Knee Osteoarthritis Lecture PDF

Knee Osteoarthritis: A Comprehensive Orthopedic Lecture will provide an in-depth overview of knee osteoarthritis, a prevalent ndition affecting millions worldwide. various aspects, from its underlying causes and clinical manifestations to gnostic techniques and comprehe...

Knee Osteoarthritis: A Comprehensive Orthopedic Lecture will provide an in-depth overview of knee osteoarthritis, a prevalent ndition affecting millions worldwide. various aspects, from its underlying causes and clinical manifestations to gnostic techniques and comprehensive treatment options. Dr. Mohamed Nabil  Introduction to Knee Osteoarthritis n Condition Degenerative Joint Disease Impact on Quality of Life thritis is a prevalent joint disease It involves the breakdown of cartilage in the Knee osteoarthritis significantly im ting millions worldwide. the knee joint, leading to pain, stiffness, and activities, limiting mobility, and red and reduced mobility. of life.  Anatomy and Function o Knee The knee joint is a complex hinge joint that connects the femur (thigh bone to the tibia (shin bone). It allows for flexion, extension, and limited rotation of the lower leg. The joint is stabilized by ligaments, tendons, and muscles. Crucial for mobility, the knee relies on a delicate balance of bones, cartilage ligaments, and tendons. The patella (kneecap) protects the joint and enhan enhances leverage during extension.  Factors Affecting Knee Weight Distribution Body Mass Index (BMI) Muscle Strength r BMI increases stress on the knee joint. Weak leg muscles contribute to uneven weight distrib distribution. Joint Deformities Foot Alignment tions like varus or valgus deformities alter weight bearing. Pronation or supination can influence knee mechanics g. Activity Level Gait Pattern mpact activities place increased stress on the knees. Abnormal gait patterns can lead to uneven weight dist distribution.  Mechanical Axis & Deviation of the Lower Limb mal Mechanical Axis Mechanical Axis Deviation hanical axis of the lower limb is an imaginary line extending Deviation from the normal mechanical axis, also know g from the center of the hip joint, through the center of the varus or valgus deformity, places abnormal stress on t oint, to the center of the ankle joint. In a healthy individual, joint. Varus deviation (bowlegged) causes increased stress is line is straight and vertical when the lower limb is bearing the lateral (outer) compartment of the knee. Valgus dev is bearing weight. (knock-kneed) results in excessive stress on the m c These deviations can contribute to the develop osteoarthritis, pain, and function  Causes and Risk Factors o Osteoa 1 Age 2 Ge Knee osteoarthritis is more common in Some individuals m common in older adults. This is because predisposed to developin because cartilage wears down over time. time. 3 Obesity 4 Previous Excess weight puts additional stress on A history of knee stress on the knee joints, increasing the ligament tears the risk of cartilage damage. contribute 5 inflammatory conditions; Rheumatoid arthritis, go  Types of Knee Osteoarthritis rtmental Bicompartmental Patellofemoral nee compartment (medial or Involves both medial and lateral Affects the kneecap (patella) and f compartments.  Pathophysiology of Knee Osteoarthritis Cartilage Deterioration The smooth articular cartilage lining the joint surfaces wears away, exposing underlying bone. Inflammation The exposed bone and cartilage debris trigger an inflammatory response, leading to pain and swelling. Bone Remodeling The underlying bone undergoes remodeling, forming bony spurs or osteophytes, further limiting limiting joint movement. Joint Instability The weakened cartilage and ligaments cause instability, leading to joint m misalignment and further damage. hritis is a chronic degenerative joint disease that affects the knee joint. It involves the progressive breakdown of cartilage, causing pain, stiffness, and inf n. As the cartilage deteriorates, the underlying bone becomes exposed, leading to bony spurs and joint instability. This cycle of degeneration and inflam inflammation continues, further exacerbating the symptoms of k oms and Diagnosis of Knee Osteoarthritis Osteoarthritis n Symptoms Pain During Activity fness, swelling, and limited range of Pain may worsen with physical activity, especially ion are common symptoms of knee especially after prolonged sitting or standing. knee osteoarthritis. Examination Radiological X-ray AP / lateral standing CT == previous plateau fr. or loose body intraarticular MRI === associated soft tissue inj eg. ACL LAB. Rh factor , SUA, urine, hemophilia protocol adiographic Evaluation and Staging Radiographic evaluation plays a crucial role in diagnosing and stag X-rays reveal joint space narrowing, bone spurs, an 0 1 2 Stage 0 Stage 1 Stage 2 Normal joint space Doubtful joint space narrowing Minimal joint space narrowing, sclerosis 3 4 Stage 3 Stage 4 arrowing, sclerosis. osteophytes, subchondral cyst Severe joint space narrowing & collapse subchondral cyst  Conservative Management Strategies in Management Physical Therapy ounter pain relievers, such as acetaminophen or ibuprofen, Physical therapy can help strengthen muscles, improve ran ibuprofen, can help reduce pain and inflammation. of motion, and pain relievers, such as capsaicin cream, may also be helpful. Physical therapists can teach patients exercises and stre helpful. to help manage the  Medications and Injections for Knee Osteoa Osteoa Pain Relievers Corticosteroid Injections Over-the-counter options include acetaminophen and Injectable corticosteroids reduce inflammation and ibuprofen. Prescription NSAIDs are available for stronger temporary pain relief. These injections are usu stronger pain relief. short-term measure to manage symptoms used in sever OA. Hyaluronic Acid Injections PRP Hyaluronic acid is a natural component of joint fluid. Injections Platelet rich plasma ,, contain growth factors can lubricate the joint and reduce pain, but the effect may not last as long as corticosteroids.  