Primer Diz Osteoartritinde Total Diz Artroplastisi ve Konservatif Tedavi Sonrası Ağrı, Fiziksel Aktivite Düzeyi ve Fonksiyonellik

Öz

Amaç: Diz eklemi osteoartritin en sık tuttuğu eklemdir ve diz osteoartriti ile ilişkili ağrı, günlük yaşam aktivitelerini kısıtlayarak fonksiyonel yetersizliğe yol açar. Bu araştırmanın amacı, primer diz osteoartriti nedeniyle total diz artroplastisi ve konservatif tedavi uygulanan hastaların tedavi sonrası ağrı, fiziksel aktivite ve fonksiyonellik düzeylerinin karşılaştırılmasıdır. Gereç ve Yöntemler: Çalışmaya diz osteoartriti tanısı ile total diz artroplastisi uygulanan 30, konservatif tedavi olarak fizyoterapi uygulanan 30 ve 36 sağlıklı kontrol olmak üzere toplam 96 olgu dahil edildi. Ağrı düzeyi Vizuel Analog Skala ile, fiziksel aktivite Uluslararası Fiziksel Aktivite Anketi kısa form ile, semptom ve fonksiyonel durum Western Ontario ve McMaster Üniversiteleri Osteoartrit İndeksi ve Oxford Diz Skoru ile değerlendirildi. Değerlendirmeler cerrahi ve konservatif tedavi sonrası 3 – 6 ay arasında olmak üzere bir kez gerçekleştirildi. Bulgular: Sonuçlar konservatif ve cerrahi tedavi uygulanan hastaların sağlıklı kontrollere göre vücut kitle indekslerinin daha yüksek olduğunu (p=0,001), fiziksel aktivite düzeylerinin daha düşük olduğunu (p<0,001) göstermiştir. Konservatif tedavi uygulanan hastaların ağrı düzeylerinin daha düşük olduğu ancak total diz artroplastisi uygulanan hastaların fonksiyonel seviyelerinin daha iyi olduğu belirlenmiştir. Sonuç: Tedavi sonrasında cerrahi tedavi uygulanan hastaların ağrı düzeylerinin daha düşük olduğu ve fonksiyonel seviyelerinin daha iyi olduğu belirlenmiştir. Kilo kontrolünün sağlanması ile diz osteoartritine bağlı semptomlar azaltılabilir ve cerrahi tedavi geciktirilebilir. Cerrahi sonrası dönemde hastaların ağrı düzeylerinin azaltılması ve fiziksel aktivite düzeylerinin geliştirilmesi için hastalar ortopedik rehabilitasyon programlarına yönlendirilmelidir.

Anahtar Kelimeler

• diz
• osteoartrit
• total diz artroplastisi
• rehabilitasyon

Pain, Physical Activity Level and Functionality in Primary Knee Osteoarthritis after Total Knee Arthroplasty and Conservative Treatment

Öz

Aim: The knee joint is the most commonly involved joint in osteoarthritis, and pain associated with knee osteoarthritis leads to functional impairment by limiting daily living activities. The aim of this study was to compare pain, physical activity and functionality levels of patients applied with surgical or conservative treatment for primary knee osteoarthritis. Material and Methods: Total knee arthroplasty was applied to 30 patients, conservative physiotherapy treatment to 30 patients and a control group was formed of 36 age-matched healthy individuals. Pain was assessed with a Visual Analogue Scale, physical activity with the International Physical Activity Questionnaire short form, symptoms and functional status with the Western Ontario and McMaster University Osteoarthritis Index and the Oxford Knee Score. Assessments were made once at 3-6 months after surgical and conservative treatment. Results: The results showed that body mass index was higher (p=0.001) and physical activity levels were lower (p<0.001) in patients who underwent conservative and surgical treatment compared to the healthy control group. Pain levels were lower and functional levels were better in patients who had undergone total knee arthroplasty. Conclusion: Pain levels were lower and functional levels were better in patients who received surgical treatment. Weight control can relieve symptoms related to knee osteoarthritis and help to avoid surgical treatment. Patients should be referred to orthopedic rehabilitation programs to reduce pain and improve physical activity levels in the postoperative period.

