Knee Osteoarthritis Overview

Knee Osteoarthritis

• A prevalent condition affecting millions globally
• Lecture provides in-depth overview from underlying causes and clinical manifestations to diagnostic techniques and comprehensive treatment options.

Introduction to Knee Osteoarthritis

• A prevalent joint disease, affecting millions worldwide.
• A degenerative joint disease involving cartilage breakdown in the knee joint
• Leads to pain, stiffness, and reduced mobility.
• Significantly impacts quality of life.

Anatomy and Function of the Knee

• A complex hinge joint connecting the femur and tibia
• Stabilized by ligaments, tendons, and muscles.
• Crucial for mobility, relying on a delicate balance of bones, cartilage, ligaments, and tendons.
• Patella (kneecap) protects the joint and enhances leverage during extension.

Factors Affecting Knee Weight Distribution

• Body Mass Index (BMI): Increased BMI stresses the knee joint.
• Muscle Strength: Weak leg muscles contribute to uneven weight distribution.
• Joint Deformities: Conditions like varus or valgus deformities alter weight bearing.
• Foot Alignment: Pronation or supination influence knee mechanics.
• Activity Level: Impact activities increase stress on the knees.
• Gait Pattern: Abnormal gait patterns lead to uneven weight distribution.

Mechanical Axis & Deviation of the Lower Limb

• An imaginary line extending from the hip joint, through the center of the knee joint, to the ankle joint
• In healthy individuals, this line is straight and vertical.
• Deviation from the normal mechanical axis (e.g., varus or valgus deformity) places abnormal stress on the joint.
• Varus deviation (bowlegged) increases stress on the lateral compartment, while valgus deviation (knock-kneed) stresses the medial compartment of the knee.

Causes and Risk Factors of Knee Osteoarthritis

• Age: More prevalent in older adults due to cartilage wear over time.
• Obesity: Excess weight increases stress on the knee joints, raising the risk of cartilage damage.
• Previous Knee Injuries: History of ligament tears can contribute.
• Inflammatory Conditions: Rheumatoid arthritis is a risk factor.

Types of Knee Osteoarthritis

• Compartmental: Affects the medial or lateral knee compartment
• Bicompartmental: Involves both medial and lateral compartments.
• Patellofemoral: Affects the kneecap (patella) and femur.

Pathophysiology of Knee Osteoarthritis

• Cartilage Deterioration: Smooth articular cartilage wears away, exposing underlying bone.
• Inflammation: Exposed bone and cartilage debris trigger an inflammatory response.
• Bone Remodeling: Bone remodeling forms bony spurs or osteophytes.
• Joint Instability: Weakened cartilage and ligaments cause instability

Symptoms and Diagnosis of Knee Osteoarthritis

• Symptoms: Pain, swelling, and limited range of motion are common.
• Pain During Activity: Pain often worsens with physical activity, especially after prolonged standing or sitting.
• Radiological Assessment: X-rays, CT scans, and MRI scans help diagnose the condition.
• Lab Tests: Rh factor, SUA, and urine tests, and hemophilia protocol.

Radiographic Evaluation and Staging

• X-rays reveal joint space narrowing, bone spurs, and other signs of osteoarthritis.
• Grading system to determine the severity of the condition, ranging from normal joint space (Stage 0) to severe narrowing and/or collapse (Stage 4).

Conservative Management Strategies

• Pain Management: Over-the-counter pain relievers (acetaminophen, ibuprofen) and topical pain relievers (capsaicin cream).
• Physical Therapy: Exercises to strengthen muscles, improve range of motion, and reduce stress on the joint.
• Weight Management: Losing weight reduces stress on the knee joint.
• Assistive Devices: Using canes or walkers, or braces to support the knee.

Medications and Injections for Knee Osteoarthritis

• Pain Relievers: Over-the-counter options such as Acetaminophen, Ibuprofen, NSAIDs
• Corticosteroid Injections: Reduce inflammation and provide temporary pain relief.
• Hyaluronic Acid Injections: Lubricate the joint, help reduce pain, but effects may not last as long as corticosteroids.
• Platelet-rich plasma (PRP): Contains growth factors.

Physical Therapy and Exercise Interventions

• Strengthening Exercises: Target quadriceps, hamstrings, and calf muscles for improved stability.
• Range of Motion Exercises: Increase flexibility and mobility to promote joint health and reduce stiffness.
• Low-Impact Aerobic Activities: Walking, swimming, and cycling improve cardiovascular health and reduce pain.

