ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
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ORIJINAL ARAŞTIRMA

Primer Diz Osteoartriti Hastalarında Radyolojik Evreleme ile Postural Stabilite, Fonksiyon, İzokinetik Değerlendirmeler Arasındaki İlişkinin Değerlendirilmesi
The Evalua on of Rela on Between Radiological Grading and Postural Stability, Func on, Isokine c Measurements in Pa ents with Primary Knee Osteoarthri s
Received Date : 25 Jun 2018
Accepted Date : 15 Oct 2018
Doi: 10.31609/jpmrs.2018-61951 - Makale Dili: TR
J PMR Sci 2019;22(1):7-15
ÖZET
Amaç: Primer diz osteoartritli (OA) hastalarda radyolojik evrelemenin ağrı, fonksiyon, izokinetik değerlendirme ve postural stabiliteye olan etkilerinin değerlendirilmesidir. Gereç ve Yöntemler: Amerikan Romatoloji Derneği kriterlerine göre primer diz OA tanısı alan 110 kadın hasta çalışmaya dahil edildi. Hastaların ön-arka ve yan diz grafileri değerlendirildi. Bu grafiler üzerinden Kellgren-Lawrence (K/L) diz OA evrelemesi yapıldı. Çalışmaya K/L diz OA evrelemesine göre evre 2 ve evre 3 olan hastalar dâhil edildi. Hastalar K/L diz OA evrelemesine göre K/L evre 2 (Grup 1) ve K/L evre 3 (Grup 2) olmak üzere iki gruba ayrıldı. Kesin osteofit ve eklem aralığında şüpheli daralma K/L evre 2 olarak kabul edildi. K/L evre 3 ise orta derecede çok sayıda osteofit, eklem aralığında kesin daralma, skleroz olarak belirlendi. Çalışmanın sonuç parametreleri vizüel analog skala (VAS), WOMAC OA ve Lequesne indeksleri, Tetrax postüral stabilite testi, izokinetik kas parametreleri olarak belirlendi. Hastaların ağrı, tutukluk ve günlük yaşam aktiviteleri değerlendirmeleri VAS, WOMAC ve Lequesne indeksleri ile karşılaştırıldı. Denge ve postüral stabilite karşılaştırmaları Tetrax İnteraktif Denge Sistemi ile gerçekleştirildi. Kas kuvveti karşılaştırmaları için Biodex System 3 Pro izokinetik dinamometre cihazı kullanıldı. Bulgular: Çalışmaya alınan hastaların yaş ortalaması Grup 1’de 57,12 ±8,34 yıl ve Grup 2’de 62,38±8,23 yıl bulundu. Gruplar arasında yaş, beden kitle indeksi, hastalık süresi değerleri benzer idi. Gruplar arasında VAS, Lequesne indeksi, WOMAC tutukluk alt grupları arasında istatistiksel olarak anlamlı fark bulunmadı. WOMAC’ın toplam skoru ile ağrı ve günlük yaşam aktivitesi altskorları ise K/L evre 3 hastalarda daha yüksek saptandı. İzokinetik değerlendirmeler içinde yer alan 60°/sn ve 180°/sn hızlarındaki kuadriseps pik tork değerleri, hamstring/kuadriseps agonist/antagonist oranlarında fark belirlenmedi. Gruplar arasında düşme riski ve postüral stabilite değerleri açısından fark saptanmadı. Sonuç: Primer diz OA’nde K/L evre 2 ve 3 olan hastaların fonksiyon ve tutuklukları arasında fark bulunmamaktadır. Ağrı ve günlük yaşam aktivitesi değerlendirmeleri ise ölçülen yönteme göre değişmektedir. K/L evre 2 ve 3 kategorisi arasında postüral stabilite ve izokinetik kas değerlendirmeleri arasında fark saptanmamıştır.
ABSTRACT
Objective: The aim of this study is to evaluate the effects of radiologic grading on pain, function, isokinetic measurement and postural stability in patients with primary knee osteoarthritis (OA). Material and Methods: Total 110 women patients with primary knee OA diagnosis according to American College of Rheumatology criteria were included in the study. The patients’ anteroposterior and lateral views of the knee radiographs were evaluated. Kellgren-Lawrence (K/L) grading system was used based on these radiographs. Patients with K/L grade 2 and K/L grade 3 knee OA were included to the study. Patients were divided to two groups as Kellgren-Lawrence (K/L) grade 2 ( Group 1) and K/L grade 3 ( Group 2) according to K/L OA grading system. K/L grade 2 was accepted as small osteophytes with possible narrowing of the joint space. K/L grade 3 was determined as the multipl, moderately sized osteophytes,sclerosis,with definite joint space narrowing. Outcome parameters of the study were determined as visual analog scale (VAS), WOMAC OA and Lequesne index, Tetrax postural stability testing, and isokinetic muscle parameters. Evaluation of pain, stiffness and daily living activities of patients were compared by using VAS,WOMAC ve Lequesne indexes. Balance and postural stability comparisons were evaluated by using Tetrax Interactive Balance System. Biodex System 3 Pro Isokinetic dynamometer were used for the muscle strength comparisons. Results: The mean age of the patients in the study was found 57.12±8.34 years in group 1 and 62.38±8.23 years in group 2. Age, body mass index, disease duration parameters were similar among groups. There was not any significant difference between goups on VAS, Lequesne index, stiffness subgroup of WOMAC. Pain, activities of daily living subgroups and total score of WOMAC were higher in patients with K/L grade 3. The quadriceps peak torque measurements at 60°/sc and 180°/sc rates, hamstring/quadriceps agonist/antagonist ratios which are within the isokinetic evaluations were not found different. There were no significant difference on falling risk and postural stability measurements among groups. Conclusion: There are no difference on function and stiffness of patients with primary knee OA according to K/L grade 2 and 3. Pain and activity of daily living may vary according to evaluation method. There are no difference on isokinetic muscle measurements and postural stability evaluations among the K/L grade 2 and 3.
