1. Osteoarthritis knee
Definition
Degenerative disease of synovial joint that cause progressive loss of articular cartilage
Risk factor
Modifiable :
- Articular trauma
- Occupation (repetitive knee bending)
- Muscle weakness
- Rupture meniscus
- Ligament instability
- Metabolic syndrome (overweight, dyslipidemia high triglycerides low density
lipoprotein, hypertension, diabetes)
Non modifiable :
- Gender (female > male)
- Increased age
- Genetic
Pathoanatomy
Articular cartilage
- Increased water content
- Decrease amount of proteoglycans
- Collagen abnormalities
Synovium and capsule
- Early phase of OA mild changes inflammatory in synovium
- Middle phase of OA moderate inflammatory changes of synovium, synovium
became hypervascular
- Late phase of OA synovium become increasingly thick and vascular
Bone
Subchondral bone attempts to remodel
“cartilage had been break caused overweight and change the region medial compartement
sclerosis subchondral bone + osteophyte cartilage fibrillation chondrocalcinosis
Classification Kellgren & Lawrence
Grade 0 : no radiographic feature of OA present
Grade 1 : doubtful joint space narrowing, possible osteophyte lipping
Grade 2 : definite osteophyte and possible joint space narrowing AP weight bearing
Grade 3 : multiple osteophyte, definite joint space narrowing, sclerosis, possible bone
deformity
Grade 4 : large osteophyte, joint space narrowing, definite bone deformity
Clinical feature
- Pain leading symptom, worse after running, on stairs
- Activity induced swelling
- Joint stiffness after rest
2. - Mechanical (instability, locking, catching sensation)
Physical exam
- Body habitus
- Gait (increased adductor moment)
- Limb alignment ( varus, valgus)
- Effusion
- Quadriceps usually wasted
- Patellofemoral crepitus
- Lack of full extension (> 5 degree flexion contracture)
- Lack of full flexion ( flexion < 110 degree ligament integrity)
Imaging
- Weight bearing view affected joint
- Sunrise view
- PA view in 30 degree of flexion
Finding
- Pattern of arthritis involvement
Medial or lateral tibio femoral
Patellofemoral
- Characteristic
Tibiofemolar joint space diminished
Sclerorosis subchondral
Subchondral cyst
Osteophytes
Treatment
Non operative
1. NSAID
- First line treatment patient with symptom OA
2. Rehabilitation, education, wellness activity
- Quadriceps exercise
- Simple elastic support
- Short wave diathermy or radiant heat
3. Weight loss program
- Patient with symptom OA and BMI > 25
4. Intraarticular injection corticosteroid
- beware of repetitive injection may cause predisposition cartilage and bone damage
progressive
operative
indicate : persistent pain, instability, deformity, progressive
- high tibial osteotomy (younger age with unicompartement disease
- TKR
