Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism

Amaç: Diz osteoartriti (OA) sık görülen ve neden olduğu ağrı ve sakatlık sonucunda sosyoekonomik yük bindiren bir hastalıktır. Türkiye Romatizma Araştırma ve Savaş Derneği (TRASD) OA tedavisi ile uğraşan hekimlere günlük klinik uygulamalarında yardımcı olmak amacıyla, uzman görüşleri ile desteklenmiş, ulusal "diz osteoartrit tedavisinde kanıta dayalı önerileri" hazırlamak için bir proje başlatmıştır.Gereç ve yöntemler: Uzmanlar komitesi 23'ü fiziksel tıp rehabilitasyon (FTR) uzmanı (üçü ayrıca romatoloji yan dal uzmanı) ikisi ise ortopedi ve travmatoloji uzmanı olan 25 akademisyenden oluşturulmuştur. İlk toplantıda konu ile ilgili önceden yayınlanmış rehberler üzerinde tartışılmış ve 2008 Osteoarthritis Research Society International (OARSI) önerilerinin ulusal öneriler için temel şablon olarak kullanılmasına karar verilmiştir. Literatür taraması için Pubmed, Embase, Cochrane ve Türk Tıp Dizini veritabanları kullanılmış olup, uluslararası taramalar için, 2009 yılına kadar yayınlanmış çalışmaların 2010 OARSI güncellemesinde yer almasından dolayı, 2009-2010 yıllarını kapsayacak bir süre kısıtlaması yapılmıştır. Ulusal yayınların taranması için tarih sınırlaması yapılmamıştır. Konuyla ilgili çalışmalar arasından seçilen makaleler kanıt düzeyi ve kalite açısından derecelendirilmiş, uzmanlar kurulu üyelerine gönderilerek kendilerinden mevcut kanıtlar ve kendi bilgi ve deneyimleri ışığında tedavi önerileri hazırlamaları istenmiştir. Hazırlanan öneriler bir araya getirilmiş, düzeltmeler yapılmış, sonrasında Delphi turları başlatılmıştır. Beş Delphi turu sonunda, üzerinde görüş birliği sağlanan öneriler son toplantıda kanıtlar ışığında tartışılmış ve vizüel analog skala (VAS) üzerinden değerlendirilerek her bir öneri için "öneri gücü" belirlenmiştir.Bulgular: Delphi turları sonucunda, üzerinde görüş birliği sağlanmış olan 19 öneri (biri genel prensip, dokuzu nonfarmakolojik, yedisi farmakolojik ve ikisi cerrahi tedaviler ile ilgili olmak üzere) "TRASD Diz Osteoartriti Kanıta Dayalı Tedavi Önerileri" olarak kabul edilmiştir.Sonuç: TRASD tarafından, ülkemizde diz OA'sı ile ilgili ilk kanıta-dayalı tedavi önerileri oluşturulmuştur. Bu önerilerin yeni kanıtlar ve görüşler ışığında düzenli olarak güncellenmesi gerekmektedir. Bu önerilerin, diz OA'sı ile ilgilenen hekimlerin günlük pratiklerine katkısı olacağı beklenmektedir

Anahtar Kelime:

Konular: Romatoloji

Diz Osteoartrit Tedavisinde Kanıta Dayalı Öneriler:Türkiye Romatizma Araştırma ve Savaş Derneği Uzlaşı Raporu

Öz:

Objectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, "evidence-based recommendations for the management of knee osteoarthritis" supported by expert- opinion in order to assist the physicians who are interested in knee OA in their daily clinical practice. Materials and methods: The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the "strength of recommendation" was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting. Results: Nineteen propositions (one for general principles, nine for non- pharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the "TLAR Evidence-Based Recommendations for the Management of Knee OA" in consensus as a result of Delphi rounds. Conclusion: Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice.

Anahtar Kelime:

Konular: Romatoloji

Belge Türü: Makale Makale Türü: Diğer Erişim Türü: Erişime Açık

Kaçar C, Gilgil E, Urhan S, Arikan V, Dündar U, Oksüz MC, et al. The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol Int 2005;25:201-4.
