuries was more difficult and it was often not possible to return to sports. However, after arthroscopy began, athlete injuries became more easily treatable.
- Is gonarthrosis more common in women?
Gonarthrosis due to doctor Among the applicants, women are more numerous than men. However, there is no gender difference in terms of the frequency of gonarthrosis. It can be thought that the reason why men apply less often and the number of female patients operated on is that men have stronger muscle structures and obesity is less common in men.
- Is gonarthrosis related to nutrition? Can it be prevented with a healthy diet?
Gonarthrosis has nothing to do with nutrition. To put it more accurately, healthy nutrition cannot prevent gonarthrosis. However, it may prevent the symptoms from appearing at a relatively young age and in a severe manner by preventing weight gain and therefore obesity.
- Do substances containing glucosamine taken orally have a place in the treatment of gonarthrosis?
Today, the most commonly used and oral substances in the treatment of gonarthrosis are glucosamine and chondroitin sulfate. These two substances are structures located in normal joint cartilage and required for the survival of cartilage, and they have effects such as inhibiting the proliferation of cartilage cells and the enzymes that cause the loss of cartilage cells. These substances do not have an analgesic effect; However, there may be some reduction in pain thanks to a substance added to the medicine (MSM). Its usage period is 6 months and it can be used again after taking a break for a while. There are many preparations on the market that contain glucosamine, chondritin sulfate and MSM, and even contain enzymes and minerals necessary for many body functions, and the daily requirement is 1500 mg. There is no problem in taking it hungry or full. Since it only contains glucose, it is not recommended for use in diabetics.
The place of these substances in the treatment of gonarthrosis is controversial and there is no scientific evidence that they change the course of the disease. Good results may be obtained in some patients.
- Do intra-knee injections have a place in the treatment of gonarthrosis?
Different drugs can be given into the knee in gonarthrosis. When done properly, it is not usually a painful practice. There is no need to perform local anesthesia before the injection.
The substances that can be given by injection into the knee are generally corticosteroids (cortisone) and cartilage protective agents. It is hyaluronic acid, also called jan.
Corticosteroids have been used in treatment for a long time with their pain-relieving and inflammation-reducing effects. However, their duration of action is short and their use in repeated doses is not recommended, especially in relatively early cases of gonarthrosis. It is mostly applied to patients who are at an advanced stage and do not want or cannot undergo surgery. Although they are an effective pain reliever, there is information in the literature showing that they cause permanent damage to joint cartilage.
Hyaluronic acid is a substance naturally found in joint cartilage. It provides lubrication of the knee joint fluid and has a protective effect on cartilage cells. In gonarthrosis, hyaluronic acid deficiency occurs. It has been used around the world since the late 1980s and is popularly known as rooster's comb. Indeed, hyaluronic acid, which was obtained from amaranth for the first time in the world, became available through bacterial fermentation in later years.
The main effect of hyaluronic acid injected into the joint is not to relieve pain. It may have a pain-relieving effect not directly but indirectly. Its main effect is to replace the missing hyaluronic acid in the joint, providing joint lubrication and increasing the durability of the cartilage.
Hyaluronic acid injections are available in the market under different names. Some of these are administered three times a week for a period of 6 months, some are administered as a single injection every 6 months, and some are administered as a single injection per year. Their mechanisms of action are not different.
There is no evidence that intra-articular injections change the course of the disease.
- Is physical therapy good for gonarthrosis?
Today, there is no treatment proven to change the course of gonarthrosis. Physical therapy and rehabilitation is one of them. In fact, every person and every gonarthrosis patient needs physical therapy. Strengthening the muscles above the knee and the hip muscles, in particular, helps the gonarthrosis patient to at least stand and even increases the success of a prosthesis surgery that may be performed at an older age.
- When is surgery required in gonarthrosis?
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