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Pathophysiology and Clinical evaulation of Gonarthrosis

Year 2015, , 413 - 419, 01.11.2015
https://doi.org/10.5505/abantmedj.2015.04274

Abstract

Osteoarthritis is a complex process that involves whole joint cartilage degeneration, synovitis, osteophytes, capsuler hypertrophy and rupture of soft tissue elements besides playing a role inflamatuary mediators. Alignment and mechanical instability of the joints usually develops. All this process is accompanied by intermittent synovitis and local inflammation. Bare bones occur with periost inflammation caused by reconstruction in patients with OA. Source of pain in patients in terms of radiologically was not fully explained. Studies emerged that a direct correlation between radiographic findings and pain were found. One of the primary goals of treatment is to reduce pain. First recommendations for the patients are giving information and education of the patients, losing weight if being obesity and exercise. Paracetamol and non-steroidal anti-inflammatory agents NSAIDs are the most recommended drugs as medical treatment. If conservative treatment was not enough, surgery can be considered but the results is not always satisfactory.

References

  • 1. Felson DT, McLaughlin S, Goggins J, LaValley MP, Gale ME, Totterman S, Li W, Hill C, Gale D.Bone marrow edema and its relation to progression of knee steoarthritis. Ann Intern Med. 2003;139:330- 36.
  • 2. Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum. 2001;44:1237-47.
  • 3. Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, Kazis L, Gale DR.. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med. 2001;134:541- 9.
  • 4. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, Felson DT. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol. 2001;28:1330-7.
  • 5. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, Felson DT. Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without knee symptoms. Arthritis Rheum. 2003;48:2836-44.
  • 6. Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol. 2005;17:624-8.
  • 7. Geenen R, Bijlsma JW. Psychological management of osteoarthritic pain. Osteoarthritis Cartilage. 2010;18:873-5.
  • 8. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011 Sep;23(5):471-8.
  • 9. Ayral X, Pickering EH, Woodworth TG, Mackillop N, Dougados M. Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthritis Cartilage. 2005;13:361-7.
  • 10. Wyke B. The neurology of joints: a review of general principles. Clin Rheum Dis. 198;57:233-9.
  • 11. Pelletier JP, Caron JP, Evans C, Robbins PD, Georgescu HI, Jovanovic D, Fernandes JC, MartelPelletier J. In vivo suppression of early experimental osteoarthritis by interleukin-1 receptor antagonist using gene therapy. Arthritis Rheum. 1997; 40:1012-9.
  • 12. Wojtys EM, Beamann DN, Glover RA, Janda D. Innervation of the human knee joint by substance-P fibers. Arthroscopy. 1990;6:254-63.
  • 13. Kellgren JH, Samuel EP. The sensitivity and innervation of the articular capsule. J Bone Joint Surg Br. 1950;32:84-92.
  • 14. Arendt-Nielsen L, Eskehave TN, Egsgaard LL, Petersen KK, Graven-Nielsen T, Hoeck HC, Simonsen O, Siebuhr AS, Karsdal M, Bay-Jensen AC. Association Between Experimental Pain Biomarkers and Serological Markers in Patients With Different Degree of Painful Knee Osteoarthritis. Arthritis & Rheumatism. 2014;28.
  • 15. Klein T, Magerl W, Hopf HC, Sandkühler J, Treede RD. Perceptual correlates of nociceptive long-term potentiation and long-term depression in humans. J Neurosci. 2004;24:964-71.
  • 16. Lindh C, Liu Z, Lyrenas S, Ordeberg G, Nyberg F. Elevated cerebrospinal substance Plikeimmunoreactivity in patients with painful osteoarthritis, but not in patientswith rhizopatic pain from a herniated lumbar disc. Scand J Rheumatol. 1997;26:468-72.
  • 17. Konttinen YT, Kemppinen P, Segerberg M, Hukkanen M, Rees R, Santavirta S, Sorsa T, Pertovaara A, Polak JM. Peripheral and spinalneural mechanisms in arthritis, with particular reference to treatment of inflammation and pain. Arthritis Rheum. 1994;37:965-82.
  • 18. Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med. 2001; 344:907-16.