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62.
Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62:1145-55.
Conaghan PG, Dickson J, Grant RL; Guideline Development Group. Care and management of osteoarthritis in adults: summary of NICE guidance. BMJ 2008;336:502-3.
American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the treatment of Osteoarthritis of the Knee(nonarthroplasty). Rosemaont (IL): American Academy of Orthopaedic Surgeons; 2008.
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.
Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines: developing guidelines. BMJ 1999;318:593-6.
Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol 1991;44:1271-8.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage 2007;15:981-1000.
Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452-4.
Bezalel T, Carmeli E, Katz-Leurer M. The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: a parallel randomised single-blind clinical trial. Physiotherapy 2010;96:137-43.
Vrezas I, Elsner G, Bolm-Audorff U, Abolmaali N, Seidler A. Case-control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload. Int Arch Occup Environ Health 2010;83:291-300.
Riecke BF, Christensen R, Christensen P, Leeds AR, Boesen M, Lohmander LS, et al. Comparing two low- energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial. Osteoarthritis Cartilage 2010;18:746-54.
Bliddal H, Leeds AR, Stigsgaard L, Astrup A, Christensen R. Weight loss as treatment for knee osteoarthritis symptoms in obese patients: 1-year results from a randomised controlled trial. Ann Rheum Dis 2011;70:1798-803.
Klussmann A, Gebhardt H, Nübling M, Liebers F, Quirós Perea E, Cordier W, et al. Individual and occupational risk factors for knee osteoarthritis: results of a case-control study in Germany. Arthritis Res Ther 2010;12:R88.
Pisters MF, Veenhof C, Schellevis FG, De Bakker DH, Dekker J. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Osteoarthritis Cartilage 2010;18:1019-26.
Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial. Phys Ther 2010;90:356-66.
Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum 2009;61:1545-53.
Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Arch Phys Med Rehabil 2009;90:388-94.
Jan MH, Lin CH, Lin YF, Lin JJ, Lin DH. Effects of weight- bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil 2009;90:897-904.
Jenkinson intervention CM, Doherty M, Avery AJ, Read A, Taylor MA, Sach TH, et al. Effects of dietary and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial. BMJ 2009;339:b3170.
Yakut E, Yağlı VN, Akdoğan A, Kiraz S. Diz osteoartriti olan hastalarda Pilates egzersizlerinin rolü: bir pilot çalışma. Fizyoterapi Rehabilitasyon 2006;17:51-60.
Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clin Rheumatol 2007;26:520-8.
Karakuş D, Ersöz M, Eser F, Karaoğlan B, Kurtaran A. Diz osteoartriti olgularında konsantrik kuadriseps-hamstring ve konsantrik-eksantrik kuadriseps izokinetik egzersiz programlarının ağrı, fonksiyonel kapasite ve kuadriseps gücüne etkisi. Turk J Phys Med Rehab 2003;49:3-7.
Sallı A, Uğurlu H, Emlik D. Diz osteoartritinde konsantrik, kombine konsantrik-eksantrik ve izometrik egzersizlerin semptomlar ve fonksiyonel kapasite üzerine etkinliğinin karşılaştırılması. Turk J Phys Med Rehab 2006;52:61-7.
Jones A, Silva PG, Silva AC, Colucci M, Tuffanin A, Jardim JR, et al. Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial. Ann Rheum Dis 2012;71:172-9.
Beaudreuil J, Bendaya S, Faucher M, Coudeyre E, Ribinik P, Revel M, et al. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis. Joint Bone Spine 2009;76:629-36.
Kozakçıoğlu M, Akı S, Karan A, Aksoy C, Eskiyurt N, Berker E. Patella femoral eklem osteoartrit tedavisinde farklı bir yaklaşım: Patellanın bandajlanması Turk J Phys Med Rehab 1997;11:168-70.
Koca B, Öz B, Ölmez N, Memiş A. Effect of lateral wedge shoe insoles on pain and function in patients with knee osteoarthritis. Turk J Phys Med Rehab 2009;55:158-62.
van Raaij TM, Reijman M, Brouwer RW, Bierma-Zeinstra SM, Verhaar JA. Medial knee osteoarthritis treated by insoles or braces: a randomized trial. Clin Orthop Relat Res 2010;468:1926-32.
