Knee Osteoarthritis

The most common causes of knee pain in adult patients are diseases that damage the articular cartilage, meniscus injuries, tears or ruptures of intra-articular ligaments (anterior cruciate ligament or collateral ligament tears), inflammation of the intra-articular membrane, and abnormal knee movements accompanied by lateral dislocation of the patella. Osteoarthritis of the knee joint can occur with aging without being related to another disease, or it can develop as a result of various rheumatic diseases, damage to the articular cartilage after trauma, and the death of intraosseous cells in the bones forming the joint due to various reasons.

What are the signs and symptoms of osteoarthritis?

Pain usually begins gradually and increases over time. Sometimes sudden pain attacks can also occur. Stiffness and swelling may be observed in the joint. Patients experience difficulty bending and fully extending the knee. The range of motion of the joint is reduced. Pain and swelling complaints generally worsen after prolonged immobility.

Walking, squatting, and climbing stairs are the movements that most increase pain. Knee pain is generally described as weakness in the joint and an internal ache. Sometimes, locking and a clicking or popping sensation may be felt along with the pain in the knee.

During a joint examination, the localization of pain and the range of motion of the joint are considered. In radiological examinations, comparative direct X-rays of both knees under weight-bearing, if possible, are sufficient for diagnosis. If deemed necessary, a knee MRI may be requested to determine the extent of cartilage loss and to obtain more information about the condition of the meniscus and ligaments.

How is the treatment administered?

In patients with early-stage osteoarthritis, lifestyle changes, exercise, the use of canes or crutches to facilitate weight distribution, and other assistive methods can be used.

Non-drug nutritional supplements that protect joints may be given to slow cartilage deterioration in early-stage osteoarthritis.

Intra-articular injections are mostly used in moderate osteoarthritis when there is no acute flare-up and pain is partially controlled. In our clinic, we perform injections using both hyaluronic acid, which is the fluid in the joint, and platelet-rich plasma (PIP), which is obtained by centrifuging the patient's own blood at high speed, into the joint. Intra-articular steroid injections are recommended for patients in very advanced stages and those who cannot undergo surgery for medical reasons.

What are the surgical treatment options?

In knee osteoarthritis, surgical treatment options can be summarized as follows: arthroscopic removal of damaged cartilage and drainage of joint fluids; reshaping of bones if there is a misalignment between the femur and tibia; and partial or total knee replacement surgery with cartilage transfer depending on the amount of damaged cartilage.

• Arthroscopic debridement: In patients with early-stage osteoarthritis, arthroscopic debridement of the knee joint is beneficial, especially for those experiencing a mechanical clicking sensation.
• Osteotomy surgeries to correct misalignment: The knee joint consists of two main parts: the inner and outer sections. Osteoarthritis largely begins in the inner section, which bears more weight. Over time, wear and tear on the cartilage causes more weight to be placed on the inner part of the knee, and the disease progresses rapidly. In patients with moderate osteoarthritis where the misalignment is not excessive, reshaping the bones can bring the center of gravity back to the middle of the knee. This reduces existing symptoms and slows the progression of the disease.
• Prosthetic surgery: In patients with advanced osteoarthritis, prosthetic surgery should be considered if their symptoms cannot be controlled with other treatment options. These patients typically require constant pain medication, have impaired daily life due to knee pain, and experience difficulty walking and performing daily tasks. In relatively early stages where only the inner part of the knee joint is affected, partial knee replacements (also known as half-type prostheses) may be preferred. This allows for less extensive surgery compared to a full joint replacement, thus alleviating symptoms and postponing the need for a complete joint replacement to later stages.