Osteoarthritis of the knee is a condition where the joint cartilage degenerates which leads to pain in the knee.

There are three different types of arthritis that can occur in the knee

  • Osteoarthritis
  • Rheumatoid arthritis
  • Post traumatic arthritis.

Facts about osteoarthritis

  • Osteoarthritis is the most common chronic joint condition.
  • With time the cartilage wears down leading to pain and stiffness.
  • It is estimated that 14% of Americans have osteoarthritis.
  • Women are affected more than med.

What causes osteoarthritis of the knee?

No one knows for sure but what causes osteoarthritis but it  may be affected by the production of collagen.

OsteoarthritisRisk factors for osteoarthritis

  • Genetics will increase the risk of osteoarthritis.
  • Obesity will place more pressure on the joints increasing the risk of osteoarthritis.
  • Injury and over use will also increase the risk.

Diagnosis of osteoarthritis

  • Detailed history, physical examination and x-rays will help with the diagnosis.

Treatment of osteoarthritis

Exercise

A home exercise program also referred to as self directed care Exercise such as low impact exercises and walking has been shown to benefit patients with osteoarthritis.

Knee taping may be useful for patients with OA of the knee.

Light weight brace can help support the knee. Bracoo Breathable Neoprene Knee Support Sleeve – Active Wear, Adjustable Size, Black
Weight lossThe extra weight places stress on the joints.

The goal should be a body mass index of 25 or below.

Calculate your body mass index

Medications

  • Non steroidals are usually first line treatment but there is concern for stoke and heart attack. Tramadol is an alternative as a first line of treatment choice of osteoarthritis.
  • Opioids are avoided as there is concern for addiction. The U.S. Food and Drug Administration (FDA) is warning about several safety issues with the entire class of opioid pain medicines.

Controversial treatment

  • There is are no long term large prospective studies showing benefits of acupuncture.
  • Electrotherapeutic modalities do not have clear support. TENS units which uses low voltage electric current to relieve pain. Data concerning the efficacy of transcutaneous electrical nerve stimulation (TENS)  is conflicting.
  • Shoe inserts are not clearly beneficial
  • Unloader bracing although there is some literature supporting their use the role of bracing with an unloader brace is inconclusive
  • Oral supplements glucosamine and chondroitin do not have sufficient evidence to show their effectiveness.
  • Joint injections with steroids do not have a clear long term benefit.
  • Injection with hyaluronic acid does not have clear benefit.
  • The use of growth factor injections and or platelet rich plasma (PRP) have insufficient evidence to show their effectiveness.
  • The use of lavage of irrigation has no clear benefit.
  • Ultrasound therapy offered help in animal studies but has led to disappointing results in humans.

Surgical treatment of osteoarthritis

  • Arthroscopy with lavage (a large amoutn of fluid to clean the area)  and or debridement offers no clear long term benefit
  • Arthroscopic partial meniscectomy offers no clear long tem benefit
  • Patients with symptomatic medial compartment osteoarthritis of the knee may benefit from surgery when a portion of the affected bone is removed (valgus producing proximal tibial osteotomy).
  • A knee replacement may be offered if the member has failed conservative management with medications and therapy.

Reference –American Academy of Orthopedic Surgeons Clinical practice Guidelines, updated 2013

Spread the love