  • 19. Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, Song J, Cahue S, Chang A, Marshall M, Sharma L. The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthritis Cartilage. 2006;14:1033-40.
  • 20. Ashraf S, Walsh DA. Angiogenesis in osteoarthritis. Curr Opin Rheumatol 2008; 20:573- 80.
  • 21. Dieppe PA. Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365:9-73.
  • 22. Roos EM, Ostenberg A, Roos H, Ekdahl C, Lohmander LS. Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls. Osteoarthritis Cartilage. 2001;9:316-24.
  • 23. Assimakopoulos AP, Katonis PG, Agapitos MV, Exarchou EI. The innervation of the human meniscus. Clin Orthop Relat Res. 1992;275:232-6.
  • 24. Danzig L, Resnick D, Gonsalves M, Akeson WH. Blood supply to the normal and abnormal menisci of the human knee. Clin Orthop Relat Res. 1983;172:271-7.
  • 25. Sellam J, Herrero-Beaumont G, Berenbaum F. Osteoarthritis: pathogenesis, clinical aspects and diagnosis. BMJ Publishing Group. 2009:444-63.
  • 26. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27:1513-17.
  • 27. Wu PT, Shao CJ, Wu KC, Wu TT, Chern TC, Kuo LC, Jou IM. Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound. Osteoarthritis Cartilage. 2012;20:1507-13.
  • 28. Lo GH, McAlindon TE, Niu J, Zhang Y, Beals C, Dabrowski C, Le Graverand MP, Hunter DJ. Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2009;17:1562-69.
  • 29. Kornaat PR, Bloem JL, Ceulemans RY, Riyazi N, Rosendaal FR, Nelissen RG, Carter WO, Hellio Le Graverand MP, Kloppenburg M. Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology. 2006;239:811-7.
  • 30. Hunter DJ, Zhang W, Conaghan P, Conaghan PG, Hirko K, Menashe L, Li L, Reichmann WM, Losina E. Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage. 2011;19:557-88.
  • 31. Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Valgus Bracing for Knee Osteoarthritis: A Meta-analysis of Randomized Trials. Arthritis Care Res (Hoboken). 2014;8.
  • 32. Armagan O, Yilmazer S, Calısir C, Ozgen M, Tascioglu F, Oner S, Akcar N. Comparison of the symptomatic and chondroprotective effects of glucosamine sulphate and exercise treatments in patients with knee osteoarthritis. J Back Musculoskelet Rehabil. 2014;5.
  • 33. Durmus D, Alayli G, Bayrak IK, Canturk F. Assessment of the effect of glucosamine sulfate and exercise on knee cartilage using magnetic resonance imaging in patients with knee osteoarthritis: a randomized controlled clinical trial. J Back Musculoskelet Rehabil. 2012;25(4):275 -84.
  • 34. Silvers HJ. Viscosupplementation during rehabilitation. Sports Health. 2014 Sep;6(5):422 -6.
  • 35. Brown MT, Murphy FT, Radin DM, Davignon I, Smith MD, West CR. Tanezumab reduces osteoarthritic knee pain: results of a randomized, double -blind placebo -controlled phase III trial. J Pain. 2012;13:790 -8.
  • 36. Bruyere O, Cooper C, Pelletier JP, Branco J, Luisa Brandi M, Guillemin F, Hochberg MC, Kanis JA, Kvien TK, Martel -Pelletier J, Rizzoli R, Silverman S, Reginster JY. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2014;14:253 -63.
  • 37. Davis AM. Osteoarthritis year in review: rehabilitation and outcomes. Osteoarthritis Cartilage. 2012 Mar;20(3):201 -16.
  • 38. Carrie Silkman Baker, Jennifer Medina McKeon. Does Preoperative Rehabilitation Improve Patient - Based Outcomes in Persons Who Have Undergone Total Knee Arthroplasty? A Systematic Review. PM R. 2012;4:756 –67
  • 39. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH. Body Mass Index and Functional Mobility Outcome Following Early Rehabilitation after a Total Knee Replacement: A Retrospective Study in Taiwan. Arthritis Care Res (Hoboken). Arthritis Care Res. 2014;8:2 -32.
  • 40. Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Multicenter Arthroplasty Aftercare Project. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil. 2012;93(2):192 -9.
  • 41. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma -Zeinstra SM, Verhaar JA. Comparison of Closing -Wedge and Opening -Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis of the Knee: A Randomized Controlled Trial with a Six -Year Follow -up. J Bone Joint Surg Am. 2014;96(17):1425 -32.

