The most common causes of knee pain in adult patients are diseases that disrupt the articular cartilage, meniscus injuries, tears or ruptures in the intra-articular ligaments (anterior cruciate ligament or lateral ligament tears), inflammation of the intra-articular membrane, and abnormal movements of the knee with the kneecap bone protruding to the side. Osteoarthritis of the knee joint can be seen together with the aging process without any other disease, as well as various rheumatic diseases, deterioration of the articular cartilage after trauma and the death of intraosseous cells in the bones forming the joint for various reasons.
What are the Symptoms and Findings in Osteoarthritis?
Usually, the pain starts gradually and continues to increase over time. Sometimes sudden attacks of pain may also occur. Joint stiffness and swelling may occur. Patients have difficulty in bending and fully extending the knee. Joint range of motion is reduced. Pain and swelling complaints usually increase after a long period of inactivity.
Walking, crouching and climbing stairs are the movements that increase the pain the most. Pain in the knee is usually expressed as joint weakness and internal pain. Sometimes, locking and pain in the knee may be accompanied by a sound or crackling sensation.
In the joint examination, the localization of the pain and the amount of joint range of motion are taken into account. In radiological examinations, if possible, comparative direct x-rays of both knees are sufficient for diagnosis. If deemed 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.
How is the Treatment?
Lifestyle changes in osteoarthritis patients in the early stages, exercise, the use of canes or crutches that facilitate load distribution, and other auxiliary methods can be used.
Non-drug nutritional supplements to protect joints can be given in order to slow down cartilage deterioration in early-stage osteoarthritis.
Intra-articular injections are mostly moderate. They are used in cases where there is no acute attack in osteoarthritis and the pain is partially under control. In our clinic, platelet-rich plasma obtained after centrifugation of both the hyaluronic acid, which is the intra-knee fluid, and the blood taken from the person at high speed, Injections are made in which the moment (PIP) is given into the joint. Intra-articular steroid injections are recommended for patients who are in advanced stages and cannot be operated on medically.
What are the Surgical Treatment Options?
Surgical treatment options for osteoarthritis in the knee joint are removal of arthroscopically impaired cartilage and joint surgery. It can be summarized as washing the fluids that disrupt the joint, reshaping the bones if there is an alignment disorder between the thigh and tibia in the knee joint, and cartilage transfer according to the amount of cartilage that has been damaged by half or full knee replacement surgeries. The surgical treatment method to be performed varies according to the stage of the disease.
- Arthroscopic cleaning: In patients with early stage calcification, arthroscopic cleaning of the inside of the knee is beneficial, especially in patients with a mechanical sticking feeling.
- Osteotomy surgeries aimed at correcting the malalignment: The knee joint consists of two main parts, the inner and the outer part. Calcification starts from the inner part, which is heavily loaded. Over time, the wear of the cartilage causes a greater load on the inner part of the knee, and the disease progresses rapidly in this way. In patients with mid-term osteoarthritis, where the angulation is not too much, the center of gravity can be brought back to the middle of the knee by reshaping the bones. Thus, existing complaints are reduced and the progression of the disease is slowed down.
- Prosthetic surgery: Prosthesis surgery should be considered in patients with advanced osteoarthritis, if the patients' complaints cannot be controlled with other treatment options. Generally, these patients are those who have to take painkillers constantly, whose comfort in daily life is impaired due to knee pain, and who have difficulty in walking and doing their daily work. Half-type prostheses may be preferred in relatively early-stage patients where only the inner part of the knee joint is affected. Thus, the complaints of the patients are relieved with a smaller surgery compared to the full joint prosthesis and the application time of the full joint prosthesis can be postponed to more advanced stages.
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