Abstract
Osteoarthritis is a condition that mostly affects the elderly population and tends to be localized to the knee joint. At old age, active treatment options are limited by co-morbidities and a higher risk for surgical complications. Therefore, the search for strategies that could become a temporary alternative to knee replacement is a pressing concern. The aim of this study was to analyze how justifiable is total knee replacement in elderly patients with knee osteoarthritis and to propose a less aggressive therapeutic alternative to this surgery. The study included 178 patients over 60 years of age with clinically established knee osteoarthritis who had been previously recommended knee replacement but chosen not to undergo it. The choice of a treatment strategy tested in the study was based on the original grading scale for the evaluation of the knee joint dislocation syndrome. The treatment consisted of therapeutic arthroscopy and intraarticular injections of hyaluronic acid and platelet-rich plasma (PRP). The data were processed in Statistica 12. Data analysis revealed that 39.3% of the participants did not have compelling indications for knee replacement. The proposed combination therapy with intraarticular PRP injections and arthroscopy allowed all the patients to delay knee replacement for at least a year; unaided by arthroscopy, intraarticular injections worked well for only 40%.
Highlights
Osteoarthritis is a condition that mostly affects the elderly population and tends to be localized to the knee joint
The severity of the condition was inferred from their total knee joint dislocation syndrome (KJDS) scores that reliably showed whether the patient needed knee replacement; unlike this scale, radiographic findings do not always correlate with patients’ complaints of pain and decreasing lifestyle, so we did not use them as a criterium
If we look at the efficacy of intraarticular injections alone, we should note that of 118 patients from groups 1 and 2, who had previously considered a possibility of surgical intervention, 42 had no compelling indications for surgery
Summary
Osteoarthritis is a condition that mostly affects the elderly population and tends to be localized to the knee joint. The aim of this study was to analyze how justifiable is total knee replacement in elderly patients with knee osteoarthritis and to propose a less aggressive therapeutic alternative to this surgery. Author contribution: Lychagin AV devised a KJDS scale, planned the study, performed arthroscopy and follow-up observation, processed and analyzed the data. Garkavi AV planned the study and proposed its design, performed arthroscopy, intraarticular injections and follow-up observation, processed and analyzed the data, and wrote the manuscript. Kaykov VS performed arthroscopy, intraarticular injections, and follow-up observation, surveyed the patients. Целью исследования было проанализировать оправданность операции эндопротезирования коленного сустава у пациентов пожилого и старческого возраста с гонартрозом и разработать комплексную систему лечения, сохраняющую сустав. В. Гаркави — планирование и создание дизайна исследования, операции артроскопии, внутрисуставные инъекции, наблюдение пациентов в динамике, систематизация и анализ результатов, оформление статьи; В. Сеченова (протокол No 17–18, 2018 г.); все пациенты подписали добровольное информированное согласие на участие в проводимом исследовании
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