Gürer G, Şendur OF, Ay C. Diz osteoartrtritli hastalarda fizik tedavinin ağrı ve günlük yaşam aktivitesine etkileri. Rheumatism 2005;20:33-7.
Seçkin U, Çakar E, Özdemir B, Kıralp MZ, Dursun H. Comparison of effects of combined physical therapy program and exercise on corrupted balance functions in patients with knee bilateral osteoarthritis. Rheumatism 2008;23:9-13.
Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev 2009;CD002823.
Kitay GS, Koren MJ, Helfet DL, Parides MK, Markenson JA. Efficacy of combined local mechanical vibrations, continuous passive motion and thermotherapy in the management of osteoarthritis of the knee. Osteoarthritis Cartilage 2009;17:1269-74.
Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2010;CD003132.
Loyola-Sánchez A, Richardson J, MacIntyre NJ. Efficacy of ultrasound therapy for the management of knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage 2010;18:1117-26.
Kalpakçıoğlu BA, Çakmak B, Bahadır C. Comparison of ultrasound and short wave diathermy terapy in knee osteoarthritis. Turk J Phys Med Rehab 2006;52:168-73.
Ozgönenel L, Aytekin E, Durmuşoglu G. A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. Ultrasound Med Biol 2009;35:44-9.
Külcü Geler D, Gülşen G, Altınok EÇ. Short term efficacy of pulsed electromagnetic field therapy on pain and functional level in knee osteoarthritis: A randomised controlled study. Turk J Rheumatol 2009;24:144-8.
Vavken P, Arrich F, Schuhfried O, Dorotka R. Effectiveness of pulsed electromagnetic field therapy in the management of osteoarthritis of the knee: a meta-analysis of randomized controlled trials. J Rehabil Med 2009;41:406-11.
Ozgüçlü E, Cetin A, Cetin M, Calp E. Additional effect of pulsed electromagnetic field therapy on knee osteoarthritis treatment: a randomized, placebo-controlled study. Clin Rheumatol 2010;29:927-31.
Madenci E, Gürsoy S, Büyükbese IA. Diz osteoartritli olgularda iyontofores ve fonoferez yöntemlerinin etkinliklerinin ve yaşam kalitesine olan etkilerinin karşılaştırılması. Romatoloji ve Tıbbi Rehabilitasyon Dergisi 2002;13:98-101.
Yıldırım K, Karatay S, Şişecioğlu M, Uğur M, Şenel K. Diz osteoartritli hastaların tedavisinde iyontoforez ve fonoferez. Turk J Phys Med Rehab 2004;50:13-6.
Kocaman Ö, Koyuncu H, Dinç A, Toros H, Karamehmetoğlu ŞS. The comparison of the effects of electrical stimulation and exercise in the treatment of knee osteoarthritis. Turk J Phys Med Rehab 2008;54:54-8.
Naragi M, Aksoy C, Ketenci A, Karan A. Diz osteoartritinin rehabilitasyonunda nöromuskuler elektrik stimülasyon ve ev egzersiz programının kantitatif kas güçlendirilmesi ve fonksiyonel iyileşme yönünden karşılaştırılması. Turk J Phys Med Rehab 1998;1:58-61.
Birtane M, Pekindil Y, Sarıkaya A, Kokino S. Isometric exercise on quadriceps muscle by 99m Tc Sestamibi scintigraphy. Turk J Phys Med Rehab 2001;47:20-7.
Monaghan B, Caulfield B, O'Mathşna DP. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement. Cochrane Database Syst Rev 2010;CD007177.
Harzy T, Ghani N, Akasbi N, Bono W, Nejjari C. Short- and long-term therapeutic effects of thermal mineral waters in knee osteoarthritis: a systematic review of randomized controlled trials. Clin Rheumatol 2009;28:501-7.
Forestier R, Desfour H, Tessier JM, Françon A, Foote AM, Genty C, et al. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis 2010;69:660-5.
