Şükrü GÜRBÜZ, Cemile AYŞE GÖRMELİ, Reşit SEVİMLİ, Gökay GÖRMELİ, Muharrem UCAR

Bilateral Knee Osteonecrosis After Intraarticular Concomitant Local Anesthetic and Corticosteroid Injection: A Case Report

Osteoartrit maluliyetin en önemli etkenlerinden biri olarak karşılaşabileceğimiz, en sık eklem hastalıkları formudur. Osteoartrit, eklem kıkırdağının dejenerasyonu, osteofit formasyonu ve subkondral kistler ile karakterizedir. Eklem kıkırdağının geniş olmadığı durumlarda konservatif tedavi tercih edilebilir. Klinisyenler tarafından tercih edilen konservatif tedavi yöntemlerden biri de lokal anestezik, kortikosteroid veya bunların her ikisinin birlikte kullanıldığı eklem içi enjeksiyonlardır. Mevcut literatür ve bizim deneyimlerimiz, eklem içi enjeksiyonların hasta memnuniyeti için olumlu etkilere sahip olduğunu göstermektedir. Eklem içi steroid uygulanımı osteoartritli hastalarda kısa dönemli ağrıyı giderir. Bu ilaçların ağrı ve maluliyeti azaltıcı etkisi olmasına rağmen kondrosit hasarına bağlı erken osteoartrit veya avasküler nekroz gibi yan etkileri de olmaktadır. Biz kortikosteroid ve lokal anestezik maddenin eklem içi enjeksiyonu sonrasında kısa dönem içerisine her iki dizde avasküler nekroz gözlenen bir olguyu sunmayı amaçladık.

Lokal Anestezik ve Kortikosteroidin Eklemiçi Birlikte Enjeksiyonu Sonrası Gelişen Bilateral Diz Osteonekrozu: Olgu Sunumu

Osteoarthritis is the most common form of joint diseases that represents the most notable basis of disability. Osteoarthritis is characterized by degeneration of the articular cartilage, osteophyte formation, and subchondral changes. Conservative treatment can be preferred if articular cartilage damage is not extensive. One of the non-operative preferred modality by the clinicians is the intraarticular injection therapy with local anesthetics, corticosteroids, or combination of both. The current literature and our experience indicate that intraarticular injections have positive effects for patient satisfaction. Intraarticular corticosteroid injections provide short term reduction in osteoarthritis pain. Although these drugs reduce pain and disability, they also have side affects such as chondrocyte damage that causes early osteoarthritis or avascular necrosis. We aim to present a case who developed bilateral knee avascular necrosis in a short time due to intrarticular injection of both corticosteroid and local anesthetics.

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Martel-Pelletier J, Boileau C, Pelletier JP, Roughley PJ. Cartilage in normal and osteoarthritis conditions. Best Pract Res Clin Rheumatol 2008;22:351-84.
D. T. Felson. "Epidemiology of hip and knee osteoarthritis "Epidemiologic Reviews 1988;10:1-28.
Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010;18:476-99.
Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2012;20:436-49.
Seshadri V, Coyle CH, Chu CR. Lidocaine potentiates the chondrotoxicity of methylprednisolone. Arthroscopy 2009;25:337-47.
Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty: a randomized trial. J Bone Joint Surg Am 2006;88:959-63.
Chu CR, Izzo NJ, Coyle CH, Papas NE, Logar A. The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 2008;90:814-20.
Dragoo JL, Korotkova T, Kanwar R, Wood B. The effect of local anesthetics administered via pain pump on chondrocyte viability. Am J Sports Med 2008;36:1484-88.
Olschewski A, Olschewski W, Brau ME, Hempelmann G, Vogel V, Safranov BV. Effect of bupivacaine on ATP dependent potassium channels in rat cardiomyocytes. British Journal of Anesthesia 1999;82:435-8.
Karpie JC, Chu CR. Lidocaine exhibits dose- and time- dependent cytotoxic effects on bovine articular chondrocytes in vitro. Am J Sports Med 2007;35:1621-7.
Mankin HJ, Conger KA. The acute effects of intra-articular hydrocortisone on articular cartilage in rabbits. J Bone Joint Surg Am 1966;48:1383-88.
Robion FC, Doizé B, Bouré L. Use of synovial fluid markers of cartilage synthesis and turnover to study effects of repeated intra-articular administration of methylprednisolone acetate on articular cartilage in vivo. J Orthop Res 2001;19:250-58.
Nakazawa F, Matsuno H, Yudoh K, Watanabe Y, Katayama R, Kimura T. Corticosteroid treatment induces chondrocyte apoptosis in an experimental arthritis model and in chondrocyte cultures. Clin Exp Rheumatol 2002;20:773-81.
Farkas B, Kvell K, Czömpöly T, Illés T, Bárdos T. Increased chondrocyte death after steroid and local anesthetic combination. Clin Orthop Relat Res 2010;468:3112-20.
Maricar N, Callaghan MJ, Felson DT, O'Neill TW. Predictors of response to intra-articular steroid injections in knee osteoarthritis--a systematic review. (Oxford) 2013;52:1022-32. Rheumatology
McArthur BA, Dy CJ, Fabricant PD, Valle AG. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Prefer Adherence 2012,6:905-10.