Knee Pain
Knee pain is one of the most common complaints. The source of knee pain may be the intra-articular tissues or the muscles, tendons, ligaments and sacs around the joint. Acute knee pain is usually caused by trauma, but the causes of chronic knee pain include rheumatic and osteoarthrosis pathologies. Depending on the cause of the pain, the patient may feel the pain in the kneecap, in front of the knee, or behind the knee.
What is osteoarthrosis (knee arthritis)?
In osteoarthrosis, the cartilage surface in the knee joint is affected. It wears away and the underlying bone layer is exposed. In this case, as the bone surfaces come into contact with the knee joint when walking, sitting, standing, and going up and down stairs, situations such as pain and locking occur in the knee. Arthrosis of the knee joint is colloquially called 'calcification'. The rate of damage to joints increases with age. It is often seen in women over the age of 60-65.
When arthrosis (calcification) occurs in the knee joint, joint movements begin to decrease, the joint becomes stiff, and swelling begins to appear around the joint. As arthrosis progresses, curvature begins to occur in the joint. Patients begin to experience difficulties in their daily activities. Arthrosis of the knee joint is called gonarthrosis.
Gonarthrosis is a chronic non-inflammatory degenerative disease that begins in the articular cartilage of the knee joint and affects other structures in the joint structure over time, resulting in new bone formation, joint stiffness and limitation of movement after cartilage damage. The pathogenesis of the disease is attributed to the disruption of the balance between cartilage matrix synthesis and destruction. In synovial fluid analysis, it was determined that proteolytic enzymes, reactive oxygen radicals and lipid peroxidation products were responsible for cartilage matrix destruction. As degeneration progresses, the proportion of hyaluronic acid in the synovial fluid, its molecular weight, viscoelasticity, shock absorbing and lumbrican properties decrease. One of the assumed mechanisms for the occurrence of pain in osteoarthritis is the loss of elastoviscosity and the decrease in the lubricity of the joint and the protection of joint tissues.
Treatment
Treatment methods in gonarthrosis are various and patient education, Health, preventive measures, drug therapy, physical therapy and surgical treatment methods can be used alone or in combination depending on the stages of the disease. While surgical treatment is preferred in patients with advanced stage degeneration, conservative methods are preferred in the early stages. Intra-articular injections positively affect pain and functional status in gonarthrosis. In intra-articular injections, hyaluronic acid derivatives and steroid derivatives applications are at the forefront. Hyaluronic acid (HA) is applied for viscous support and is known to provide significant improvement in pain and function.
Liquid Injection
Intra-articular steroid injections are used to reduce pain, inflammation and stiffness in joint movements, and it is known that they have no effect on the progression of the disease. It does not cure damage to the joint, but can be used to reduce pain in older patients and those with additional diseases.
Hyaluronic acid derivatives are applied into the joint. It is known that it provides relief in joint movements and is effective in the medium term. It is applied in the early stages of joint damage and in young patients.
Platelet-rich plasma is a liquid obtained from the person's own blood and applied into the knee. Repeated injections can be made in various situations. Different results of intra-knee platelet-rich plasma applications have been reported in various publications.
Physical Therapy
Physical therapy increases the range of motion of the knee joint in patients with arthrosis and improves the knee joint. It contributes to strengthening the surrounding muscles. As the muscle groups around the knee are strengthened, joint pain decreases.
Surgery
Intra-knee injections and Preventive methods such as physical therapy provide partial recovery in patients with joint arthrosis. Such preventive methods make the daily lives of patients easier by reducing joint pain rather than ensuring the healing of the cartilage.
As the damage to the knee joint progresses and patients begin to have difficulty in performing their daily activities, they experience chronic long-term pain. Surgical treatment is applied to patients with knee pain that does not relieve with significant painkillers.
Surgical treatment varies depending on the damage to the knee joint and the age of the patient. Unicondylar knee prosthesis can be applied to young patients with damage to the inner part of the knee joint. Nowadays, total knee prosthesis surgeries are frequently performed.
In total knee prosthesis, damaged areas in the knee joint are removed and metallic implants are applied to the joint surface with bone cement. In total knee prosthesis, the surface of the kneecap is replaced depending on the damage to the kneecap. Knee prostheses are available in various brands and designs. Different knee prosthesis designs are used depending on many variables such as patients' knee joint damage, rheumatic diseases, additional diseases and age. There is a polyethylene interface between two metallic implants.
Knee prostheses have a lifespan depending on the patient's condition and activities. The main goal for patients who have undergone knee prosthesis is to have no pain in their daily activities. Movement is started early after the operation. After the surgery, the patient can start weight bearing as soon as he can tolerate it. Although there may be pain during joint movements and bending-opening in the first weeks, the pain during this period is reduced with various methods (pain pump, femoral catheter, etc.). In the first weeks, support is taken with walkers while moving, 15-20 days after the operation. Stitches are removed within days.
Knee exercises and daily walks must be done after the operation. In this way, stiffness in the knee is prevented and the range of motion of the knee joint is increased, ensuring that patients are comfortable in their daily activities.
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