Kiliçoğlu O, Dönmez A, Karagülle Z, Erdoğan N, Akalan E, Temelli Y. Effect of balneotherapy on temporospatial gait characteristics of patients with osteoarthritis of the knee. Rheumatol Int 2010;30:739-47.
Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010;CD001977.
Hawker GA, Mian S, Bednis K, Stanaitis I. Osteoarthritis year 2010 in review: non-pharmacologic therapy. Osteoarthritis Cartilage 2011;19:366-74.
Rahme E, Barkun A, Nedjar H, Gaugris S, Watson D. Hospitalizations for upper and lower GI events associated with traditional NSAIDs and acetaminophen among the elderly in Quebec, Canada. Am J Gastroenterol 2008;103:872-82.
Curhan GC, Knight EL, Rosner B, Hankinson SE, Stampfer MJ. Lifetime nonnarcotic analgesic use and decline in renal function in women. Arch Intern Med 2004;164:1519-24.
Benson M, Marangou A, Russo MA, Durocher J, Collaku A, Starkey YY. Patient preference for sustained-release versus standard paracetamol (acetaminophen): a multicentre, randomized, open-label, two-way crossover study in subjects with knee osteoarthritis. J Int Med Res 2009;37:1321-35.
Borman P, Kutsal YG. Diz osteoartritli hastaların tedavisinde diflünisal etkinliği. Fiziksel Tıp 1999;2:25-7.
Kim J, Lee EY, Koh EM, Cha HS, Yoo B, Lee CK, et al. Comparative clinical trial of S-adenosylmethionine versus nabumetone for the treatment of knee osteoarthritis: an 8-week, multicenter, randomized, double-blind, double- dummy, Phase IV study in Korean patients. Clin Ther 2009;31:2860-72.
Schnitzer TJ, Kivitz A, Frayssinet H, Duquesroix B. Efficacy and safety of naproxcinod in the treatment of patients with osteoarthritis of the knee: a 13-week prospective, randomized, multicenter study. Osteoarthritis Cartilage 2010;18:629-39.
de Boer TN, Huisman AM, Polak AA, Niehoff AG, van Rinsum AC, Saris D, et al. The chondroprotective effect of selective COX-2 inhibition in osteoarthritis: ex vivo evaluation of human cartilage tissue after in vivo treatment. Osteoarthritis Cartilage 2009;17:482-8.
Bjordal JM, Klovning A, Ljunggren AE, Slİrdal L. Short- term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. Eur J Pain 2007;11:125-38.
Chevalier X, Jerosch J, Goupille P, van Dijk N, Luyten FP, Scott DL, et al. Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial. Ann Rheum Dis 2010;69:113-9.
Shimizu M, Higuchi H, Takagishi K, Shinozaki T, Kobayashi T. Clinical and biochemical characteristics after intra-articular injection for the treatment of osteoarthritis of the knee: prospective randomized study of sodium hyaluronate and corticosteroid. J Orthop Sci 2010;15:51-6.
Jİrgensen A, Stengaard-Pedersen K, Simonsen O, Pfeiffer- Jensen M, Eriksen C, Bliddal H, et al. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double- blind study of 337 patients followed for 1 year. Ann Rheum Dis 2010;69:1097-102.
Bütün B, Kacar C, Evcik D. Intraarticular injection of sodium hyaluronate in the treatment of knee osteoarthritis. Rheumatism 2002;17:31-8.
Sezgin M, Demirel AÇ, Ortancıl Ö, Karaca C, Çınar C, Çakçı A. The efficacy of hyaluronan treatment on the knee osteoarthritis with effusion: one year placebo controlled trial. Rheumatism 2003;18:133-9.
Diracoglu D, Vural M, Baskent A, Dikici F, Aksoy C. The effect of viscosupplementation on neuromuscular control of the knee in patients with osteoarthritis. J Back Musculoskelet Rehabil 2009;22:1-9.
Persiani S, Rotini R, Trisolino G, Rovati LC, Locatelli M, Paganini D, et al. Synovial and plasma glucosamine concentrations in osteoarthritic patients following oral crystalline glucosamine sulphate at therapeutic dose. Osteoarthritis Cartilage 2007;15:764-72.
