Osteoarthritis - Knee Flashcards
Where might you elicit pain on examination in a patient with osteoarthritis of the knee
Along the joint lines of the affected compartment
What X-ray changes would you expect in a patient with osteoarthritis of the knee
LOSS
Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts
*Ensure that X-rays are taken with the patient weight-bearing
What is viscosupplementation
Intra-articular injections of hyaluronic acid
May be beneficial in osteoarthritis of the knee
What surgical options are available for patients with osteoarthritis of the knee
Arthroscopic debridement and washout
Realignment osteotomy
Unicompartmental or total knee arthroplasty
Arthrodesis
What is involved in arthroscopic debridement and washout
May give temporary relief
Useful in younger patients before subsequent arthroplasty
Degenerate meniscal tears and osteophytes can be trimmed
What is involved in realignment osteotomy
Either the tibia or femur are cut and reshaped to relieve pressure on the knee joint
Useful in younger patients with medial compartment osteoarthritis
A high tibial valgus osteotomy redistributes weight to the lateral side of the joint
What are the indications for a total knee replacement
Radiographic evidence of degenerative joint disease
Severe, refractory knee pain, often at night
Difficulty with activities of daily living
Decreased mobility
Failure to respond to conservative measures
What is arthrodesis
Artificial induction of joint ossification
Indicated if there is a strong contraindication to arthroplasty
Can occur as a salvage procedure for a failed arthroplasty
What are the intraoperative complications of a TKA
Fracture of the tibia or femur
What are the immediate complications of a TKA
Vascular injuries - superficial femoral, popliteal and genicular vessels
What are the early complications of a TKA
DVT and PE
Peroneal nerve palsy (1%)
Infection
Fat embolism syndrome
What are the late complications of a TKA
Infection
Loosening (septic or aseptic)
Patellar instability/fractures/disruption of extensor mechanism
Periprosthetic fractures
What are the clinical features of RA of the knee
Stage 1 - proliferative
Palpable effusions and thickened synovium but stable joint
Acute rupture of Baker’s cysts
Stage 2 - destructive
Increasing instability of the knee joint
Marked muscle wasting
Some loss of flexion and extension
Stage 3 - reparative
Severe pain and instability
May have fixed flexion and/or valgus deformities
What are the surgical options for RA of the knee
Synovectomy and debridement
Supracondylar osteotomy
Total knee arthroplasty
