lec 11 - osteoarthritis Flashcards
what is osteoarthritis (OA)
degeneration of the articular cartilage in synovial joints
- disease of the whole joint (cartilage, bone, ligaments, tendons, synovium, and meniscus)
where does OA usually occur
highest weight bearing joints
- hip, knee, ankle
what are the symptoms of OA
pain, stiffness, loss of mobility and function
what are some outcomes of OA
disability, inactivty, comorbidities, poor QoL, higher mortality
is there a cure for OA
no cure
what are some risk factors for OA
intra articular injury
early RTS
obesity and poor diet
low PA and muscle weakness
fear of mvmt
insufficient exercise therapy
joint dysplasia
genetic predisposition
sex and hormones
what is the economic impact of OA
increasing number of total hip and knee replacements is increasing due to the increase in intra articula injuries
- one of the most expensive diseases to treat
what can severe OA knees show on physical exam
fixed flexion deformity - can’t straighten their legs all the way
what is the kellgran lawrence grading scale for OA (done by xray)
based on hwo much the joint space has been lost as a result of degeneration
grade 1 = doubtful
grade 2 = mild
grade 3 = moderate
grade 4 = severe - no joint space at all (sclerosis from bone and bone contact)
what is the 3 stage treatment pyramid for OA
stage 1 (all patients) = education, exercise, and weight loss
stage 2 (some patients) = pharmacological pain relief, orthoses / aids, passive treatment by therapist
stage 3 (few patients) = surgery
what are the benefits of evidence based exercise therapy for OA
effectively reduces pain
cost effective
can delay surgery
less pain and functional disability at 1 year
what is OA bracing (orthosis)
off loading / unloading bracing (off load where there is bone on bone contact)
reduce symptoms (inflammation and pain)
which portion of the knee is first affected by OA
medial portion of the knee (can brace to offload this portion of the knee)
what is the GLA:D program
exercise based program for treatment and management of OA symptoms
NM exercises which focus on the muscles controlling the joint as it moves
leg strength, core strength, functional exercises, positional exercises (alignment)
what are the benefits of the GLA:D program
decrease pain
decrease amount of sick leaves
increase in PA
what are the effects of a total knee replacement
relieves pain in 8/10 patients
(expensive)
what is post traumatic OA (PTOA)
trauma initiated joint degradation that results in permanent and often progressive joint pain and dysfunction
arises after joint injury and/or repetitive joint trauma
associated with recurrent instability
what is the prevalence of PTOA
about 12% of all OA cases
increased prevalence due to increased joint injuries in sport
what are the triggers of PTOA
acute ligament strain
chronic ligament instability
ACL rupture
meniscus injury
fracture
cartilage damage
when do PTOA signs arise after ACL injury
50% show signs after 8 years
80% show signs after 15 years
nearly all patients show signs within 20 years
(doesn’t depend on whether ACL reconstruction was performed)
what are the roles of exercise of knee OA
- pain management
- increased PA
- reducing the risk of comorbidities
- improving strength
- improving alignment and gait
what are the stages of prevention of PTOA
primary = prevent joint injuries in susceptible populations
secondary = identify and slow down PTOA onset after joint injury
tertiary = slow progression and improve function in those with PTOA
what are the current problems in knee OA
injury prevention is not happening
most ACL injuries have immediate surgery
right now we wait until the joint is destroyed and then get a knee replacement