Towheed TE, Maxwell L, Anastassiades TP, Shea B, Houpt J, Robinson V, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2005;CD002946.
Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis. Rheumatol Int 2010;30:357-63.
Hochberg MC. Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration. Osteoarthritis Cartilage 2010;18 Suppl 1:S28-31.
Kahan A, Uebelhart D, De Vathaire F, Delmas PD, Reginster JY. Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2009;60:524-33.
Sawitzke AD, Shi H, Finco MF, Dunlop DD, Bingham CO 3rd, Harris CL, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/ chondroitin arthritis intervention trial. Arthritis Rheum 2008;58:3183-91.
Wen ZH, Tang CC, Chang YC, Huang SY, Hsieh SP, Lee CH, et al. Glucosamine sulfate reduces experimental osteoarthritis and nociception in rats: association with changes of mitogen-activated protein kinase in chondrocytes. Osteoarthritis Cartilage 2010;18:1192-202.
Petersen SG, Saxne T, Heinegard D, Hansen M, Holm L, Koskinen S, et al. Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training. Osteoarthritis Cartilage 2010;18:34-40.
Sawitzke AD, Shi H, Finco MF, Dunlop DD, Harris CL, Singer NG, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis 2010;69:1459-64.
Bruyere O, Pavelka K, Rovati LC, Gatterová J, Giacovelli G, Olejarová M, et al. Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials. Osteoarthritis Cartilage 2008;16:254-60.
Dostrovsky NR, Towheed TE, Hudson RW, Anastassiades TP. The effect of glucosamine on glucose metabolism in humans: a systematic review of the literature. Osteoarthritis Cartilage 2011;19:375-80.
Volpi N. Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. J Pharm Pharmacol 2009;61:1271-80.
Avouac J, Gossec L, Dougados M. Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2007;15:957-65.
Kean WF, Bouchard S, Roderich Gossen E. Women with pain due to osteoarthritis: the efficacy and safety of a once- daily formulation of tramadol. Pain Med 2009;10:1001-11.
Nüesch E, Rutjes AW, Husni E, Welch V, Jüni P. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2009;CD003115.
Brouwer RW, Raaij van TM, Bierma-Zeinstra SM, Verhagen AP, Jakma TS, Verhaar JA. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 2007;CD004019.
Griffin T, Rowden N, Morgan D, Atkinson R, Woodruff P, Maddern G. Unicompartmental knee arthroplasty for the treatment of unicompartmental osteoarthritis: a systematic study. ANZ J Surg 2007;77:214-21.
Dettoni F, Bonasia DE, Castoldi F, Bruzzone M, Blonna D, Rossi R. High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature. Iowa Orthop J 2010;30:131-40.
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg [Am] 2003;85-A:259-65.
Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg [Am] 2004;86:963-74.
Lingard EA, Katz JN, Wright EA, Sledge CB; Kinemax Outcomes Group. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg [Am] 2004;86:2179-86.
Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009;169:1113-21.

APA	tuncer t, ÇAY H, KAÇAR C, ALTAN İNCEOĞLU L, ATİK O, AYDIN A, AYHAN F, ÇÖREKÇİ YANIK B, DURMAZ B, eskiyurt n, Genc H, GÖKÇE KUTSAL Y, GUNAYDIN R, HEPGÜLER A, HİZMETLİ S, Kaya T, KURTAİŞ Y, ÖLMEZ N, SARIDOĞAN F, SİNDEL D, SONEL TUR B, SÜTBEYAZ S, ŞENDUR Ö, UĞURLU H, ünlü z (2012). Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. , 1 - 17.
Chicago	tuncer tiraje,ÇAY Hasan Fatih,KAÇAR Cahit,ALTAN İNCEOĞLU LALE,ATİK Osman Şahap,AYDIN Ahmet Turan,AYHAN F. Figen,ÇÖREKÇİ YANIK Burcu,DURMAZ Berrin,eskiyurt nurten,Genc Hakan,GÖKÇE KUTSAL Yeşim,GUNAYDIN Rezzan,HEPGÜLER ASİYE SİMİN,HİZMETLİ Sami,Kaya Taciser,KURTAİŞ Yeşim,ÖLMEZ Neşe,SARIDOĞAN FEVZİYE MERİH,SİNDEL Dilşad,SONEL TUR BİRKAN,SÜTBEYAZ Serap,ŞENDUR Ömer Faruk,UĞURLU Hatice,ünlü zeliha Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. (2012): 1 - 17.
