Gonartrozda Klinik ve Radyolojik Uyum

Öz

Amaç: Bu calismanin amaci gonartrozu olan hastalarda semptomlar ve radyolojik derecelendirme sistemi arasindaki ilişkiyi degerlendirmektir. Hastalar ve yöntem: Ocak 2012 ile Haziran 2013 tarihleri arasında primer gonartrozu olan hastalar prospektif olarak değerlendirildi. Kriterleri karşılayan 724 hastanın 512'si (%70,7) kadın, 212'si (%29,3) erkekti.Ortalama yaş 56 (35-79) yıl idi. Klinik değerlendirme için WOMAC skorlaması kullanıldı. Her iki diz yarı fleksiyonda ayakta yük alırken ön-arka, yan ve patella tanjansiyel röntgenleri çekildi ve Kellgren – Lawrence sınıflamasına göre derecelendirme yapıldı. Hastaların WOMAC skorları radyolojik derecelerine göre düzenlendi. Derece 1 derece 2 ile, derece 2 derece 3 ile ve derece 3 derece 4 ile karşılaştırıldı.Ayrıca ek görüntüleme çalışmaları ve önerilen tedavi seçenekleri not edildikten sonra Kellgren – Lawrence derecelerine göre dağılım hesaplandı. Bulgular: Hastaların 89'u (%12.2) evre 1, 208'i (%28.7) evre 2, 256'sı (%35.3) evre 3 ve 171'i (%23.8) evre 4 idi. WOMAC puanlarına göre 1. ve 2. sınıf arasındaki fark istatistiksel olarak anlamlıydı (p=0.003). 2. ve 3. derece arasındaki fark anlamlı değildi (p=0.071). Aynı şekilde 3. ve 4. derece arasındaki fark anlamlı değildi (p=0.097). Ek görüntüleme çalışmaları MRI, tomografi ve sintigrafi olup; sunulan tedavi seçenekleri konservatif tedavi, artroskopi, tibial osteotomi, unikondiler diz artroplastisi ve total diz artroplastisi idi. Sonuç: Tedavide karar vermede röntgen ve evreleme yeterli görünmemektedir. Ayrıca semptomlar ve radyolojik bulgular da dikkate alınmalıdır.

Anahtar Kelimeler

• Gonartroz
• klinik sonuçlar
• görüntüleme

Clinical and Radiological Compatibility in Gonarthrosis

Öz

Objective: The aim of this study was to evaluate the relationship between symptoms and radiologic grading system. Patients and Methods: Patients with primary gonarthrosis between January 2012 and June 2013 were evaluated prospectively. 512 (70.7%) of 724 patients were women and 212 (29.3%) were men, who meet the criteria. Mean age was 56 (35-79). WOMAC total score was used for clinical evaluation. Both knees semiflexion weight bearing anteroposterior, lateral and patella tangential X-rays were obtained, then grading was made according to Kellgren – Lawrence classification. WOMAC scores of patients were arranged according to their radiologic grades. Grade 1 was compared with grade 2, grade 2 with 3 and grade 3 with 4. Also additional imaging studies and offered treatment choices were noted, then distribution according to Kellgren – Lawrence grades was calculated. Results: 89 (%12.2) of patients were grade 1, 208 (%28.7) of patients were grade 2, 256 (%35.3) of patients were grade 3 and 171 (%23.8) of patients were grade 4. There was a significant difference between grade 1 and 2 according to WOMAC scores (p=0.003). The difference between grade 2 and 3 was not significant (p=0.071). The difference between grade 3 and 4 was not significant (p=0.097). Additional imaging studies were MRI, tomography and scintigraphy. Offered treatment options were non operative, arthroscopy, tibial osteotomy, unicondylar knee arthroplasty and total knee arthroplasty. Conclusion: X-rays and staging seems to be not enough for decision making in treatment. Also symptoms and radiological findings should be considered.

Anahtar Kelimeler

• gonarthrosis
• clinical results
• imaging

Kaynakça

1. 1. Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):571-6.
2. 2. Van Saase JLCM, Van Romunde LKJ, Cats A, Vandenbroucke JP, Valkenburg HA. Epidemiology of osteoarthritis: Zoetermer survey. Comparison of radiological osteoarthritis in Dutch population with that in 10 other populations. Ann Rheum Dis. 1989;48(4):271-80.
3. 3. O’Reilly SC, Jones A, Muir KR, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect of pain and disability. Ann Rheum Dis. 1998;57(10):588-94.
4. 4. Rogind H, Nielsen BB, Jensen B, Moller HC, Frimodt-Moller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil. 1998;79(11):1421-7.
5. 5. Kean WF, Kean R, Buchanan WW. Osteoarthritis: symptoms, signs and source of pain. Inflammopharmacology. 2004;12(1):3-31.
6. 6. Peat G, Thomas E, Duncan R, Wood L, Wilkie R, Hill J et al. Estimating the probability of radiographic osteoarthritis in the older patient with knee pain. Arthritis Rheum. 2007;57(5):794-802
7. 7. Duncan R, Peat G, Thomas E, Hay E, McCall I, Croft P. Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be? Ann Rheum Dis. 2007;66(1):86-91.
8. 8. Dowsey MM, Dieppe P, Lohmander S, Castle D, Liew D, Choong PF. The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis. Knee. 2012;19(6):860-5

9. 9. Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P et al. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ. 2009;21;339:b2844. doi: 10.1136/bmj.b2844.
10. 10. Cubukcu D, Sarsan A, Alkan H. Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study. Arthritis. 2012;2012:984060. doi: 10.1155/2012/984060
11. 11. Sanghi D, Avasthi S, Mishra A, Singh A, Agarwal S, Srivastava RN. Is radiology a determinant of pain, stiffness, and functional disability in knee osteoarthritis? A cross-sectional study. J Orthop Sci. 2011;16(6):719-25.
12. 12. Ozcakir S, Raif SL, Sivrioglu K, Kucukcakir N. Relationship between radiological severity and clinical and psychological factors in knee osteoarthritis. Clin Rheumatol. 2011;30(12):1521-6.