| Abstract | Osteoartritis je kronična, progresivna, degenerativna bolest, starije životne dobi i broj oboljelih postupno se povećava. Karakterizira ju početno propadanje hrskavice, nakon čega se degenerativne promjene šire na sve dijelove zgloba. U kliničkoj slici se pojavljuju bol, ukočenost koja nestaje razgibavanjem, krepitacije prilikom pokreta, bolnost na palpaciju, ograničenje pokreta, deformacije zgloba, atrofija mišića i kontrakture. Na rendgenskim snimkama moguće je naći suženje zglobne pukotine, formiranje osteofita, sklerozu subhondralne kosti, cistične promjene, te deformacije kosti i zgloba. Klinički nalaz bolesti se nužno ne podudara sa rendgenskim snimkama, ali se one koriste kao kriteriji za klasifikaciju i po njima se planira kirurški zahvat.
U liječenju osteoartritisa moguće su opcije edukacija, fizikalna terapija, farmakološko i kirurško liječenje. Farmakološko liječenje provodi se simptomatski, analgeticima i nesteroidnim protuupalnim lijekovima, te injekcijama glukokortikoida, s ili bez anestetika intraartikularno i injekcijama hijaluronske kiseline. Kirurško liječenje može biti palijativno, kauzalno, artroplastika i artrodeza. Palijativni zahvati provode se sa svrhom ublažavanja simptoma, a kauzalni su usmjereni prema uklanjanju deformacija koje dovode do osteoartritisa. Artroplastika je zapravo metoda izbora kod starijih osoba, a artrodeza je fiksacija zgloba u određenom položaju i radi se kada je artroplastika zakazala. Artroplastika je kirurški postupak kojim se oblikuje umjetni zglob funkcionalno i anatomski identičan biološkom. Tim se zahvatom u pravilu ugrađuju endoproteze kuka i koljena i to su izuzetno uspješne operacije. Materijali koji se koriste u njihovoj izradi su polietilenska plastika, medicinska keramika i određeni metali. Endoproteze mogu biti cementne i bescementne, s obzirom na način fiksacije. Kod cementnih se koristi posebni cement koji povezuje endoprotezu i kost, a bescementne imaju nepravilnu površinu u koju urasta koštano tkivo. Postoje i hibridni oblici kod kojih je jedan dio fiksiran cementom, a drugi bez. Slijedeća podjela je na parcijalne i totalne. Parcijalne mijenjaju jedno zglobno tijelo, a druga zglobna tijela ostaju biološka, dok totalne endoproteze mijenjaju sva zglobna tijela. Nakon artroplastike potrebna je rehabilitacija kako bi se bolesnik što prije mogao vratiti svakodnevnim aktivnostima. Ona započinje u bolnici, edukacijom bolesnika o ograničenjima i mogućnostima endoproteze, te učenjem obavljanja osnovnih stvari, poput odlaska na zahod sa štakama. Bolesnik se educira i o načinu hoda sa dvije, poslije i sa jednom štakom, te se sa fizioterapeutom pravi plan vježbanja kojeg se mora pridržavati. Svrha vježbe je poboljšati mišićnu snagu, propriocepciju i koordinaciju i samim time osigurati stabilnost endoproteze, smanjiti njezino trošenje, produljiti vijek trajanja i omogućiti pacijentu dobru kvalitetu života. Režim tjelovježbe treba zadržati i godinama nakon same operacije, da ne dođe do propadanja funkcije endoproteze. |
| Abstract (english) | Osteoarthritis is a chronic, progressive and degenerative disease of old age, with constantly increasing number of patients. It is initially characterized by the loss and deterioration of cartilage tissue, followed by degenerative changes that affect all of the joint bodies. Clinically, patients report pain, stiffness that disappears with exercise or movement, crepitations during movement, painful palpation of the joint, decreased range of motion, joint deformations, muscle atrophy and contractures. X-ray imaging can reveal narrowing of the joint space, osteophytes, subchondral bone sclerosis, cystic changes and bone and joint deformities. Clinical presentation of the disease does not have to match radiologic findings, but radiologic findings are used as criteria for diagnosis and to determine and plan surgical intervention. As a treatment of osteoarthritis, education, physical therapy, medications and surgery are available. Pharmacological treatments involve use of analgesics drugs, non-steroid anti-inflammatory drugs, intra-articular injections of glucocorticoids, with or without anesthetics and hyaluronate injections. Surgical treatment options can be palliative, causal, arthroplasty and arthrodesis. Palliative procedures are used to relive symptoms, while causal procedures remove deformities that can lead to osteoarthritis. Arthroplasty is the best method of choice in older patients and arthrodesis is used as a last resort, when arthroplasty fails. Arthroplasty is a surgical procedure that forms an artificial joint and resembles the biological joint both, anatomically and functionally. With this procedure, hip and knee replacement are usually performed and those are two extremely successful operations. Materials used to make endoprostheses are polyethylene plastic, medical ceramics and certain metals. Endoprostheses can be fixated in the bone using special medical cement, or without it. Endoprosthesis that doesn’t require cement has a rugged surface and bone tissue grows into it, holding it securely in place. Hybrid forms use cement on some parts, while other parts do not require it. There are also partial and total forms of endoprostheses. Partial endoprostheses replace only one joint body and total endoprostheses replace all joint bodies with artificial joint.
After arthroplasty, rehabilitation is needed in order to return the patient to his or hers daily routine. Rehabilitation begins in hospital, by educating the patient about limitations and possibilities of endoprosthesis and learning how to perform basic actions, such as going to the toilet with crutches, or walking with two and later with one crutch. Alongside physiotherapist, a workout plan is made and a patient has to stick with it. The point of the workout is to increase muscle strength, proprioception and coordination and by doing this, ensuring the stability of endoprosthesis. Workout routine should be preserved even a few years after the procedure, in order to prevent deterioration of the endoprosthesis. |
