RESUMEN. Antecedentes: La gonartrosis es una entidad muy frecuente en la actualidad, las deformi- dades angulares son un hallazgo usual en pacientes. Objetivo: Determinar la eficacia de la infiltración intrarticular de la rodilla con ozono médico en pacientes que presentan gonalgia por gonartrosis crónica.
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A 72 year old woman presented bikateral severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy.
At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing.
Six sessions of knee prolotherapy protocol was applied to the patient, one session bilaterwl. Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year.
Our case is the report that presents radiological evidence in addition to clinical findings of improvement of osteoarthritis level. As a result of this case report, further studies aiming to offer a different minimally invasive treatment option to the patients before surgery may be performed.
We are in the opinion that prolotherapy may be preferred more commonly as an efficient method once the importance of ligamentous structures at pathogenesis of osteoarthritis is established. Degenerative joint disease osteoarthritis is a chronic, non-inflammatory and common joint disease characterized with degeneration of synovial gonartrossi cartilage, and new bone formation at joint surfaces and margins 1.
Osteoarthritis is the most common joint disease iblateral one of the most common causes of physical deformity. It affects both genders and all races. Knee is the most commonly affected joint, particularly due to weight bearing. On the other hand, a pathological process including exchange of joint surface with metals may be preferred at orthopedic approach 12.
Prolotherapy is an injection therapy method that is capable of reversing the degeneration process by activating the regeneration potential of the body. This is the only method capable of avoiding the patient from major surgical procedures by providing clinical improvement at even grade IV gonarthrosis 3. She had history of chronic obstructive pulmonary disease for 10 years, diabetes mellitus for 20 years, and hypertension for 30 years.
In addition to physiotherapy, intra-articular steroid two years ago and hyaluronic acid injections one year ago had been applied, and her complaints had not resolved with these treatments, although she used mg paracetamol, 30 mg caffeine, 10 mg codein every six hour and 25 mg dexketoprofen trometamol every eight hour.
The last physician patient was referred had recommended bolateral knee prosthesis but stated that surgical intervention would be unfavorable due to her irregular chronic diseases. After all, the patient was referred to our clinic. Physical examination revealed tenderness at medial and lateral collateral ligaments, pes anserius, patellar ligament, and coronary ligament.
Pain level was detected as close to the most severe pain level Scala 1. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing Table 1 Figure 1. Blood analysis and biochemical tests were reported as normal. Administration of prolotherapy protocol was decided after getting the written informed consent from the patient.
The patient was monitored with ECG, arterial blood pressure and pulse oximeter measurements. Tenderness points at examination were marked after sterilizing the injection area.
We administered five times the skin attempt for 15 point injections and used 22 cc solutions totally. Nonsteroidal anti-inflammatory drugs and steroids have been lost. Weight loss, decreasing the weight bearing on the joint, stretching exercises and physiotherapy was continued.
The patient was evaluated at the end of 6 sessions. VAS score was measured as close to the no-pain point Scala 2. Osteoarthritis level of the patient was improved to grade Bialteral at radiological evaluation after a year Figure 2. Gonartrosiw is quite important that an improvement was shown at a patient with advanced stage gonarthrosis by clinical and radiological evidences after prolotherapy.
In addition to gonqrtrosis decrease at pain levels, grade IV arthritis was radiographically improved to grade I after a year. Injection therapies are commonly used for gonarthrosis as non-surgical treatment methods.
The majority of these procedures include either corticosteroids or hyaluronic acid. These therapies decrease the complaints at short-term. But no evidence could be found that they improve arthritis level at long-term 1 – 367.
Clinical and radiological improvements iblateral demonstrated with our therapy method. A limited number of double-blinded, randomized studies are found in the literature.
The study by Hackett et al. The studies of Reeves et al. Prolotherapy is a procedure which proliferative solutions are injected into ligamentous structures for regeneration. Injected solution gonartrossis inflammation at connective tissue.
The immune response to inflammation regenerates ligamentous compounds and resolves ligamentous laxity occurring at joint during arthritis 67. The reason of degeneration at synovial joint cartilage which has role at the pathology of osteoarthritis has not been well-established yet 67. In our case, prolotherapy has been successful at reversal of the degeneration. Thus, ligamentous structures may be considered to have a key role at formation of arthritis. The stability of the joint is maintained by ligamentous structures.
The impairment at joint mechanics due to laxity gojartrosis degeneration at these structures may cause excessive weight bearing at synovial tissues. Cartilage degeneration, a reason for the complaints, may be the last step of the degeneration at pathological pathway; not the onset of the arthritis 7. The improvement at joint mechanics after regeneration of ligamentous structures may result with synovial regeneration 7. Ligamentous approach may offer new solutions at the treatment of arthritis and prevent plenty of patients from major surgical procedures.
Prolotraphy treatment offer different minimally invasive treatment option to the patients whom surgery could not performed due to co-morbidities. Study concept and design: Ilker Solmaz, Onder Taylan CifciCritical revision of the manuscript for important intellectual content: Ilker Solmaz, Suleyman Deniz, Administrative, technical, and material support: Ilker Solmaz, Suleyman Deniz, Study supervision: We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
The research presented in this manuscript has not been funded by any institution. National Center for Biotechnology InformationU. Journal List Anesth Pain Med v.
Published online Dec Author information Article notes Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Presentation A gonaryrosis year gonzrtrosis woman presented with severe pain at her knees for over 5 years. Osteoarthritis, Knee; Degeneration; Treatment.
Introduction Degenerative joint disease osteoarthritis is a chronic, non-inflammatory and common joint disease characterized with degeneration of synovial joint cartilage, and new bone formation at joint surfaces and margins 1. Radiological Knee Staging of Gonarthrosis Patients.
Stage Explanation 1 Minimal osteophyte, normal joint space 2 Significant osteophyte, suspicious joint space narrowing 3 Significant osteophyte and significant joint space narrowing 4 Significant osteophyte and complete joint space narrowing. Open in a separate window.
Therapy Protocol Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly. Conclusions The patient was evaluated at the end of 6 sessions. Significant improvement was noted at WOMAC scale Pain level; 5 points, stiffness level; 2 points, Physical function loss; 15 points, and total WOMAC 22 points Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year Figure 2.
GONARTROSIS BILATERAL by Marcela Dorado Ortega on Prezi
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