5 Rawatan Penyakit Lutut Osteoarthritis Tanpa Pembedahan. Disediakan oleh Dr. Sanjiv Rampal, Pakar Tulang Kuala Lumpur

▪Dr Sanjiv my parents are having difficulty kneeling to do daily prayers

• Dr. Sanjiv, ibu/bapa saya menghadapi kesukaran untuk melutut semasa sembahyang

▪Doctor I am unable to walk around my neighborhood like I used to?

• Doktor, saya tidak dapat berjalan-jalan di taman perumahan saya seperti dahulu.

▪Prof I develop a weird deep aching kind of pain, especially when standing or walking for a bit

• Prof, saya mengalami kesakitan yang perit semasa berdiri dan berjalan.

▪Doc I have been having this pain over the front bone of the knee especially after jumping and trekking exercise

• Doktor, saya mengalami kesakitan lutut dibahagian hadapan selepas saya melakukan activiti senaman seperti melompat dan meredah hutan.

Knee pain is a common complaint among adults. It is often associated with general wear and tear from daily activities like walking, bending, standing, and lifting. It is estimated roughly 1 in every 5 adults would have some form of chronic pain in their later years.

Dianggarkan 1 daripada 5 orang dewasa menghidapi masalah sakit sendi lutut yang berpunca dari kehausan penggunaan fungsi lutut itu sendiri disebabkan oleh aktiviti seharian seperti berjalan, berdiri, mengangkat berat dan sebagainya.

Osteoarthritis (OA) is one of the most common types of arthritis that affects 100 million people globally. Knee OA remain among the most common musculoskeletal patient complaint in Malaysian clinical setting. Questions like the above are common questions asked by our patients locally.

Penyakit Osteoarthritis merupakan keradangan sendi yang dihidapi oleh 100 juta orang di dunia. Penyakit tersebut menyumbang kepada masalah lutut yang sering diajukan kepada doktor di Malaysia, dan di atas merupakan aduan lazim pesakit.

Risk factors with strong evidence for OA onset and/or progression include age, sex, socioeconomic status, obesity, family history, joint injury, joint alignment, and occupational joint loading.

Faktor menyumbang kepada osteoarthritis adalah seperti; umur, jantina, sosioekonomi, pekerjaan, berat badan, keturunan, kecederaan yang lalu, penjajaran sendi yang tidak normal.

1. OA involves the whole joint which includes structural alteration of the knee joint

1. Osteoarthritis merangkumi perubahan struktur tulang lutut.

2. It is an active and dynamic cartilage composition change that arises from an imbalance between the repair and destruction of joint tissues

2. Ia merupakan proses perubahan komposisi yang dinamik di mana kesembuhan tulang tidak selari dengan kecederaan yang di alami.

If you are in young mid 60s and have knee pain and stiffness. Have no fear as its relatively common in your age group.

Sekiranya anda diperingkat pertengahan umur 60 tahun dan menghidapi sakit sendi lutut, perkara ini biasa terjadi kepada golongan seperti anda dan anda tidak perlu risau.

Treatment of osteoarthritis often depends on a multitude of factors including factors like severity of pain, duration of pain and other clinical factors. The treatment of this chronic condition has evolved over time and has improved clinical outcomes. Not all patients that have chronic osteoarthritis would require surgery. The non-surgical option is often 1st line in the treatment of knee osteoarthritis and the only option in surgically not fit patients. These evidence-based methods of treatment of knee osteoarthritis would include

▪Pain management- A short course of NSAIDS and Acetaminophen. Tropical NSAIDS recommended

▪ Supervised Physical and physiotherapy including the use of thermotherapy, knee bracing and mind training

▪ Self-Management Programs – muscle tone, muscle training and functional adaptation

▪ Offloading the knee joint with the use of a walking aid or cane.

▪Early lifestyle modification especially weight loss and increasing muscle tone and physical activity

Rawatan osteoarthritis bergantung kepada beberapa faktor seperti, tahap kesakitan, durasi kesakitan dan lain-lain. Sejajar dengan kemajuan ilmu perubatan, kini, pesakit kronik yang mengalami masalah lutut, boleh mendapatkan rawatan susulan di klinik atau hospital dan tidak semestinya perlu menjalani pembedahan implan lutut untuk menyelesaikan masalah tersebut. Bahkan, rawatan tanpa pembedahan merupakan rawatan awal yang akan diberikan kepada pesakit dan juga kepada golongan yang tidak boleh menjalani pembedahan. Berikut merupakan kaedah rawatan awal menangani penyakit osteoarthritis:

• Pemberian ubat tahan sakit bukan steroid seperti pil atau krim sapuan.

• Terapi fisio seperti regangan lutut, tuaman panas dan latihan minda.

• Program pengurusan adaptasi otot

• Penggunaan alat bantuan berjalan seperti tongkat

• Perubahan cara hidup untuk penurunan berat badan dan menguatkan otot

Current literature and guidelines would recommend weight reduction, a short course of oral and topical NSAIDs, supervised physical therapy, self-management and if needed an Intraarticular steroid injection.

Garis panduan untuk rawatan osteoarthritis adalah pengurangan berat badan, pengambilan ubat tahan sakit atau sapuan ubat bukan steroid, fisio terapi, pengurusan diri dan jika perlu, suntikan steroid pada lutut.

There is limited evidence of the effectiveness of the recommended use of supplements including glucosamine chondroitin sulphate, curcumin powder tablets, Hyaluronic acid injection, and Plasma rich Platelet injection.

Terdapat bukti terhad akan keberkesanan pengambilan makanan tambahan seperti glucosamine, chondroitin sulphate, serbuk curcumin atau suntikan asid hyaluronik dan PRP (plasma kaya platelet) dalam membantu merawat penyakit osteoarthritis.

It cannot be over-emphasized here that the best treatment for OA after a trial of conservative treatment which is safe and cost-effective is total knee replacement. It is a relatively short surgery that promises good long-term pain relief and maintenance of a functional range of motion.

Sekiranya rawatan menggunakan kaedah konservatif seperti pengambilan ubat dan fisio terapi masih tidak berjaya mengurangkan kesakitan, pembedahan implan lutut (total knee replacement), adalah alternatif terbaik dan selamat untuk mengatasi masalah pesakit. Kos pembedahan adalah efektif untuk memberikan kelegaan kepada pesakit untuk jangka masa yang panjang.

References

1. Management of Osteoarthritis of the
   Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline
   Adopted by: The American Academy of Orthopaedic Surgeons Board of Directors