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Osteoarthritis of the Knee

Introduction

Osteoarthritis of the knee is a common cause of pain, disability and deformity. It typically affects middle age and elderly patients, but can occur in the young adult after as a sequelae of trauma or infection.

Osteoarthritis can cause a wide spectrum of symptoms which can vary in severity between individuals.

Treatment needs to be proportionate, effective, and meet the needs of the patient.

History

End stage osteoarthritis is easy to diagnose on the history alone. It causes chronic pain, worse on activity. There is often associated stiffness and sometimes deformity that is severe enough to be evident to the patient, especially if valgus. Collectively these factors contribute to functional deterioration, with difficulty walking, climbing stairs and with activities of daily living.

Examination

There is often an effusion evident on examination. Range of movement is typically reduced and there is often a fixed flexion deformity. Varus or less commonly valgus deformities can also be present when the patient is examined from the front.

The patient should also be axamined for common co-morbidities such as osteoarthritis of the hip, peripheral vascular disease and spinal stenosis.

Special Investigations

Knee X-ray Showing OsteoarthritisWeight bearing plain XRay is the first line investigation of choice. MRI can be helpful in the early stages of disease if XRay is normal.

Natural History

The natural history tends to be rather indolent with gradual deterioration of pain and function over time. The disease can plateau, but if it deteriorates, there can be a gradual reduced level of mobility.

Conservative Treatment

Conservative treatment is recommended as first line, especially for the young and in patients with early stage disease.

Analgesia and non-steroidal anti-inflammatory drugs should be prescribed unless contraindicated. Physiotherapy has been shown to be effective and can help with secondary quadriceps inhibition and stiffness. Arthroscopy is of only limited use for help with mechanical symptoms such as locking. Weight loss should be recommended in obese patients. Steroid or viscosupplementation injections have a limited role.

Operative Treatment

Knee X-ray Showing Knee ReplacementFor patients with advanced stage disease and significant symptoms, joint replacement is often required. Total knee replacement is the gold standard, but encouraging results have also been reported for partial knee replacement if the disease is localised to one or two compartments.

Alternatives to joint replacement such as osteotomies around the knee are used to offload the affected compartment by realignment of the mechanical axis of the limb.

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