Anahtar Kelimeler

• Knee
• osteoarthritis
• total knee replacement
• rehabilitation

Kaynakça

1. 1. Felson DT. Epidemiology of knee and hip osteoarthritis. Epidemiol Rev. 1988; 10: 1-28.
2. 2. Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010; 107(9): 152-62.
3. 3. Covinsky K. Aging, arthritis, and disability. Arthritis Rheum. 2006; 55(2): 175-6.
4. 4. Dunlop DD, Manheim LM, Song J, Chang RW. Arthritis prevalence and activity limitations in older adults. Arthritis Rheum. 2001; 44(1): 212-21.
5. 5. Cross M, Smith E, Hoy D, Nolte S, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014; 73(7): 1323-30.
6. 6. Martin JA, Ramakrishnan PA, Lim T, Thedens D, Buckwalter JA. Articular cartilage and intervertebral disk. In: Flynn JM, editor. Orthopaedic knowledge update. 10th ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011. p. 23-6.
7. 7. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012; 64(4): 465-74.
8. 8. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014; 22(3): 363-88.

9. 9. Van Manen MD, Nace J, Mont MA. Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. JAOA. 2012; 112(11): 709-15.
10. 10. Küçükoğlu HS. Osteoartritte kanıtlar ışığında fizik tedavi uygulamaları ve egzersizin önemi. Turkish Journal of Geriatrics. 2011; 14(Suppl 1): 79-81.
11. 11. Van Manen MD, Nace J, Mont MA. Management of primary knee osteoarthritis and ındications for total knee arthroplasty for general practitioners. J Am Osteopath Assoc. 2012; 112 (11): 709-15.
12. 12. Daşkapan A, Anaforoğlu B, Karataş M, Kumru Atalay D. Osteoartritli hastalarda fiziksel aktivite düzeyinin değerlendirilmesi. FTR Bilimleri Dergisi. 2011; 14(3-4): 75-9.
13. 13. Gürkan HS, Kırdı N, Tüzün EH, Atilla B. Diz osteoartritli olgularda denge problemleri, fiziksel fonksiyonellik ve yaşam kalitesinin değerlendirilmesi. Akademik Geriatri. 2010; 2: 94-8.
14. 14. Malhotra R. Mastering orthopedic techniques: total knee arthroplasty. 1st ed. New Delhi: Jaypee Brothers, Medical Publishers; 2010.
15. 15. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016; 474(8): 1886-93.
16. 16. Gift AG. Visual analogue scales: measurement of subjective phenomena. Nursing Research. 1989; 38(5): 286-7.
17. 17. Booth, ML, Ainsworth BE, Pratt M, Ekelund U. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8): 1381-95.
18. 18. Saglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E ,et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010; 111(1): 278-84.
19. 19. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: international knee documentation committee (IKDC), Subjective knee evaluation form, knee injury and osteoarthritis outcome score (KOOS), Knee injury and osteoarthritis outcome score physical function short form (KOOS&PS), Knee outcome survey activities of daily living scale (KOS&ADL), Lysholm knee scoring scale, Oxford knee score (OKS), Western Ontario and McMaster universities osteoarthritis index (WOMAC), Activity rating scale (ARS), and Tegner activity score (TAS)." Arthritis Care and Res. 2011; 63(Suppl 11): 11-22.
20. 20. Tuğay BU, Tuğay N, Güney H, Kınıklı Gİ, Yüksel İ, Atilla B. Oxford knee score: cross-cultural adaptation and validation of the Turkish version in patients with osteoarthritis of the knee. Acta Orthop Traumatol Turc. 2016; 50(2): 198-206.
21. 21. Faucher M, Poiraudeau S, Lefevre-Colau MM, Rannou F, Fermanian J, Revel M. Algo-functional assessment of knee osteoarthritis: Comparison of the test–retest reliability and construct validity of the WOMAC and Lequesne indexes. Osteoarthritis and Cartilage. 2002; 10(8): 602-10.
