lec 11 - osteoarthritis

Question 1

what is osteoarthritis (OA)

Answer 1

degeneration of the articular cartilage in synovial joints
- disease of the whole joint (cartilage, bone, ligaments, tendons, synovium, and meniscus)

Question 2

where does OA usually occur

Answer 2

highest weight bearing joints
- hip, knee, ankle

Question 3

what are the symptoms of OA

Answer 3

pain, stiffness, loss of mobility and function

Question 4

what are some outcomes of OA

Answer 4

disability, inactivty, comorbidities, poor QoL, higher mortality

Question 5

is there a cure for OA

Answer 5

no cure

Question 6

what are some risk factors for OA

Answer 6

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

Question 7

what is the economic impact of OA

Answer 7

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

Question 8

what can severe OA knees show on physical exam

Answer 8

fixed flexion deformity - can’t straighten their legs all the way

Question 9

what is the kellgran lawrence grading scale for OA (done by xray)

Answer 9

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)

Question 10

what is the 3 stage treatment pyramid for OA

Answer 10

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

Question 11

what are the benefits of evidence based exercise therapy for OA

Answer 11

effectively reduces pain
cost effective
can delay surgery
less pain and functional disability at 1 year

Question 12

what is OA bracing (orthosis)

Answer 12

off loading / unloading bracing (off load where there is bone on bone contact)
reduce symptoms (inflammation and pain)

Question 13

which portion of the knee is first affected by OA

Answer 13

medial portion of the knee (can brace to offload this portion of the knee)

Question 14

what is the GLA:D program

Answer 14

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)

Question 15

what are the benefits of the GLA:D program

Answer 15

decrease pain
decrease amount of sick leaves
increase in PA

Question 16

what are the effects of a total knee replacement

Answer 16

relieves pain in 8/10 patients
(expensive)

Question 17

what is post traumatic OA (PTOA)

Answer 17

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

Question 18

what is the prevalence of PTOA

Answer 18

about 12% of all OA cases
increased prevalence due to increased joint injuries in sport

Question 19

what are the triggers of PTOA

Answer 19

acute ligament strain
chronic ligament instability
ACL rupture
meniscus injury
fracture
cartilage damage

Question 20

when do PTOA signs arise after ACL injury

Answer 20

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)

Question 21

what are the roles of exercise of knee OA

Answer 21

• pain management
• increased PA
• reducing the risk of comorbidities
• improving strength
• improving alignment and gait

Question 22

what are the stages of prevention of PTOA

Answer 22

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

Question 23

what are the current problems in knee OA

Answer 23

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