Osteoarthritis Of Knee Joint

Osteoarthritis is a complex, active, degenerative joint disease involving bone, cartilage, synovium, ligament, surrounding muscles and surrounding affected joint. It is an age related wear and tear of joints.

It is a non-inflammatory degenerative disease of the joints. It can be either primary occurring due to natural aging factors or secondary due to any infection, trauma or any other past history that can result in osteoarthritis.

After Hip joint, knee joint is the second most affected arthritic joint.

Anatomy of Osteoarthritis Knee Joint 

Types-

There are 2 types of Osteoarthritis of knee
  1. Primary OA
  2. Secondary OA

Causes: 

Primary Osteoarthritis:

•Age (generally affecting old age)

•Obesity

•Infection 

•Trauma 

•Genetics 

•Hormonal changes

•Idiopathic

•Repetitive weight bearing

•Sedentary lifestyle

•Metabolic Disorders 

•Intra articular injury 

•Excessive steroid therapy 

•Ligament laxity

Secondary Osteoarthritis:

•Infection

•Tuberculosis

•Hemophilia

•Diabetes mellitus 

•Excessive steroid Therapy

Clinical Features:

•Pain

•Stiffness

•Movement restriction

•Swelling

•Crepitus

•Effusion

•Synovial thinking

Also there may be present deformities like genu varum, fixed flexion Deformity in advance Cases of osteoarthritis.

Examination And Diagnosis:

Physical examination:

  • To examine the medial compartment a varus strain is applied to the knee and the knee is moved after which a crepitus will be heard and felt under the hand applying varus strain and pain will be produced indicating arthritis.
  • Similarly, valgus strain is applied on the lateral compartment.
  • For examination of laxity of the collateral ligament and to some extent the cruciate ligament the presence of any fixed flexion deformity should be noted.
  • Knee rating scale for pain and functions-

X-Ray : 

  • X-Ray Shows Narrow Joint space with osteophytes. Knee deformities can also be seen on X-Ray. There may also be an unusual opening of lateral joint space.
  • One or more compartments- medial, lateral or patello femoral may be involved. The medial compartment is predominantly involved.
  • Loose bodies in the joints can also be visible.

Magnetic Resonance Imaging (MRI) :

MRI shows detailed Images for decreasing joint Space and soft tissue of the underlying. 

Lab Test:

Breaking down your blood or joint liquid can assist with pinpointing the conclusion.

  • Blood tests-

Blood tests might assist rule with trip different reasons for joint torment, like rheumatoid joint inflammation.

  • Joint liquid examination-

Your primary care physician might utilize a needle to coax liquid out of the impacted joint. Analyzing and testing the liquid from your joint can decide whether there’s irritation and assuming your agony is brought about by gout or a disease.

TREATMENTS AND DRUGS:

There’s no known remedy for osteoarthritis, yet medicines can assist with diminishing torment and keep up with joint development.

Medications

Osteoarthritis symptoms may be helped by certain medications, including:

  • Acetaminophen :Acetaminophen (Tylenol, others) can relieve pain, but it doesn’t reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs):NSAIDs may reduce inflammation and relieve pain. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others).

Treatment:

  • Early treatment of OA of the knee can be quite beneficial if done correctly. Weight loss should be encouraged but not expected to happen overnight.
  • Strengthening your quadriceps can make a big difference.
  • Quadriceps strength can significantly postpone the need for surgery. If you have pain in your patella, only do extension exercises over the last 20 degrees.
  • Activities that raise the patellofemoral joint reaction forces (PFJRFs), such as deep squatting, kneeling, and stair climbing, increase pain.
  • Electric stimulation may be utilized to start the procedure if the patient has severely weak muscles to begin with. Other than heat and cold, no other modalities have been proved to be useful.
  • Injections of hyaluronic acid into the knee are of minimal benefit. They seem to operate best before bone-on-bone crepitus develops. Hyaluronic acid injections have been proven to be “equally beneficial” to nonsteroidal anti-inflammatory medications in independent studies (NSAIDs) and intra-articular steroid injections.
  • Measured wedge insoles to relieve pain by reducing compressive forces.

Surgical Treatment:

  • Osteotomy– Indicated in unicompartmental (medial or lateral) diseases with marked deformity. Close or open wedge osteotomy with internal fixation for genu varum and femoral osteotomy with or without internal fixation for genu valgum is done. 3 weeks of postoperative immobilization with plaster cast for joints treated with staples and 6 weeks without staples. Full weight bearing is allowed after 8-10 weeks.
  • Arthrodesis– least performed surgery as better options are available. It results in a pain free and stable but stiff joint.
  • Arthroplasty– Commonly used in elderly patients. It is of 2 types- unicondylar knee replacement and total knee replacement.
  • Arthroscopic surgery– Used in mild to moderate types of osteoarthritis. Arthroscopy includes joint lavage with removal of osteochondral loose bodies, shaving of osteophytes and removal of degeneration and torn meniscus.

Suggested Exercise Plan for Patients with Osteoarthritis of the Knee:

Mild Symptoms:

  • Active Range of Motion Exercises for hip, knee and ankle.
  • Physical therapy modalities as needed (TENS, IFT, UltraSound ).
  • Quadriceps Sets for Vastus Medialis Oblique.
  • Advance to isometric progressive resistive Exercises for quadriceps, Hamstring and Hip adductors and abductors.
  • Low impact conditioning exercises (Avoid High patellofemoral compressive forces)

Moderate To severe Symptoms:

  • Active Assisted Range of motion exercise for hip, knee and ankle.
  • Stretching for quadriceps, Hamstrings, adducators , Gastrocnemius (If there is a contraction in the hamstring, ultrasonography may be used).
  • Quadriceps sets for vastus Medialis Obliques.
  • For hamstring contracture, start supine and work your way up to a sitting posture.
  • Aerobic Workouts ( pool, walker, etc)
  • Improve your strength by using isometric closed-kinetic-chain (CKC) workouts like wall-sitting.
  • Strengthening of the hip adductors and abductor muscles.
  • Straight Leg Raising is a series of progressive resistance exercises for the legs.
  • Lunges necessitate a high level of strength as well as outstanding balance and coordination but in later stages.
  • Activity modification in daily living like avoiding kneeling, squatting, sitting on hard surfaces, high impact sports etc.
  • Walk with Cane in opposite hand to relieve stress on arthritic joints.
  • Walk with brace
  • Aquatic exercises with warm water are very beneficial (45 minutes for 6-10 weeks).
  • Wall squats.
  • Stair : step up step down.

Do’s and Don’ts for patients with OA of knee-

Reference:

  • Jayant Joshi and Prakash Kotwal ( Orthopedics and applied physiotherapy)
  • J. Maheshwari and Vikram A. Mhaskar ( Essential orthopedics)
  • S. Brent Brotzman and Kevin E. Wilk ( Clinical orthopedic rehabilitation)