22. 22. Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005; 13(1): 28-33.
23. 23. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011; 377(9765): 557-67.
24. 24. Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national health and nutrition examination survey (HANES I): evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol. 1988; 128(1): 179-89.
25. 25. Sridhar MS, Jarrett CD, Xerogeanes JW, Labib SA. Obesity and symptomatic osteoarthritis of the knee. J Bone Joint Surg Br. 2012; 94(4): 433-40.
26. 26. Magliano M. Obesity and arthritis. Menopause Int. 2008; 14(4): 149-54.
27. 27. Sadeghi A, Rad ZA, Sajedi B, Heydari AH, Akbarieh S, Jafari B. Effect of weight losing on the clinical status improvement of patients with knee osteoarthritis. Reumatol Clin. 2019; 15(2): 73-6.
28. 28. Nazari A, Moezy A, Nejati P, Mazaherinezhad A. Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow up. Lasers Med Sci. 2019; 34(3): 505-16.
29. 29. Itoh K, Hirota S, Katsumi Y, Ochi H, Kitakoji H. A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA). Chin Med. 2008; 3: 2.
30. 30. Cherian JJ, Jauregui JJ, Leichliter AK, Elmallah RK, Bhave A, Mont MA.The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee. Bone Joint J. 2016; 98-B(1 Suppl A): 89-94.
31. 31. O’Neill TW, Felson DT. Mechanisms of osteoarthritis (OA) pain. Curr Osteoporos Rep. 2018; 16(5): 611-6.
32. 32. Miller RE, Miller RJ, Malfait AM. Osteoarthritis joint pain: the cytokine connection. Cytokine. 2014; 70(2): 185-93.
33. 33. Bindawas SM, Vennu V. Longitudinal effects of physical inactivity and obesity on gait speed in older adults with frequent knee pain: data from the Osteoarthritis Initiative. Int J Environ Res Public Health. 2015; 12(2): 1849-63.
34. 34. Hinman RS, Bennell KL, Metcalf BR, Crossley KM. Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests. Rheumatology (Oxford). 2002; 41(12): 1388-94.
35. 35. Wallace IJ, Bendele AM, Riew G, Frank EH, Hung HH, Holowka NB, et al. Physical inactivity and knee osteoarthritis in guinea pigs. Osteoarthritis Cartilage. 2019; 27(11): 1721-8.
36. 36. Soutakbar H, Sarah E Lamb, Alan J Silman. The different influence of high levels of physical activity on the incidence of knee OA in overweight and obese men and women-a gender specific analysis. Osteoarthritis Cartilage. 2019; 27(10): 1430-6.
37. 37. Hawke LJ, Shields N, Dowsey MM, Choong PFM, Taylor NF. Physical activity levels after hip and knee joint replacement surgery: an observational study. Clin Rheumatol. 2019; 38(3): 665-74.
38. 38. Peter WF, Tilbury C, Verdegaal SH, Onstenk R, Vehmeijer S, Vermeulenet E, et al. The provision of preoperative and postoperative physical therapy in elderly people with hip and knee osteoarthritis undergoing primary joint replacement surgery. Curr Orthop Prac. 2016; 27(2): 173-83.
39. 39. McCarthy C, Mills P, Pullen R, Roberts C, Silman A, Oldham J. Supplementing a home exercise programme with a classbased exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology. 2004; 43(7): 880-6.
40. 40. Su X, Li C, Liao W, Liu J, Zhang H, Li J, Li Z. Comparison of arthroscopic and conservative treatments for knee osteoarthritis: a 5-year retrospective comparative study. Arthroscopy. 2018; 34(3): 652-9.
41. 41. Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S, et al. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis Cartilage. 2018; 26(9): 1170-80.