Osteoarthritis of the knee: Texts

Text A

Osteoarthritis (OA) often becomes symptomatic in the 40s and 50s and is nearly universal (although not always symptomatic) by age 80. Below age 40, most OA occurs in men and results from trauma. Women predominate from age 40 to 70, after which men and women are equally affected.

Classification
OA is classified as primary (idiopathic) or secondary to some known cause.

Primary OA may be localised to certain joints (eg, chondromalacia patellae is a mild OA that occurs in young people). Primary OA is usually subdivided by the site of involvement (eg, hands and feet, knee, hip). If primary OA involves multiple joints, it is classified as primary generalised OA.

Secondary OA results from conditions that change the microenvironment of the cartilage. These conditions include significant trauma, congenital joint abnormalities, metabolic defects, infections (causing post infectious arthritis), endocrine and neuropathic diseases, and disorders that alter the normal structure and function of hyaline cartilage (eg, RA, gout, chondrocalcinosis).

Text B

Diagnosis of knee osteoarthritis

Physical Examination

  • Joint swelling, warmth, or redness
  • Tenderness about the knee
  • Range of passive (assisted) and active (self-directed) motion
  • Instability of the joint
  • Crepitus (a grating sensation inside the joint) with movement
  • Pain when weight is placed on the knee
  • Problems with gait
  • Any signs of injury to the muscles, tendons, and ligaments surrounding the knee
  • Involvement of other joints (an indication of rheumatoid arthritis)

Imaging Tests

  • X-rays. These imaging tests create detailed pictures of dense structures, like bone. They can help distinguish among various forms of arthritis. X-rays of an arthritic knee may show a narrowing of the joint space, changes in the bone and the formation of bone spurs.
  • Other tests. Occasionally, a magnetic resonance imaging (MRI) scan, a computed Tomography (CT) scan, or a bone scan may be needed to determine the condition of the bone and soft tissues of the knee.
Text C

Knee OA causes cartilage to be lost. The ligaments become lax and the joint becomes less stable, with local pain arising from the ligaments and tendons.

Text D

Treating Osteoarthritis of the Knee

The primary goals of treating osteoarthritis of the knee are to relieve the pain and return mobility. The treatment plan will typically include a combination of the following:

  • Weight loss. Losing even a small amount of weight, if needed, can significantly decrease knee pain from osteoarthritis.
  • Exercise. Strengthening the muscles around the knee makes the joint more stable and decreases pain. Stretching exercises help keep the knee joint mobile and flexible.
  • Pain relievers and anti-inflammatory drugs. This includes over-the-counter choices such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen sodium (Aleve). Patients shouldn’t take over-the-counter medications for more than 10 days without checking with their doctor. Taking them for longer increases the chance of side effects. If over-the-counter medications don\'t provide relief, patients may require an anti-inflammatory drug or other medication to help ease the pain.
  • Injections of corticosteroids or hyaluronic acid into the knee. Steroids are powerful anti-inflammatory drugs. Hyaluronic acid is normally present in joints as a type of lubricating fluid.
  • Using devices such as braces. There are two types of braces: "unloader" braces, which take the weight away from the side of the knee affected by arthritis; and "support" braces, which provide support for the entire knee.
  • Physical and occupational therapy. Physical therapists assist patients with ways to strengthen muscles and increase flexibility in the joint. Occupational therapists teach ways to perform regular, daily activities, such as housework, with less pain.
  • Surgery. When other treatments don\'t work, surgery may be a good option. After any type of surgery for arthritis of the knee, there is a period of recovery. Recovery time and rehabilitation depends on the type of surgery performed.
Last modified: Tuesday, 26 April 2022, 11:07 AM