Lecture 11 osteoarthritis

Question 1

Osteoarthritis (OA)

Answer 1

• Degeneration of articular cartilage in synovial joints
• Disease of the whole joint (cartilage, bone, ligaments, tendons, synovium and meniscus)
• can cause joint cartilage

Question 2

OA

Answer 2

• OA is the most common arthritis
• Hip, knee and ankle
• More common in females than males
• Prevalence increases with age
• Popping/cracking, stiffness, loss of flexibility, pain, swelling, bone spurs
• Disability, inactivity, comorbidities, poor quality of life, mortality
• There is no cure for OA

Question 3

Causes of OA

Answer 3

• OA is a multifactorial disease, the causes aren’t really understood
• aging and trauma are the main risk factors
• Other contributing factors: genetic predisposition, obesity, sex and hormones, environmental factors

Question 4

Economic impact

Answer 4

• The number of Toal hip and knee replacements is increasing -> severe challenge to health care system (costs)
• In canada, from 2010 to 2031the total direct costs of OA is estimated to increase from 2.9 billion to 7.6 billion (2.6 fold increase)

Question 5

Direct coast in 2031

Answer 5

The cost components that will constitute the
total direct cost of OA in 2031 are:
* Hospitalization cost $2.9 billion
* Outpatient services $1.2 billion
* Rehabilitation after surgery $0.7 billion
* Drugs & Side-effects of drugs $1.6
billion
* Physiotherapy & complementary $1.2 billion
care
- one of the most expensive injuries to that especially when surgery is involved

Question 6

Diagnosis

Answer 6

• History and physical examination
• clinical criteria: pain, stiffness, crepitus, bony tenderness and bony enlargement

Question 7

Treatment pyramid

Answer 7

All- education, exercise and weight loss
Some- Pharmacological pain relief, orthoses/aids, and passive treatments given by a therapist
Few- surgery

Question 8

Treatment affects

Answer 8

Treatment effect of all different typed, exercise having the greatest affect

Question 9

Osteoarthritis bracing

Answer 9

• Also called offloading/unloading bracing
• is used to reduce symptoms such as inflammation and pain in the knee joint

Question 10

GLAD canada

Answer 10

• components: 2-day course for clinicians, 8-week exercise and education program for patients
• data registry

Question 11

results- one year after GLAD:

Answer 11

Pain: knee -28% hip -26%
Physical activity: knee +20% hip +22%
Sick leaves: Knee -42% hip -21%

Question 12

GLAD: program

Answer 12

• Neuromuscular exercises which focus on the muscles controlling the joint as it moves
• 10min warm-up & Four exercise stations (two exercises at each station):
• Leg strength
• Core strength
• Functional exercises
• Positional exercises
  (Alignment)
• Program is different for each person

Question 13

Exercise and cartilage

Answer 13

Conlcusions:
- knee joint loading exercise seems to not be harmful for articular cartilage in people at increased risk of, or with, knee OA
- More studies needed

Question 14

The trouble is…

Answer 14

• Only a few with OA have tried exercise therapy and education prior to surgery
• Treatment guidelines and best evidence are not sufficiently applied
• WHY?
• Business, might prefer doing the surgery or prescribing drugs for the money. Billion dollar industry

Question 15

Total knee replacement

Answer 15

• relieves pain in 8/10 patients
• 1/10 experience a severe adverse event
• current 90-day care cost for total knee replacement is about 12,000 CAD (Ontario)

Question 16

Exercise therapy or surgery?

Answer 16

Exercise first approach can delay or avoid surgery

Question 17

Post-traumatic osteoarthritis: PTOA

Answer 17

• PTOA arises after joint injury and/or repetitive joint trauma and is associated with recurrent instability
• Trauma-initiated joint degeneration that results in permanent and often progressive joint pain and dysfunction
• Primarily affects the knee and ankle joints
• PTOA causes about 12% of all osteoarthritis cases

Question 18

Most often triggered by:

Answer 18

Acute ligament strain
chronic ligamentous instability
ACL rupture
Meniscus injury
fracture
cartilage damage or a combination of these

Question 19

PTOA after ACL injury

Answer 19

• Eight years after an ACL injury, 50% of patients display radiological signs of OA
• After 15 years, 80% of patients display radiological signs of OA
• Within 20 years, nearly all patients display radiological signs of OA
• Prevalence of OA does not seem to depend on whether an ACL reconstruction was performed or
  not

Question 20

Roles of exercise in knee OA

Answer 20

• Pain management
• increasing physical activity
• reducing the risk of comorbidities
• improving strength
• improving alignment and gait

Question 21

Prevention of post-traumatic osteoarthritis

Answer 21

Primary prevention: prevent joint injuries in susceptible populations
Secondary prevention: Identify and slow down PTOA onset after joint injury
Tertiary prevention: slow progression and improve function in those with PTOA

Question 22

current problems

Answer 22

• Injury prevention is not happening (Primary
  prevention)!
• Injury prevention training programs
  (strength & technique) can reduce the risk
  of severe acute knee joint injuries by 50%
• Only 3% of coaches apply these programs
• Most with ACL injury have immediate surgery
• Only a few with OA have tried exercise therapy & education prior to surgery
• Current treatment is to wait until the joint is destroyed and replace it with metal and
  plastic

Question 23

Summary

Answer 23

OA is characterized by degeneration of articular cartilage in synovial joints. Disease of the whole joint.
Symptoms and outcomes: Pain, disability, poor quality of life, comorbidities, mortality
Risk factors: Intra-articular injury, early RTS, obesity, physical inactivity, muscle weakness, fear of movement, poor diet, unrealistic expectations,
insufficient exercise therapy, joint dysplasia
Treatment: Education, exercise, weight loss, pharmacotherapy, orthosis, surgery
Role of exercise: Method for reducing pain and comorbidities; exercise can improve strength, physical activity, alignment and gait