Gonartozun patofizyolojisi ve klinik değerlendirilmesi

Year 2015, , 413 - 419, 01.11.2015
https://doi.org/10.5505/abantmedj.2015.04274

Abstract

Osteoartrit OA tüm eklemi tutan kıkırdak dejenerasyonu, sinovit, subkondral kemik oluşumu, kapsül hipertrofisi ve yumuşak doku rüptürlerinin yanında enflamatuar mediatörlerin de rol oynadığı kompleks bir süreçtir. Hastaların ekleminde genellikle dizilim ve mekanik dengesizlik gelişir. Tüm bu sürece aralıklı sinovit ve lokal inflamasyonda eşlik eder. OA’lı hastalarda kemiğin yeniden yapımı sonucu oluşan periost inflamasyonu ile çıplak kemik oluşur. Radyografik olarak OA hastalarında ağrı kaynağı tam olarak açıklanamamıştır. Yapılan araştırmalarda radyografik bulgularla ağrı arasında doğrudan bir korelasyon bulunamamıştır. OA tedavisinin primer amacı ağrıyı azaltmaktır. İlk yapılacak öneriler, hasta bilgilendirilmesi ve eğitimi, obez ise kilo verilmesi ve egzersizlerdir. Medikal tedavi olarak parasetamol ve non-steroid anti-İnflamatuar İlaçlar NSAİİ en çok tavsiye edilen ilaçlardır. Koruyucu tedaviler yeterli gelmediğinde cerrahi tedavi düşünülebilir ama sonuçlar her zaman yüz güldürücü değildir.