Physical Therapy and Exercise Interventions Strengthening Exercises Target quadriceps, hamstrings, and calf muscles. Improve knee stability and reduce strain on the joint. Range of Motion Exercises Increase flexibility and mobility. Promote joint health and reduce stiffness. Low-Impact Aerobic Exercises Walking, swimming, and cycling can improve cardiovascular health and reduce pain. reduce pain.  Weight Loss and Lifestyle Modifications ht Management Exercise Modifications loss can significantly reduce stress on the knee joint. Even a Regular physical activity is crucial for knee osteoarthritis m Even a modest weight loss can make a difference. m g weight can be achieved through a combination of diet and Low-impact exercises like swimming, cycling, or wate and exercise. are recommended to strengthen muscles and impr  Assistive Devices and Bracing Cane or Walker Knee Braces Custom Orthotics devices can provide support and Knee braces can provide stability and pain Custom orthotics can help alig d reduce stress on the knee joint, relief by supporting the joint and limiting and ankle, which can reduce st particularly during walking. excessive movement. Surgical Treatment Options py Osteotomy Joint Replacement asive procedure to diagnose and Bone realignment surgery to correct Surgery to replace damaged knee j treat knee problems. Used to misalignment of the knee joint and reduce with an artificial prosthesis. A signi maged cartilage, repair ligaments, reduce stress on the affected area. procedure that can improve pain a remove bone spurs. function. Uni Vs TKR TKR with patellar component  Total Knee Replacement Surgery Pre-operative Planning 1 Assess patient's overall health. Surgical Procedure 2 Resection of damaged bone and cartilage. Implantation 3 Placement of prosthetic components. Post-operative Care 4 Rehabilitation and pain management. e replacement surgery is a major surgical procedure. It involves replacing the damaged joint surfaces with artificial components. This This procedure can significantly alleviate pain, improve mobility, and enhance quality of life for patients with severe knee Rehabilitation and Recovery After Early Postoperative Care Immediate post-surgery focuses on pain management and minimizing swelling. Gentle range of motion exercises start soon after surgery. Physical Therapy Physical therapy plays a vital role in strengthening muscles and improving mobility Specialized exercises target the knee joint, improving flexibility and stability. Weight Management Maintaining a healthy weight reduces stress on the knee joint. Weight loss can be beneficial for long-term recovery. Activities of Daily Living Gradual return to daily activities is important for functional recovery. Follow the advice of your surgeon and physical therapist for safe progression.  Conclusion and Key Takeaways 1 1. Understanding Knee 2 2. Manage Symptom Osteoarthritis Early intervention helps mana Knee osteoarthritis is a common and delay degenerative joint disease. 3 3. Treatment Options 4 4. Individualized Ap A variety of treatments exist, ranging from Treatment plans should be t from conservative to surgical. the individual pa  lofemoral Arthritis: erstanding and Managing Pain al arthritis is a common condition that affects the kneecap, or patella, and he femur, the thigh bone. n causes pain, stiffness, and swelling in the front of the knee, and can be aused by overuse, injury, or other factors. Dr. Mohamed Nabil What is patellofemoral arth Degenerative Condition Cartilage Breakd Patellofemoral arthritis is a form of The smooth cartilage tha of osteoarthritis that affects the cushions the joint surfa kneecap (patella) and the femur. wears down, causing pain femur. stiffness, and infl Joint Space Narrowing The space between the kneecap and femur narrows as cartilage de leading to bone rubbing aga  Anatomy of the patellofemoral joint Femur Patellofemoral Joint r kneecap, is a small, triangular The femur is the thigh bone, the largest bone in The patellofemoral joint is the artic s in front of the knee joint. It helps the body. The patella sits on top of the femur, articulation between the patella an e knee joint and improve the forming the patellofemoral joint. femur. This joint allows for smooth he quadriceps muscles. movement of the knee and helps t distribute forces evenly.  Causes of Patellofemoral Arthritis arthritis Injuries Patellar maltracking Genetics ost common cause. A knee injury, such as a fracture or Patellofemoral arthritis can also Some people may be of wear and tear on fracture or ligament tear, can also occur when the kneecap is genetically predispose ge can cause it to damage the cartilage and lead to is not properly aligned, leading to developing patellofem n, leading to arthritis. lead to arthritis. leading to abnormal wear and arthritis. tear. nderstanding Patellar Maltracking Patellar maltracking occurs when the kneecap (patella) deviates from its normal path of movement along the femoral groove during knee fle ormal Alignment ella should glide smoothly within the trochlear groove of the femur during knee movement echanical Deviation ious factors cause the patella to track laterally or medially outside its optimal path eg. varus / valgus uscle Imbalance ak vastus medialis obliquus (VMO) and tight lateral structures contribute to abnormal tracking ogressive Damage ntinued maltracking leads to cartilage wear and potential arthritis development This condition often results from a combination of anatomical factors, muscle imbalances, and biomechanical issues that affect proper  Risk factors for developing patellofemoral art Several factors can significantly increase your risk of developing patellofemoral arthritis. These key risk fa Age Gender Obe Older age is a significant risk factor. Women are more frequently affected Excess weight puts extra affected than men. Prior Knee Injury Repetitive Stress Activities Malalignm ious injuries can increase the risk of Activities causing repetitive stress on the developing arthritis. knee increase risk.  