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Management of Knee Osteoarthritis
Management of Knee Osteoarthritis
ON
BY
(ORTHOPEDICS UNIT)
1
OUTLINE
Introduction
Epidemiology
Etiology
Relevant Anatomy
Pathophysiology
Risk factors
Clinical signs and symptoms
Diagnoses
Outcome measure
Management
Prognosis
Case presentation
Conclusion
References 2
Introduction
4
Etiology
Primary knee OA: this is articular degeneration without any known cause.
Secondary knee OA: articular degeneration of a known cause.
Obesity
Joint hyper mobility or instability
Malpositioning of the joint e.g valgus/varus posture.
Congenital defects
Immobilization and loss of mobility
Family history
Metabolic causes e.g. ricket
Scoliosis
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Relevant Anatomy
6
Pathophysiology
8
Clinical features of knee OA
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Risk Factors of Knee OA
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Diagnosis of Knee OA
Radiological findings of OA
Diagnosis
Special Test
• Patellar Apprehension (patella
instability)
• McMurray test (medial and lateral
meniscus tear)
• Anterior Drawer’s test (Anterior
Cruciate ligament (ACL) injury)
• Valgus stress test (Medial collateral
ligament (MCL) injury)
• Varus stress test (Lateral collateral
ligament (LCL) injury)
• Lachman test (ACL)
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Differential Diagnosis
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OUTCOME MEASURE
15
Management of Knee OA
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Management
pharmacological management
Acetaminophen
Nonsteroidal anti-inflammatory drugs
(NSAIDs)
COX-2 inhibitors
Glucosamine and chondroitin sulfate
Corticosteroid injections
Hyaluronic acid (HA)
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Management
Surgical management
Arthroscopy
Tibial Osteotomy
Patellofemoral joint arthroplasty
Unicompartmental Knee arthroplasty
Total knee replacement
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Physiotherapy Management
The physiotherapeutic management for knee OA begins with obtaining a detailed history and
carrying out physical examination that will aid diagnoses and effective management of
patients’ symptoms. (Hay et al., 2006).
Roles of Physiotherapy
• To educate the patient
• To reduce knee pain and inflammation.
To normalize knee joint range
Improves proprioception, agility and balance.
To strengthen weak muscles
Promotes physical function.
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Physiotherapy Intervention
Heat Therapy
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Physiotherapy Intervention
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Physiotherapy Intervention
Strengthening Exercises
Static quad set in extension
Standing terminal extension
Seated leg presses
Partial squats
Straight leg raise
Stretching Exercises
Standing calf stretch
Supine hamstring muscle stretch
Prone quadriceps muscle stretch
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Physiotherapy Intervention
ROM Exercises
Active and passive knee flexion & extension
Use of Bicycle ergometer
Aerobic Exercises
Walking
Cycling
Swimming
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External Aids for Knee OA
Knee Braces
Walking Aids
Foot Insoles (orthopedic insoles)
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Prognoses
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CASE PRESENTATION
Name: Mrs. E
Age: 71 years old
Sex: Female
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CASE PRESENTATION
F&SHX: A 71 year-old Farmer, married in a monogamous setting and blessed with 4 children. She
does not smoke, drink or take any form of tobacco. She lives in a bungalow.
O/E: A healthy looking aged woman walked into the treatment cubicle with an antalgic gait, well
oriented in TPP, afebrile to touch, acyanosed, anicteric and in no obvious respiratory distress.
Vitals: BP: 145/80mmHg
Pulse: 85bpm
Weight: 92kg
Pain: 8/10 on Visual Analogue Scale
Segmental Examination
Head & Neck: Monocular Vision
Back & Spine: NAD
Thorax & Abdomen: NAD
Pelvic & Perineum: NAD
Upper Limb: NAD 27
CASE PRESENTATION
Lower Limb Right Left
AROM (knee flexion) Limited and painful Limited & painful
(0-99 degrees) (0-100 degrees)
PROM (knee flexion) Limited & painful Limited & painful
(0-108 degrees) (0-115 degrees)
•Patella mobile mobile
Functional Assessment
Patient cannot stand for a long time.
Difficulty in walking and climbing stairs.
Standing up from a chair is difficult.
Difficulty in carrying out her farm work.
Patient cannot carry out ADL maximally. 29
CASE PRESENTATION
Physical diagnosis
Motion impairment: Limited ROM in both flexion and extension on the bilateral knee joint.
Tenderness on palpation of the bilateral knee joints.
Muscle impairment: Weakness of flexors and extensors of both knees.
Mild swelling at the bilateral knee joints.
Pain at the bilateral knee joint. (VAS: 8/10)
Ligamentous injuries as reported by special tests
Functional disability
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CASE PRESENTATION
Conclusion
Knee osteoarthritis is a degenerative joint disease that is posing a serious public health problem
for the global economy. Physiotherapy intervention in conjunction with other non physical means
of management have been proven to be efficient in the management of knee OA, as they help to
slow down the progression of the condition, improve patient’s symptoms, prevent further
deformities and improve the overall quality of life of the patient.
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REFERENCE
Akinpelu, A., Alonge, T., Adekanla, B. and Odole, A. (2009). Prevalence and Pattern of
Symptomatic Knee Osteoarthritis in Nigeria: A Community-Based Study. Internet Journal of Allied
Health Sciences and Practice. doi:https://doi.org/10.46743/1540-580x/2009.1254.
Aweid, O., Haider, Z., Saed, A. and Kalairajah, Y. (2018). Treatment modalities for hip and knee
osteoarthritis: A systematic review of safety. Journal of Orthopaedic Surgery, 26(3),
p.230949901880866. doi:https://doi.org/10.1177/2309499018808669.
Ayhan, E. and Kesmezacar, H. (2014). A clinical perspective of IL-1β as the gatekeeper of
inflammation. European Journal of Immunology, 41(5), pp.1203–1217.
doi:https://doi.org/10.1002/eji.201141550.
Brosseau, L., Yonge, K., Welch, V., Marchand, S., Judd, M., Wells, G.A. and Tugwell, P. (2003).
Thermotherapy for treatment of osteoarthritis. Cochrane Database of Systematic Reviews.
doi:https://doi.org/10.1002/14651858.cd004522.
REFERENCES
Sellam, J. and Berenbaum, F. (2010). The role of synovitis in pathophysiology and clinical
symptoms of osteoarthritis. Nature Reviews Rheumatology, [online] 6(11), pp.625–635.
doi:https://doi.org/10.1038/nrrheum.2010.159.
Wang, C., Bannuru, R., Ramel, J., Kupelnick, B., Scott, T. and Schmid, C.H. (2010). Tai Chi on
psychological well-being: systematic review and meta-analysis. BMC Complementary and
Alternative Medicine, [online] 10(1). doi:https://doi.org/10.1186/1472-6882-10-23.
Woolf, A.D. (2001). Understanding the burden of musculoskeletal conditions. BMJ, [online]
322(7294), pp.1079–1080. doi:https://doi.org/10.1136/bmj.322.7294.1079.
WYATT, F.B., MILAM, S., MANSKE, R.C. and DEERE, R. (2001). The Effects of Aquatic and
Traditional Exercise Programs on Persons With Knee Osteoarthritis. The Journal of Strength and
Conditioning Research, 15(3), p.337. doi:https://doi.org/10.1519/1533-
4287(2001)015%3C0337:teoaat%3E2.0.co;2.