References

  • 1. Felson DT, McLaughlin S, Goggins J, LaValley MP, Gale ME, Totterman S, Li W, Hill C, Gale D.Bone marrow edema and its relation to progression of knee steoarthritis. Ann Intern Med. 2003;139:330- 36.
  • 2. Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum. 2001;44:1237-47.
  • 3. Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, Kazis L, Gale DR.. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med. 2001;134:541- 9.
  • 4. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, Felson DT. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol. 2001;28:1330-7.
  • 5. Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, Felson DT. Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without knee symptoms. Arthritis Rheum. 2003;48:2836-44.
  • 6. Felson DT. The sources of pain in knee osteoarthritis. Curr Opin Rheumatol. 2005;17:624-8.
  • 7. Geenen R, Bijlsma JW. Psychological management of osteoarthritic pain. Osteoarthritis Cartilage. 2010;18:873-5.
  • 8. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011 Sep;23(5):471-8.
  • 9. Ayral X, Pickering EH, Woodworth TG, Mackillop N, Dougados M. Synovitis: a potential predictive factor of structural progression of medial tibiofemoral knee osteoarthritis results of a 1 year longitudinal arthroscopic study in 422 patients. Osteoarthritis Cartilage. 2005;13:361-7.
  • 10. Wyke B. The neurology of joints: a review of general principles. Clin Rheum Dis. 198;57:233-9.
  • 11. Pelletier JP, Caron JP, Evans C, Robbins PD, Georgescu HI, Jovanovic D, Fernandes JC, MartelPelletier J. In vivo suppression of early experimental osteoarthritis by interleukin-1 receptor antagonist using gene therapy. Arthritis Rheum. 1997; 40:1012-9.
  • 12. Wojtys EM, Beamann DN, Glover RA, Janda D. Innervation of the human knee joint by substance-P fibers. Arthroscopy. 1990;6:254-63.
  • 13. Kellgren JH, Samuel EP. The sensitivity and innervation of the articular capsule. J Bone Joint Surg Br. 1950;32:84-92.
  • 14. Arendt-Nielsen L, Eskehave TN, Egsgaard LL, Petersen KK, Graven-Nielsen T, Hoeck HC, Simonsen O, Siebuhr AS, Karsdal M, Bay-Jensen AC. Association Between Experimental Pain Biomarkers and Serological Markers in Patients With Different Degree of Painful Knee Osteoarthritis. Arthritis & Rheumatism. 2014;28.
  • 15. Klein T, Magerl W, Hopf HC, Sandkühler J, Treede RD. Perceptual correlates of nociceptive long-term potentiation and long-term depression in humans. J Neurosci. 2004;24:964-71.
  • 16. Lindh C, Liu Z, Lyrenas S, Ordeberg G, Nyberg F. Elevated cerebrospinal substance Plikeimmunoreactivity in patients with painful osteoarthritis, but not in patientswith rhizopatic pain from a herniated lumbar disc. Scand J Rheumatol. 1997;26:468-72.
  • 17. Konttinen YT, Kemppinen P, Segerberg M, Hukkanen M, Rees R, Santavirta S, Sorsa T, Pertovaara A, Polak JM. Peripheral and spinalneural mechanisms in arthritis, with particular reference to treatment of inflammation and pain. Arthritis Rheum. 1994;37:965-82.
  • 18. Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med. 2001; 344:907-16.
  • 19. Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, Song J, Cahue S, Chang A, Marshall M, Sharma L. The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthritis Cartilage. 2006;14:1033-40.
  • 20. Ashraf S, Walsh DA. Angiogenesis in osteoarthritis. Curr Opin Rheumatol 2008; 20:573- 80.
  • 21. Dieppe PA. Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365:9-73.
  • 22. Roos EM, Ostenberg A, Roos H, Ekdahl C, Lohmander LS. Long-term outcome of meniscectomy: symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls. Osteoarthritis Cartilage. 2001;9:316-24.
  • 23. Assimakopoulos AP, Katonis PG, Agapitos MV, Exarchou EI. The innervation of the human meniscus. Clin Orthop Relat Res. 1992;275:232-6.
  • 24. Danzig L, Resnick D, Gonsalves M, Akeson WH. Blood supply to the normal and abnormal menisci of the human knee. Clin Orthop Relat Res. 1983;172:271-7.
  • 25. Sellam J, Herrero-Beaumont G, Berenbaum F. Osteoarthritis: pathogenesis, clinical aspects and diagnosis. BMJ Publishing Group. 2009:444-63.
  • 26. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27:1513-17.
  • 27. Wu PT, Shao CJ, Wu KC, Wu TT, Chern TC, Kuo LC, Jou IM. Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound. Osteoarthritis Cartilage. 2012;20:1507-13.
  • 28. Lo GH, McAlindon TE, Niu J, Zhang Y, Beals C, Dabrowski C, Le Graverand MP, Hunter DJ. Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2009;17:1562-69.
  • 29. Kornaat PR, Bloem JL, Ceulemans RY, Riyazi N, Rosendaal FR, Nelissen RG, Carter WO, Hellio Le Graverand MP, Kloppenburg M. Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology. 2006;239:811-7.
  • 30. Hunter DJ, Zhang W, Conaghan P, Conaghan PG, Hirko K, Menashe L, Li L, Reichmann WM, Losina E. Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage. 2011;19:557-88.
  • 31. Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Valgus Bracing for Knee Osteoarthritis: A Meta-analysis of Randomized Trials. Arthritis Care Res (Hoboken). 2014;8.
  • 32. Armagan O, Yilmazer S, Calısir C, Ozgen M, Tascioglu F, Oner S, Akcar N. Comparison of the symptomatic and chondroprotective effects of glucosamine sulphate and exercise treatments in patients with knee osteoarthritis. J Back Musculoskelet Rehabil. 2014;5.
  • 33. Durmus D, Alayli G, Bayrak IK, Canturk F. Assessment of the effect of glucosamine sulfate and exercise on knee cartilage using magnetic resonance imaging in patients with knee osteoarthritis: a randomized controlled clinical trial. J Back Musculoskelet Rehabil. 2012;25(4):275 -84.
  • 34. Silvers HJ. Viscosupplementation during rehabilitation. Sports Health. 2014 Sep;6(5):422 -6.
  • 35. Brown MT, Murphy FT, Radin DM, Davignon I, Smith MD, West CR. Tanezumab reduces osteoarthritic knee pain: results of a randomized, double -blind placebo -controlled phase III trial. J Pain. 2012;13:790 -8.
  • 36. Bruyere O, Cooper C, Pelletier JP, Branco J, Luisa Brandi M, Guillemin F, Hochberg MC, Kanis JA, Kvien TK, Martel -Pelletier J, Rizzoli R, Silverman S, Reginster JY. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2014;14:253 -63.
  • 37. Davis AM. Osteoarthritis year in review: rehabilitation and outcomes. Osteoarthritis Cartilage. 2012 Mar;20(3):201 -16.
  • 38. Carrie Silkman Baker, Jennifer Medina McKeon. Does Preoperative Rehabilitation Improve Patient - Based Outcomes in Persons Who Have Undergone Total Knee Arthroplasty? A Systematic Review. PM R. 2012;4:756 –67
  • 39. Liao CD, Huang YC, Lin LF, Huang SW, Liou TH. Body Mass Index and Functional Mobility Outcome Following Early Rehabilitation after a Total Knee Replacement: A Retrospective Study in Taiwan. Arthritis Care Res (Hoboken). Arthritis Care Res. 2014;8:2 -32.
  • 40. Liebs TR, Herzberg W, Rüther W, Haasters J, Russlies M, Hassenpflug J. Multicenter Arthroplasty Aftercare Project. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil. 2012;93(2):192 -9.
  • 41. Duivenvoorden T, Brouwer RW, Baan A, Bos PK, Reijman M, Bierma -Zeinstra SM, Verhaar JA. Comparison of Closing -Wedge and Opening -Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis of the Knee: A Randomized Controlled Trial with a Six -Year Follow -up. J Bone Joint Surg Am. 2014;96(17):1425 -32.
There are 41 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Bünyamin Koç This is me