Weight Loss and Lifestyle Modifications

• Weight Management: Loss plays a crucial role in reducing stress and minimizing knee joint stress.
• **Exercise Modifications:**Regular physical activity, focusing on low-impact exercises tailored to maintaining/improving quality of life.

Assistive Devices and Bracing

• Cane or Walker: Provide support and reduce stress on the knee, especially during walking.
• Knee Braces: Offer stability and pain relief, limit excessive movement.
• Custom Orthotics: Correct foot and ankle alignment for reduced stress on the knee.

Surgical Treatment Options

• Osteotomy: Bone realignment surgery to correct misalignment and reduce stress on the affected area.
• Joint Replacement: Replacing damaged knee with an artificial prosthesis to improve pain and function.
• Arthroscopy: Minimally invasive procedure to diagnose and treat knee problems.

Total Knee Replacement Surgery

• A major surgical procedure involving the replacement of damaged joint surfaces with artificial components.
• The major steps in the procedure are pre-operative planning, surgical procedures, implantation, and post-operative care.

Rehabilitation and Recovery After Surgery

• Immediate post-surgery focuses on pain management and minimizing swelling.
• Gentle range-of-motion exercises begin soon after surgery.
• Physical therapy is vital to restore muscle strength, mobility, and function.
• Maintaining a healthy weight reduces stress on the knee joint
• Activities of Daily Living are gradually returned to as tolerated to achieve optimal functional recovery.

Conclusion and Key Takeaways

• Understanding Knee Osteoarthritis: A degenerative joint disease affecting the knee
• Manage Symptoms: Early intervention to prevent progression and maximize quality of life.
• Treatment Options: A variety of treatments exist (conservative and surgical).
• Individualized Approach: Treatment plans to address individual needs and improve overall quality of life, with monitoring of healing over time.

Patellofemoral Arthritis

• A common condition impacting the kneecap (patella) and femur.
• Causes pain, stiffness, and swelling in the front of the knee.
• Can result from overuse, injury, or other factors.

Causes of Patellofemoral Arthritis

• Injuries: Knee injuries (fractures, ligament tears) can damage cartilage and lead to arthritis.
• Patellar Maltracking: Kneecap misalignment leads to abnormal wear and tear.
• Genetics: Some individuals are predisposed to developing patellofemoral arthritis.

Understanding Patellar Maltracking

• Normal alignment: Kneecap gliding smoothly within the trochlear groove during knee movement.
• Mechanical Deviation: Factors (e.g., muscle imbalances, anatomical issues) cause the kneecap to track laterally or medially outside its optimal path.
• Progressive Damage: Continuous maltracking leads to cartilage wear and potential arthritis.

Risk Factors for Developing Patellofemoral Arthritis

• Age: Older age is a significant risk factor.
• Gender: Women are more commonly affected than men.
• Obesity: Excess weight puts extra stress on the knee joint.
• Prior Knee Injury: Previous injuries increase the risk of developing arthritis
• Repetitive Stress Activities: Repetitive movements increase risk due to stress on the knee.
• Malalignment: Malalignment of bones can increase risk.

Symptoms of Patellofemoral Arthritis

• Pain: Pain around the kneecap, often exacerbated by activities like climbing stairs or squatting.
• Stiffness: Difficulty bending or straightening the knee, often after a period of inactivity.

Diagnosing Patellofemoral Arthritis

• Physical Exam: Assessing range of motion, swelling, tenderness, and stability.
• Medical History: Identifying symptoms and prior knee injuries.
• Imaging Tests: X-rays, MRIs, or ultrasounds may be needed for confirmation

Conservative Treatment Options for Patellofemoral Arthritis

• Pain Management: Medications such as NSAIDs, acetaminophen, and other over-the-counter analgesics.
• Physical Therapy: Exercises, stretching to strengthen muscles around the knee and improve flexibility, reducing strain on the joint.
• Weight Management: Losing excess weight, reducing stress on the knee joint.
• Assistive Devices: Braces or canes to support the knee and reduce stress.

Surgical Treatment Options for Patellofemoral Arthritis

• Arthroscopy: Minimally invasive procedure to diagnose and treat knee problems.
• Osteotomy: Surgical procedure to correct bone alignment.
• Joint Replacement: Replacing the damaged joint surface with artificial components to alleviate pain and enhance function.