MLA	tuncer tiraje,ÇAY Hasan Fatih,KAÇAR Cahit,ALTAN İNCEOĞLU LALE,ATİK Osman Şahap,AYDIN Ahmet Turan,AYHAN F. Figen,ÇÖREKÇİ YANIK Burcu,DURMAZ Berrin,eskiyurt nurten,Genc Hakan,GÖKÇE KUTSAL Yeşim,GUNAYDIN Rezzan,HEPGÜLER ASİYE SİMİN,HİZMETLİ Sami,Kaya Taciser,KURTAİŞ Yeşim,ÖLMEZ Neşe,SARIDOĞAN FEVZİYE MERİH,SİNDEL Dilşad,SONEL TUR BİRKAN,SÜTBEYAZ Serap,ŞENDUR Ömer Faruk,UĞURLU Hatice,ünlü zeliha Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. , 2012, ss.1 - 17.
AMA	tuncer t,ÇAY H,KAÇAR C,ALTAN İNCEOĞLU L,ATİK O,AYDIN A,AYHAN F,ÇÖREKÇİ YANIK B,DURMAZ B,eskiyurt n,Genc H,GÖKÇE KUTSAL Y,GUNAYDIN R,HEPGÜLER A,HİZMETLİ S,Kaya T,KURTAİŞ Y,ÖLMEZ N,SARIDOĞAN F,SİNDEL D,SONEL TUR B,SÜTBEYAZ S,ŞENDUR Ö,UĞURLU H,ünlü z Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. . 2012; 1 - 17.
Vancouver	tuncer t,ÇAY H,KAÇAR C,ALTAN İNCEOĞLU L,ATİK O,AYDIN A,AYHAN F,ÇÖREKÇİ YANIK B,DURMAZ B,eskiyurt n,Genc H,GÖKÇE KUTSAL Y,GUNAYDIN R,HEPGÜLER A,HİZMETLİ S,Kaya T,KURTAİŞ Y,ÖLMEZ N,SARIDOĞAN F,SİNDEL D,SONEL TUR B,SÜTBEYAZ S,ŞENDUR Ö,UĞURLU H,ünlü z Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. . 2012; 1 - 17.
IEEE	tuncer t,ÇAY H,KAÇAR C,ALTAN İNCEOĞLU L,ATİK O,AYDIN A,AYHAN F,ÇÖREKÇİ YANIK B,DURMAZ B,eskiyurt n,Genc H,GÖKÇE KUTSAL Y,GUNAYDIN R,HEPGÜLER A,HİZMETLİ S,Kaya T,KURTAİŞ Y,ÖLMEZ N,SARIDOĞAN F,SİNDEL D,SONEL TUR B,SÜTBEYAZ S,ŞENDUR Ö,UĞURLU H,ünlü z "Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism." , ss.1 - 17, 2012.
ISNAD	tuncer, tiraje vd. "Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism". (2012), 1-17.

APA	tuncer t, ÇAY H, KAÇAR C, ALTAN İNCEOĞLU L, ATİK O, AYDIN A, AYHAN F, ÇÖREKÇİ YANIK B, DURMAZ B, eskiyurt n, Genc H, GÖKÇE KUTSAL Y, GUNAYDIN R, HEPGÜLER A, HİZMETLİ S, Kaya T, KURTAİŞ Y, ÖLMEZ N, SARIDOĞAN F, SİNDEL D, SONEL TUR B, SÜTBEYAZ S, ŞENDUR Ö, UĞURLU H, ünlü z (2012). Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. Turkish Journal of Rheumatology(.)Archives of Rheumatology, 27(1), 1 - 17.
