Osteoarthritis is a painful, chronic joint disorder that primarily affects not only the knees but also hands, hips and spine. The intensity of the symptoms vary for each individual and usually progress slowly.
Knee osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage. It is most common in elderly people and can be divided into two types, primary and secondary:
Primary osteoarthritis - is articular degeneration without any apparent underlying cause.
Secondary osteoarthritis - is the consequence of either an abnormal concentration of force across the joint as with post-traumatic causes or abnormal articular cartilage, such as
-Rheumatoid Arthritis (RA)
-Obesity
-Joint hypermobility or instability
-Malpositioning of the joint e.g. valgus/varus posture
-Previous injury to the joint e.g. fracture along articular surface (tibial plateau fracture)
-Congenital defects
-Immobilisation and loss of mobility
-Family history
-Metabolic causes e.g. rickets
Epidemiology
OA is the most common disease of the joints worldwide, with the knee being the most commonly affected joint in the body. It mainly affects people over the age of 45.
OA can lead to pain and loss of function, but not everyone with radiographic findings of knee OA will be symptomatic: in one study only 15% of patients with radiographic findings of knee OA were symptomatic.
OA affects nearly 6% of all adults
Women are more commonly affected than men
Roughly 13% of women and 10% of men 60 years and older have symptomatic knee osteoarthritis.
Among those older than 70 years of age, the prevalence rises to as high as 40%.
Prevalence will continue to increase as life expectancy and obesity rises.
Symptoms
-Pain upon movement
-Stiffness, particularly early morning stiffness
-Loss of range of movement
-Pain after prolonged sitting or lying
-Pain on joint line palpation
-Joint enlargement
Diagnosis
The diagnosis can be established by clinical examination, and it can be confirmed by X-rays
Treatment/Management
Treatment for knee OA can be broken down into conservative and surgical management.
Initial treatment always begins with conservative modalities and moves to surgical treatment once conservative management has been exhausted. There is a wide range of conservative modalities available for the treatment of knee OA.
The main focus in OA management is on promoting self-management, reducing pain, optimise function, and modifying the disease process and its effects.
Conservative Treatment Options
The primary treatment for OA knee conservatively is exercise therapy within physiotherapy.
Physiotherapy normally involves
-Patient education
-Exercise therapy
-Activity modification
-Advice on weight loss
-Knee bracing
The first-line treatment for all patients with symptomatic knee osteoarthritis includes patient education and physiotherapy. A combination of supervised exercises and a home exercise program have been shown to have the best results. These benefits are lost after 6 months if the exercises are stopped.
Weight loss is valuable in all stages of knee OA. It is indicated in patients with symptomatic OA with a body mass index greater than 25. The best recommendation to achieve weight loss is with diet control and low-impact aerobic exercise.
Knee bracing in OA can be used. Offloading-type braces which shift the load away from the involved knee compartment. This can be effective when there is a deformity.
Other non-physiotherapy based interventions include pharmacological management.
Drug therapy alongside physiotherapy should be the first-line treatment for patients with symptomatic OA. There are a wide variety of NSAIDs available, however, caution should be used when prescribing NSAIDs due to their side effects.
Glucosamine and chondroitin sulfate are available as dietary supplements. They are structural components of articular cartilage, and the thought is that a supplement will aid in the health of articular cartilage.
Intra-articular corticosteroid injections may be useful for symptomatic knee OA.
Intra-articular hyaluronic acid injections (HA) injections are another inject-able option. Local delivery of HA into the joint acts as a lubricant and may help increase the natural production of HA in the joint.
Operative - Total Knee Replacement
Dr N Hegde (Ortho-Surgeon)
Seven Hills Hospital, Bengaluru | Call 080 299 15084 / 819 771 9636
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