Tibial Plateau Fractures

• Complex injuries involving the articular upper surface of the tibia
• Caused by high-energy impacts (e.g., motor vehicle accidents) or indirect forces (e.g., twisting motion)
• Can occur in contact sports.

Anatomy of the Tibial Plateau

• Upper weight-bearing surface of the tibia, made or two distinct articular surfaces: the medial and lateral tibial condyles.
• Articulates with the medial and lateral femoral condyles, facilitating smooth movement.

Mechanism of Injury for Tibial Plateau Fractures

• High-Energy Impacts: Resulting from high-impact events such as motor vehicle accidents, falls, etc.
• Indirect Forces: Occur due to twisting/sudden motions of the knee joint (common during sporting activities).

Classification of Tibial Plateau Fractures

• Six types, based on pattern and severity of injury (e.g., simple split to complex bicondylar fractures). This classification guides selection of treatment based on the underlying damage pattern.

Schatzker Classification

• Categorizes fractures based on the pattern/severity of injury, ranging from simple splits to complex bicondylar fractures of the tibial plateau.

Associated Injuries with Tibial Plateau Fractures

• Ligament Tears (ACL, PCL, MCL, LCL): Accompany fractures due to force exerted on the knee joint.
• Meniscal Injuries: Injury to shock absorbers of the knee joint.
• Vascular Damage: Injuries to blood vessels in the knee resulting from fractures.
• Nerve Damage: Injuries to the peroneal nerve can affect foot movement.

Diagnosis and Imaging for Tibial Plateau Fractures

• X-rays: Initial examination to identify fracture patterns.
• CT scans: Provides detailed information about the extent and type of fracture, bone and soft tissue damage.
• MRI: May be used to evaluate soft tissue injuries.

Conservative Management Strategies for Tibial Plateau Fractures

• Immobilization: Resting the injured joint with bracing or specialized immobilization techniques to prevent further injury.
• Ice and Compression: Reducing pain, swelling, and inflammation initially.
• Rehabilitation Exercises: Increasing range of motion and restoring normal function through strengthening exercises and balance training.

Surgical Treatment Options for Tibial Plateau Fractures

• Open Reduction and Internal Fixation (ORIF): A surgical procedure where an incision is made, the fracture is reduced (realigned), and internal fixations such as plates, screws, and wires are used to stabilize the fracture.
• Minimally Invasive Approaches (Arthroscopy): Less invasive method involving small incisions to assess, treat, and stabilize less severe fractures.
• External Fixation: Provides fracture stability using pins and an external frame to allow healing.

Complications and Risks of Tibial Plateau Fractures

• Infection: Site infections are common, requiring prompt treatment.
• Non-union: Fracture failure to heal, often leading to pain and instability
• Compartment Syndrome: Increased pressure in muscles causing nerve and blood flow problemsrequiring immediate intervention
• Other Problems: Also include articular damage, ligament damage, and nerve damage

Rehabilitation and Post-Operative Care following Tibial Plateau Fractures

• Early Mobilization: Early range of motion exercises and weight-bearing assistance to improve healing and prevent complications.
• Comprehensive Physiotherapy: Includes strengthening, balance training, and functional rehabilitation.
• Gradual Return to Activity: Gradual progression from assistive devices to full weight-bearing to restore normal gait patterns and adapt to daily life.
• Long-Term Monitoring: Necessary to monitor healing, identify and manage complications

Long-Term Outcomes of Tibial Plateau Fractures

• Osteoarthritis Risk: Long-term risks of post-traumatic osteoarthritis, which are common after fractures.
• Return to Work: Success rates for returning to work vary depending on the severity of the fracture and the individual patient’s recovery.
• Functional Limitations: Limitations in activities like kneeling or performing certain types of movements after fracture.

Complications After Tibial Plateau Fractures

• Early Complications: Such as compartment syndrome (requiring fasciotomy), thrombosis (risk of embolism).
• Intermediate Complications: Including malunion (improper alignment), non-union (failure to heal) and significant joint stiffness.
• Long-term Complications: Including post-traumatic arthritis, chronic pain, and functional limitations.

This quiz provides a comprehensive overview of knee osteoarthritis, exploring its causes, clinical manifestations, and various diagnostic and treatment options. Understand how this prevalent condition affects mobility and quality of life, and the related anatomical aspects of the knee joint.