Chicago	tuncer tiraje,ÇAY Hasan Fatih,KAÇAR Cahit,ALTAN İNCEOĞLU LALE,ATİK Osman Şahap,AYDIN Ahmet Turan,AYHAN F. Figen,ÇÖREKÇİ YANIK Burcu,DURMAZ Berrin,eskiyurt nurten,Genc Hakan,GÖKÇE KUTSAL Yeşim,GUNAYDIN Rezzan,HEPGÜLER ASİYE SİMİN,HİZMETLİ Sami,Kaya Taciser,KURTAİŞ Yeşim,ÖLMEZ Neşe,SARIDOĞAN FEVZİYE MERİH,SİNDEL Dilşad,SONEL TUR BİRKAN,SÜTBEYAZ Serap,ŞENDUR Ömer Faruk,UĞURLU Hatice,ünlü zeliha Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. Turkish Journal of Rheumatology(.)Archives of Rheumatology 27, no.1 (2012): 1 - 17.
MLA	tuncer tiraje,ÇAY Hasan Fatih,KAÇAR Cahit,ALTAN İNCEOĞLU LALE,ATİK Osman Şahap,AYDIN Ahmet Turan,AYHAN F. Figen,ÇÖREKÇİ YANIK Burcu,DURMAZ Berrin,eskiyurt nurten,Genc Hakan,GÖKÇE KUTSAL Yeşim,GUNAYDIN Rezzan,HEPGÜLER ASİYE SİMİN,HİZMETLİ Sami,Kaya Taciser,KURTAİŞ Yeşim,ÖLMEZ Neşe,SARIDOĞAN FEVZİYE MERİH,SİNDEL Dilşad,SONEL TUR BİRKAN,SÜTBEYAZ Serap,ŞENDUR Ömer Faruk,UĞURLU Hatice,ünlü zeliha Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. Turkish Journal of Rheumatology(.)Archives of Rheumatology, vol.27, no.1, 2012, ss.1 - 17.
AMA	tuncer t,ÇAY H,KAÇAR C,ALTAN İNCEOĞLU L,ATİK O,AYDIN A,AYHAN F,ÇÖREKÇİ YANIK B,DURMAZ B,eskiyurt n,Genc H,GÖKÇE KUTSAL Y,GUNAYDIN R,HEPGÜLER A,HİZMETLİ S,Kaya T,KURTAİŞ Y,ÖLMEZ N,SARIDOĞAN F,SİNDEL D,SONEL TUR B,SÜTBEYAZ S,ŞENDUR Ö,UĞURLU H,ünlü z Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. Turkish Journal of Rheumatology(.)Archives of Rheumatology. 2012; 27(1): 1 - 17.
Vancouver	tuncer t,ÇAY H,KAÇAR C,ALTAN İNCEOĞLU L,ATİK O,AYDIN A,AYHAN F,ÇÖREKÇİ YANIK B,DURMAZ B,eskiyurt n,Genc H,GÖKÇE KUTSAL Y,GUNAYDIN R,HEPGÜLER A,HİZMETLİ S,Kaya T,KURTAİŞ Y,ÖLMEZ N,SARIDOĞAN F,SİNDEL D,SONEL TUR B,SÜTBEYAZ S,ŞENDUR Ö,UĞURLU H,ünlü z Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism. Turkish Journal of Rheumatology(.)Archives of Rheumatology. 2012; 27(1): 1 - 17.
IEEE	tuncer t,ÇAY H,KAÇAR C,ALTAN İNCEOĞLU L,ATİK O,AYDIN A,AYHAN F,ÇÖREKÇİ YANIK B,DURMAZ B,eskiyurt n,Genc H,GÖKÇE KUTSAL Y,GUNAYDIN R,HEPGÜLER A,HİZMETLİ S,Kaya T,KURTAİŞ Y,ÖLMEZ N,SARIDOĞAN F,SİNDEL D,SONEL TUR B,SÜTBEYAZ S,ŞENDUR Ö,UĞURLU H,ünlü z "Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism." Turkish Journal of Rheumatology(.)Archives of Rheumatology, 27, ss.1 - 17, 2012.
ISNAD	tuncer, tiraje vd. "Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism". Turkish Journal of Rheumatology(.)Archives of Rheumatology 27/1 (2012), 1-17.