İsmail Boyraz This is me

Hakan Sarman This is me

Publication Date November 1, 2015
Published in Issue Year 2015

Cite

APA Koç, B., Boyraz, İ., & Sarman, H. (2015). Gonartozun patofizyolojisi ve klinik değerlendirilmesi. Abant Medical Journal, 4(4), 413-419. https://doi.org/10.5505/abantmedj.2015.04274
AMA Koç B, Boyraz İ, Sarman H. Gonartozun patofizyolojisi ve klinik değerlendirilmesi. Abant Med J. November 2015;4(4):413-419. doi:10.5505/abantmedj.2015.04274
Chicago Koç, Bünyamin, İsmail Boyraz, and Hakan Sarman. “Gonartozun Patofizyolojisi Ve Klinik değerlendirilmesi”. Abant Medical Journal 4, no. 4 (November 2015): 413-19. https://doi.org/10.5505/abantmedj.2015.04274.
EndNote Koç B, Boyraz İ, Sarman H (November 1, 2015) Gonartozun patofizyolojisi ve klinik değerlendirilmesi. Abant Medical Journal 4 4 413–419.
IEEE B. Koç, İ. Boyraz, and H. Sarman, “Gonartozun patofizyolojisi ve klinik değerlendirilmesi”, Abant Med J, vol. 4, no. 4, pp. 413–419, 2015, doi: 10.5505/abantmedj.2015.04274.
ISNAD Koç, Bünyamin et al. “Gonartozun Patofizyolojisi Ve Klinik değerlendirilmesi”. Abant Medical Journal 4/4 (November 2015), 413-419. https://doi.org/10.5505/abantmedj.2015.04274.
JAMA Koç B, Boyraz İ, Sarman H. Gonartozun patofizyolojisi ve klinik değerlendirilmesi. Abant Med J. 2015;4:413–419.
MLA Koç, Bünyamin et al. “Gonartozun Patofizyolojisi Ve Klinik değerlendirilmesi”. Abant Medical Journal, vol. 4, no. 4, 2015, pp. 413-9, doi:10.5505/abantmedj.2015.04274.
Vancouver Koç B, Boyraz İ, Sarman H. Gonartozun patofizyolojisi ve klinik değerlendirilmesi. Abant Med J. 2015;4(4):413-9.