Knee osteoarthritis and treatment

Question 1

describe what osteoarthritis(OA) is

Answer 1

imbalance between the wear and repair of articular(hyaline) cartilage leading to progressive loss

Question 2

what does osteoarthritis lead to

Answer 2

leads to increased pressure on the bony surfaces and inflammation causing pain, swelling and stiffness

Question 3

what conditions can predispose to knee OA

Answer 3

previous meniscal tear, ligament injuries, genu varum/valgum, inflammatory arthritis

Question 4

what are some predisposing factors to knee OA

Answer 4

joint deterioration with age, obesity, intense sports, genetics

Question 5

what clinical features can be seen in knee OA

Answer 5

pain, stiffness, weakness of surrounding muscles, feelings of instability, loss of confidence in joint, can be asymtpomatic

Question 6

what is used in the treatment of knee OA

Answer 6

analgesics, NSAIDs, weight loss, physiotherapy, steroid injection for flare-ups

Question 7

for what patients is TKR(total knee replacement) appropriate

Answer 7

older, medically fit, end stage arthritis, constant severe pain, sleep disturbance, pain limiting function/walking distance, frequent flare-ups

Question 8

when may osteotomy of tibia be used as treatment for knee OA

Answer 8

in younger patients with isolated medial compartment OA, particularly useful for heavy manual workers as knee replacement susceptible to failure in early exposure to heavy work

Question 9

what are some of the limitations of TKR

Answer 9

doesn’t act like normal knee, don’t last forever(15-20 years), often don’t improve symptoms, high dissatisfaction, 20% have unexplained moderate/severe pain

Question 10

what are some predictors of poor TKR outcome

Answer 10

young age, obesity, chronic pain syndrome, depression + anxiety, very active lifestyle

Question 11

what are the potential complications of a knee replacement

Answer 11

deep infection, pain, stiffness, instability, early failure/loosening

Question 12

what are some of the problems with a second knee replacement

Answer 12

all same as first, but more risk, more blood loss, bigger surgery, don’t work as well

Question 13

describe what a UKR(unicompartmental knee replacement) is

Answer 13

only the worn part of the knees is replaced

Question 14

what are the benefits of UKR

Answer 14

less invasive, no ligaments removed or lengthened, knee may feel more natural, fairly easy to revise

Question 15

what are some of the cons of UKR

Answer 15

second surgery more likely, many cases not suitable, OA may continue in unreplaced knee if not done properly

Question 16

describe what osteotomy is

Answer 16

surgical realignment of joint to redistribute forces, doesn’t remove damaged joint