REFERENCES
  1. Farpour HR, Fereydooni F. Comparative effectiveness of intra-articular prolotherapy versus peri-articular prolotherapy on pain reduction and improving function in patients with knee osteoarthritis: a randomized clinical trial. Electron Physician. 2017;9:5663-9. [Crossref]  [PubMed]  [PMC] 
  2. Kim HS, Yun DH, Yoo SD, et al. Balance control and knee osteoarthritis severity. Ann Rehabil Med. 2011;35:701-9. [Crossref]  [PubMed]  [PMC] 
  3. Duman I, Taskaynatan MA, Mohur H, et al. Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis. Rheumatol Int. 2012;32:3793-8. [Crossref]  [PubMed] 
  4. Marks R, Quinney HA, Wessel J. Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol. 1993;12:170-5. [Crossref] 
  5. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis. 2001;60:612-8. [Crossref]  [PubMed] 
  6. Rabe KG, Matsuse H, Jackson A, et al. Evaluation of the combined application of neuromuscular electrical stimulation and volitional contractions on thigh muscle strength, knee pain, and physical performance in women at risk for knee osteoarthritis: a randomized controlled trial. PM R. 2018;S1934-1482:30286-7.
  7. Bobic Lucic L, Grazio S. Impact of balance confidence on daily living activities of older people with knee osteoarthritis with regard to balance, physical function, pain, and quality of life-a preliminary report. Clin Gerontol. 2018;41:357-65. [Crossref] 
  8. Esfandiari E, Sanjari MA, Ashraf Jamshidi A, et al. Knee osteoarthritis at the early stage: the four-week effect of lateral wedge insole on pain and risk of falls. Med J Islam Repub Iran. 2018;32:17. [Crossref]  [PMC] 
  9. Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145-5. [Crossref]  [PMC] 
  10. Parsons C, Fuggle NR, Edwards MH, et al; EPOSA Research Group. Concordance between clinical and radiographic evaluations of knee osteoarthritis. Aging Clin Exp Res. 2018;30:17-25. [Crossref]  [PMC] 
  11. Tuna S, Balci N. The relationship between radiological severity and functional status in patients with knee osteoarthritis. Clin Rheumatol. 2014;33:667-70. [Crossref] 
  12. Savluk OF, Baysal A, Erbas M ve ark. Dejeneratif diz osteoartriti (OA) olan hastalarda intraartiküler steroid uygulamasinin etkinligi. Duzce Tip Derg. 2013;15:27-31.
  13. Lo GH, LaValley M, McAlindon T, et al. Intraarticular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003;290:3115-21. [Crossref] 
  14. Ertekin C. Agrinin noroanatomi ve norofizyolojisi. Yegul I, editor. Agri ve Tedavisi. Izmir: Yapim Matbaacilik; 1983. p.1-17.
  15. Tuzun EH, Eker L, Aytar A, et al. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;13:28-33. [Crossref] 
  16. Lee JK, Lee BY, Shin WY, et al. Effect of extracorporeal shockwave therapy versus intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis. Ann Rehabil Med. 2017;41:828-35. [Crossref] 
  17. Doruk P, Adam M, Leblebici B ve ark. Primer diz osteoartritinde fiziksel tip ve rehabilitasyon modalitelerinin kas gucu ve postural stabilite uzerine etkisi. J PMR Sci. 2013;16:55-61.
  18. Tasci Bozbas G, Sendur OF, Aydemir AH. Primary knee osteoarthritis increases the risk of falling. J Back Musculoskelet Rehabil. 2017;30:785-9. [Crossref] 
  19. Bjordal JM, Johnson MI, Lopes-Martins RA, et al. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007;8:51. [Crossref] 
  20. Amin S, Baker K, Niu J, et al. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum. 2009;60:189-98. [Crossref] 
  21. Bruyere O, Honore A, Rovati LC, et al. Radiologic features poorly predict clinical outcomes in knee osteoarthritis. Scand J Rheumatol. 2002;31:13-6. [Crossref] 
  22. Cho HJ, Chang CB, Yoo JH, et al. Gender differences in the correlation between symptom and radiographic severity in patients with knee osteoarthritis. Clin Orthop Relat Res. 2010; 468:1749-58. [Crossref] 
  23. Barker K, Lamb SE, Toye F, et al. Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clin Rehabil. 2004;18: 793-800. [Crossref] 
  24. Link TM, Steinbach LS, Ghosh S, et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology. 2003;226:373-81. [Crossref] 
  25. Zeni JA Jr, Axe MJ, Snyder-Mackler L. Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis. BMC Musculoskelet. Disord. 2010;11:86. [Crossref] 
  26. Skou ST, Wise BL, Lewis CE, et al; Multicenter Osteoarthritis Study Group. Muscle strength, physical performance and physical activity as predictors of future knee replacement: a prospective cohort study. Osteoarthritis Cartilage. 2016;24:1350-6. [Crossref] 
  27. Baert IA, Staes F, Truijen S, et al. Weak associations between structural changes on MRI and symptoms, function and muscle strength in relation to knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2014;22:2013-25. [Crossref] 
  28. Cudejko T, van der Esch M, van der Leeden M, et al. Proprioception mediates the association between systemic inflammation and muscle weakness in patients with knee osteoarthritis: results from the Amsterdam Osteoarthritis cohort. J Rehabil Med. 2018;50: 67-72. [Crossref]