title: Treatment of advanced stage gonarthrosis with prolotherapy: case report.
abstract: BACKGROUND
  This case report aims to discuss the clinical and radiological outcomes of prolotherapy at a patient whom to total knee prosthesis had been planned but surgery couldn't be performed due to co-morbidities.
  
  
  METHODS
  A 72 year old woman presented with severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was applied to measure the osteoarthritis level of the patient: Pain level; 25 points, stiffness level; 10 points, Physical function loss; 80 points, and total WOMAC 115 points. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing. Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly.
  
  
  CONCLUSIONS
  Significant improvement was noted at WOMAC scale (Pain level; 5 points, stiffness level; 2 points, Physical function loss; 15 points, and total WOMAC 22 points). Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year. Our case is the report that presents radiological evidence in addition to clinical findings of improvement of osteoarthritis level. As a result of this case report, further studies aiming to offer a different minimally invasive treatment option to the patients before surgery may be performed. We are in the opinion that prolotherapy may be preferred more commonly as an efficient method once the importance of ligamentous structures at pathogenesis of osteoarthritis is established.
authors.affiliation: Turkey Proloteraphy and Pain Clinic, Istanbul, Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Solmaz
authors.affiliation: Department of Anesthesiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Deniz
authors.affiliation: Gumussuyu Military Hospital, Istanbul, Turkey.
authors.forename: Onder Taylan
authors.initials: OT
authors.lastname: Cifci
keywords: Degeneration; Osteoarthritis, Knee; Treatment