Knee arthritis is a very common musculoskeletal system disease. Since the knee joint is a load-bearing joint, it impairs the patient's ability to move and negatively affects the quality of life. Since the pain is usually chronic (continuous), it forces the patient to constantly seek treatment. In this search, intra-knee treatments are recommended to patients. As far as we can see, these suggestions confuse the patients a little.
Let's try to clarify what interventions can be done inside the knee:
The procedure performed inside the knee that patients fear the most are cortisone injections. The patient is worried that with this application he will become fat, develop edema, and his blood pressure or sugar will rise. I have also seen patients who were worried that they would develop osteoporosis. Could these be? Yes, maybe. But it is not something that will happen to everyone. The important thing is to carefully select the patient to whom cortisone will be administered. If fluid has collected in a patient's knee, it means there is a strong inflammatory reaction in the knee. The knee feels hot and pain occurs with movement and pressing on it. The first thing to do is to check blood tests for rheumatism to determine whether this fever is due to inflammatory rheumatic disease or infection. If there is no inflammatory rheumatism, the presence of this fluid due to the inflammatory reaction means that the knee will be further damaged. To remove this fluid, treatment begins with antirheumatic drugs, rest and ice applications. But sometimes it is not possible to calm the knee with these methods. Then cortisone injection can be made into the knee. Since this cortisone injection is used only once, the possibility of side effects is low. However, it should not be performed on patients with uncontrolled high blood pressure or fasting blood sugar levels above 200 or should be closely monitored. Depending on the medication administered after the injection, the doctor informs you how many days sugar and salt should be reduced.
Another form of treatment is PRP (Platelet Rich Plasma) (platelet rich serum) treatment. It is based on the principle of concentrating and removing platelets from the patient's own blood and injecting them into the joint. Blood is taken from the patient's arm, processed, the layer where blood platelets accumulate is removed and injected into the knee through a syringe. lyre. Blood platelets are actually cells that enable blood clotting. When there is an injury anywhere in the body, these cells accumulate there and initiate the wound healing process. This is exactly why it is used in patients with arthritis.
In patients with arthritis, both the joint cartilage and soft tissues within the joint such as meniscus and ligaments are damaged. When blood platelets are intensively injected into the joint, substances that enable wound healing and attract other factors that enable wound healing are secreted from the platelets that come into contact with the damaged tissue. Thus, repair of damaged areas is ensured. The repair process takes approximately 3 weeks. There may be a slight increase in pain for 3-5 days after the first application. This is all about starting the healing process. If the pain has not completely disappeared at the end of the third week, another application is made.
Another intra-articular treatment is hyaluronic acid treatment. It is popularly known as joint fluid supplement. In knees with arthritis, the substance called hyaluronic acid, which makes the joint surfaces more slippery, has decreased in the joint fluid. It is not possible to take this substance orally with medications, so it is injected into the knee. As stated, the main purpose is to protect the lubricity of the joint surfaces by covering them, to distribute the future loads like a pillow by creating volume between the joints, to increase the flexibility and durability of the cartilage, and to reduce pain.
Another application is to inject ozone into the knee. Ozone is a gas derived from oxygen and has an antioxidant effect. It ensures the removal of toxic substances accumulated in the cells where it is applied, while also increasing the oxygenation of the cells. In this way, it reduces pain and inflammation.
As for which of these treatments to choose;
Cortisone is different from other applications as it is used to calm the disease in inflamed knees. It relieves the patient in a short time and removes the increased fluid in the knee. In a sense, it reduces it and prepares the ground for other treatments.
When it comes to hyaluronic acid and PRP application, other factors come into play. In terms of effectiveness, PRP is more effective than hyaluronic acid. It is more successful in reducing pain and increasing functionality. But in patients using blood thinners, the drug Since the person is on blood platelets, the function of these blood platelets has changed and they are not suitable for PRP. For this reason, in patients taking blood thinners, the drug should be stopped for a week and then PRP should be applied. However, of course, there are situations in which blood thinners should never be stopped (conditions such as previous stroke, cardiovascular disease, stent placement), PRP cannot be performed in these patients since the drug cannot be stopped. Then, intra-articular hyaluronic acid applications can be performed in these patients.
Another issue that should be noted for PRP and hyaluronic acid is the degree of knee calcification. The effectiveness of both treatments is low in advanced calcification. However, some hyaluronic acid formulations are prepared for advanced calcification. These formulations can be tried.
Intra-articular ozone application is also an extremely effective treatment and can also be effective in advanced calcifications. However, it should be applied at least 5 times a week, not once or twice like other applications. In ozone therapy, it is necessary to ensure that there is no medical condition that would prevent the use of ozone (such as favemia, some blood diseases). The doctor will evaluate this anyway. Using blood thinners does not pose a problem for ozone, as does hyaluronic acid application. The physician should only monitor whether there is increased bleeding after the application.
All of these are general information, how the treatment will be done will of course be determined by the decision taken by talking to your physician.
Hope you stay in good health.
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