Etiopathogenesis: It is osteoarthritis of the knee joint. It is known as calcification among the people. It is more common in women over the age of 50. It is more common than arthrosis of the hip joint. Further; The fact that the knee joint is more unprotected than the hip and is more exposed to biomechanical loads, obesity (overweight) puts more load on the knee joint and not doing activities such as sports-exercise increases the damage in the knee joint. It has two etiological forms, primary and secondary. Primary osteoarthritis, which has an idiopathic form, is more common and usually shows bilateral involvement. Changes in cartilage tissue caused by aging are blamed in its etiology. The secondary form may occur due to posttraumatic, avascular necrosis, inflammatory diseases (RA, SLE etc.), postinfectious, postmenisectomy, metabolic diseases and deformities (genu varum, genu valgum, etc.). In the pathogenesis of the disease, chronic progressive destruction of the joint cartilage, synovitis formation, new bone and cartilage formation (osteophyte) in the joint periphery, subchondral sclerosis and extensive cartilage degeneration results.
Clinic: Patients usually present to the clinic with complaints of pain, swelling, limitation of movement, deformity and decrease in activity level. In the early stages, pain increases with movement and decreases with rest. In advanced stages, night pain and resting pain develop. On physical examination, limitation of active and passive movements, crepitation, deformity (often genu varum), pain with palpation in the joint line, synovitis and quadriceps atrophy are observed.
Diagnosis: Standing plain radiographs and ortho x-rays are sufficient for radiological examination. Radiological findings of the disease; There may be narrowing of the joint space, osteophytes, subchondral sclerosis and cysts, collapse in the tibial plateau, and intraarticular free bodies. MRI can be performed only in young patients and in suspected cases to distinguish intra-articular pathology. Otherwise, MRI is not required for gonarthrosis diagnosis.
Treatment: It is done according to the age of the patient and the stage of the disease. Weight loss, activity modification, NSAIDs, viscosupplementation and physical therapy can be used in the conservative treatment of the disease. If conservative treatment methods are unsuccessful for at least 6 months, surgical treatment should be considered. Surgical treatment options of the disease are arthroscopic debridement, high tibia osteotomy, arthroplasty (surface arthroplasty, unicompartmental arthroplasty, total knee prosthesis) and arthrodesis.
Total knee prosthesis surgery should be performed in case of complete destruction of the joint. In this way, the damaged cartilage surfaces are removed and metal implants are placed, and since the pain disappears, the patient can return to his daily activities comfortably. It is the most common surgical treatment for gonarthrosis. In patients where one half of the joint is damaged and the other half remains intact, a half prosthesis (unicondylar) may be preferred. Because the purpose is to relieve the pain and return the patient to normal daily activities, the solid cartilage structure is preserved. In patients younger than 60 years of age, it is possible to treat it without any prosthesis by cutting the bone and providing resequence.This method, which we call high tibial osteotomy, is preferred especially in middle-aged, active sports and dynamic patients With this method, patients are comfortable for an average of 10-15 years. At the end of this period, total knee replacement surgery is required in some patients.
