Knee OA Flashcards
What is osteoarthritis?
Imbalance between wear and repair of articular cartilage leading to progressive loss and destruction of hyaline cartilage
What are the general symptoms of OA?
Pain
Swelling
Stiffness
What factors predispose to OA?
Obesity Heavy physical workload Sports and hobbies Family history Previous injury Malalignment - venu varus or valgum
What are the x-ray features of OA?
Loss of joint space
Subchondral sclerosis
Osteophytes
Cysts
Which knee OA is more common - medial or lateral, and why?
Medial
Medial meniscus tears are much more common - predisposes
Twist and pivot on medial knee
Genu varum is more common than valgum
What are the symptoms of knee OA?
Pain Stiffness Weakness of surrounding muscles Feelings of instability Loss of confidence in joint
What is the treatment for knee OA?
Analgesics, NSAIDs Weight loss Physio Activity modification In flare up: steroid injection Surgical: total knee replacement
Which patients are appropriate for total knee replacement?
Older, medically fit patients with end stage arthritis and severe symptoms refractory to conservative management
What symptoms of OA knee OA are considered ‘severe’?
Constant severe pain
Sleep disturbance
Pain limiting function
Frequent bad ‘flare-ups’ of pain
What are the limitations of total knee replacement?
Don’t last forever and will be worn out
Often don’t improve stiffness
Can loosen or become infected
20% have unexplained pain
What are predictors of a poor outcome of total knee replacement?
Young age Obesity Chronic pain syndrome Depression and anxiety Very active lifestyle
What are the alternatives to total knee replacement?
Uni-compartmental knee replacement
Osteotomy
Keyhole surgery
