Calcification of knee joint (Knee osteoarthritis, gonarthrosis)The most common cause of the knee pain in adult patients are, diseases which destruct joint cartilage (osteoarthritis, calcification), meniscus injuries, tear and rupture of intra articular ligaments ( anterior cruciate ligament or lateral ligament tears), inflammation of the intra articular membrane, lateral displacement of knee with abnormal movements.
Osteoarthritis of the knee joint may be seen just because of aging process without any other disease, but it may occur because of various rheumatic diseases (rheumatoid arthritis etc.), loss of joint cartilage after trauma (post traumatic arthritis) and death of the bone cells which form the joint (osteonecrosis).
Generally pain enhances slowly and it increases progressively in time. Sudden pain attacks may sometimes happen. Rigidity and swelling may be seen in the joint. Patients have difficulties to bend and to open completely their knees. Opening of the joint movement is decreased. Pain and swelling complaints are generally more increased after prolonged immobility.
Walking, squatting and climbing stairs are the movements which increase the pain most. Pain at knee is usually expressed as weakness at joint and ache from inside. Sometimes there may be locking of knee and sound or crackling with pain may be sensed.
Localization of pain and amount of joint movement opening is considered during joint examination. Comparative direct compressed X-ray of both knees enough for the diagnosis. Knee MRI may be requested if it is needed to determine amount of cartilage loss, and to gain more information about meniscus and ligaments.
For early stage osteoarthritis patients, life style rearrangements, exercise, stick to ease load distribution and other assistive methods may be used.
Drug treatment, generally pain killers (paracetamol etc.) with non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, etodolac etc.) are used to control pain during an acute pain attack, if synovitis exists or when patient refuses surgical treatment. It is definitely known that these drugs cause liver, kidney and stomach disease in prolonged usage.
Nutritional supports (glucosamine and chondroitin) which are not medicine may be given to decelerate cartilage loss in early stage osteoarthritis.
Intra-articular injections are used mostly in mid stage osteoarthritis, while there is no acute attack and in the situation which pain is under control. In our clinics, both hyaluronic acid which is a intra knee fluid and platelet rich plasma (PIP) which is produced from patients own blood via centrifuge injections are applied. Intra-articular steroid injections are recommended for advanced stage patients who will not be operated.
Alternative treatments are applied successfully to early and mid stage patients in our clinics by anaesthesiologists who are specialised on pain and acupuncture.
Surgical treatment for calcification of knee joint can be summarized as arthroscopic cleaning of destructed cartilage and washing of intra-articular fluids which destruct joint, remodelling of the bones if there is a sequence defect in the knee joint between thigh and leg bones, cartilage transfer according to amount of destructed cartilage via half or complete prosthesis operations. Method of operation is changed according to stage of the disease.
Arthroscpic cleaning intervention of knee inside may be especially helpful for the patients who sense mechanical obstruction in early stage calcification patients.
Knee joint is consisted of two main region which are outer and inner parts. Calcification mostly starts from inner portion which carries more loads. Cartilage erosion causes putting more loads on to inner portion in time and disease progress in this way. In the mid stage calcification patients, who do not show angel formation so much, it is possible to bring centre of gravity to the middle part of knee via remodelling of the bones. Therefore, current complaints would be decreased and disease progression gets slower.
In the advanced stage calcification (osteoarthritis) patients, prosthesis operation must be thought unless it is possible to control patient’s complaints with other treatment options.
These patients generally are patients who are obliged to take pain killers continuously; their daily life comfort is affected by disease and having difficulties in walking and doing their daily life activities.
In the earlier stage patients, only inner part of the joint is affected, half type prosthesis (unicondylar) can be preferred. Therefore, patients complaints are improved with a smaller surgery comparing to complete joint replacement and complete joint prosthesis application may be postponed.
Knee prosthesis operations are preferred by patients and surgeons because it lets joint movements so early, patient can walk and press on it after one day and rehabilitation is easier. Both half and complete knee prosthesis are applied in our clinics successfully