Knee pain

 

Knee pain is one of the most common complaints. The source of knee pain can be intra-articular tissues or muscles, tendons, ligaments and sacs around the joint. Acute knee pain is usually of trauma origin, but rheumatic and osteoarthrosis pathologies lie among the causes of chronic knee pain. Depending on the cause of the pain, the patient may feel the pain in the kneecap, in front of the knee, and behind the knee.

 

What is osteoarthrosis (knee calcification)?

 

In osteoarthrosis, the cartilage surface of the knee joint is eroded and the underlying bone layer is exposed. In this case, situations such as knee pain and locking occur in the knee joint when the bone surfaces come into contact in situations such as walking, sitting up and going up and down the stairs. Arthrosis of the knee joint is popularly called calcification;.  The rate of damage to the joints increases with age. It is most often seen in women over the age of 60-65.

When arthrosis (calcification) occurs in the knee joint, joint movements begin to decrease, joint hardening and swelling around the joint begin to be seen. 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 starts in the articular cartilage in 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 degradation. Synovial fluid analysis revealed that proteolytic enzymes, reactive oxygen radicals and lipid peroxidation products were responsible for cartilage matrix degradation. With the progression of degeneration, the hyaluronic acid ratio, molecular weight, viscoelasticity, shock absorbing and lumbrican properties in the synovial fluid decrease. One of the presumed mechanisms for the development of pain in osteoarthritis is the loss of elastoviscosity and decreased lubricity of the joint  and the preservation of joint tissues.

   

Treatment

 

Treatment methods in gonarthrosis are various and patient education, rest, preventive measures, drug therapy, physical therapy and surgical treatment methods can be used alone or in combination according to the stages of the disease. While surgical treatment is preferred in patients with advanced degeneration, conservative methods are preferred in the early stages. Intra-articular injections positively affect pain and functional status in gonarthrosis. Applications of hyaluronic acid derivatives and steroid derivatives are at the forefront in intra-articular injections. 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 can be used to reduce pain in patients with co-morbidity, mostly in elderly patients, as it does not heal joint damage.

Hyaluronic acid derivatives are administered intraarticularly. It is known that it provides relief in joint movements and is effective in the mid-term. It is applied in the early stages of joint damage and in young patients.

Platelet-rich plasma is also a liquid applied into the knee and obtained from the persons own blood. In various cases, repeated injections can be made. Different results of intra-knee platelet-rich plasma applications have been reported in various publications. Although very good results have been reported in some publications, long-term results are unknown.

 

Physiotheraphy

 

Physical therapy contributes to patients with arthrosis of the knee joint by increasing the range of motion and strengthening the muscles around the knee. As the muscle groups around the knee are strengthened, joint pain decreases.

 

Surgical

 

Preventive methods such as intra-knee injections and physical therapy provide partial improvement in patients with joint arthrosis. Such protective methods  make the daily life of patients easier by reducing joint pain rather than improving cartilage.

When the damage to the knee joint progresses and the patients begin to have difficulty in performing their daily activities, surgical treatment is applied in patients with knee pain that cannot be relieved by chronic long-term painkillers.

Surgical treatment varies according to the damage of the knee joint and the age of the patient. Unicondylar knee prosthesis can be applied in young patients with damage to the inner part of the knee joint. Today, total knee replacement surgeries are frequently performed.

In total knee prosthesis, the 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 changed according to the damage of the kneecap. Knee prostheses are available in various brands  and designs. Different knee prosthesis designs are used depending on many variables such as knee joint damage, rheumatic diseases, co-morbidities and age. There is a polyethylene interface between the two metallic implants.

Knee prostheses have a lifespan depending on the condition and activities of the patients. The main goal is to not feel pain in daily activities in patients who have undergone knee prosthesis. Movement is started in the early period after the operation. After the operation, the patient can start to bear weight as soon as he can tolerate it. Although there may be pain during joint movements and bending-opening in the first weeks, the pain in this period is reduced by various methods (such as pain pump, femoral catheter). In the first weeks, support is taken with walkers while moving, 15-20 days after the operation. Sutures are removed in 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, allowing patients to feel comfortable in their daily activities.