Symptoms of Patellofemoral Arthritis Pain Stiffness round the kneecap is a common symptom (anterior knee Difficulty bending the knee or straightening it fully can occu larly during activities like climbing stairs or squatting. particularly after a period of inactivity. Stiffness can also be experienced after sitting for an extend worsen after prolonged sitting or standing. Diagnosing Patellofemoral Arthritis Physical Exam ROM,swelling, and tenderness, stability. Medical History Patient shares their symptoms and any previous injuries. Imaging Tests X-rays, MRIs, or ultrasounds may be needed to confirm the diagnosis. A doctor will use a combination of methods to diagnose patellofem  Conservative Treatment Options 1. Pain Management 2 2. Physical Therapy medications, like NSAIDs or acetaminophen, can help relieve Exercises and stretches can strengthen muscles, imp and inflammation. flexibility, and reduce stress on the joint. 3. Weight Management 4 4. Assistive Devices ng even a small amount of weight can significantly reduce Braces or canes can provide support and help reduce ce pressure on the knee joint. strain on the knee.  Surgical Treatment Options hroscopic Surgery Osteotomy Joint Replacement s minimally invasive procedure is This procedure involves cutting and In severe cases, a total knee re ommonly used for patellofemoral repositioning the bone to improve replacement may be nece. Surgeons can remove damaged alignment and reduce stress on the joint. involves replacing the damaged ged cartilage and smooth out the Osteotomy can be used to correct with a prosthet the joint. misalignment.  Rehabilitation and physical therapy Strength training 1 Improve muscle strength around the knee. Range of motion exercises 2 Increase flexibility and mobility of the knee joint. Low-impact aerobic activities 3 Improve cardiovascular fitness and endurance. Proprioceptive exercises 4 Enhance balance and coordination. al therapy is essential in managing patellofemoral arthritis. It can help reduce pain, improve function, and prevent further damage to  Preventing the Progression of Patellofemoral Arthr Weight Management 2 Strengthening Exercises Excess weight puts stress on the knee joint. Exercises target quadriceps especially VMO and hamst sta Stretching 4 Proper Footwear Improve flexibility around the knee, reducing strain on the joint. Wear supportive shoes that provide cushioning and reduc impa  Living with patellofemoral arthritis Modifications Pain Management Healthy Diet ctivities to minimize stress on your Over-the-counter pain relievers and physical Maintain a healthy diet rich in fruit (avoid knee flex.>90,squat). therapy can help manage pain and stiffness. vegetables, and whole grains for o gement can also help reduce Your doctor may recommend prescription joint health. ure on the joint. medications for severe pain.  Conclusion and Key Takeaways ction Multifaceted Approach Active Lifestyle ng the symptoms of patellofemoral A combination of conservative treatment, Maintaining a healthy weight, enga al arthritis is crucial for seeking treatment, rehabilitation, and lifestyle in regular low-impact exercise, and treatment. modifications can effectively manage pain and strengthening the muscles around pain and improve quality of life. knee are crucial for preventing furt damage. Tibial Plateau Fractures: u fractures are complex injuries involving the articular upper surface of the standing the anatomy, mechanisms of injury, and appropriate treatment is crucial for optimal patient outcomes. Anatomy of the Tibial Plateau ateau refers to the upper, weight-bearing surface of the tibia. It consists of sists of two distinct articular surfaces: the medial and lateral tibial condyles. condyles. ndyles articulate with the medial and lateral femoral condyles, forming the e knee joint. The tibial plateau is covered by hyaline cartilage, which allows allows for smooth movement and reduces friction during joint articulation. articulation. ntercondylar eminence, located between the condyles, serves as a point of for the anterior and posterior cruciate ligaments, which provide stability to the knee joint. Mechanism of Injury High-Energy Impacts Tibial plateau fractures are often caused by high-energy impacts, such as motor vehicle accidents or falls from significant heights. Indirect Forces These fractures can also occur due to indirect forces, such as a sudden, sudden, twisting motion of the knee joint. Sporting Injuries Active individuals, especially those participating in contact sports, are at risk of sustaining tibial plateau fractures from sudden impacts or rapid changes in direction.  Classification of Tibial Plateau Fractures ssification ctures are classified into six types based on the pattern and severity of the injury, ranging from simple splits to complex bicondylar fractures.  Schatzker Classification racture of the lateral tibial plateau racture & depressionof lateral tibial plateau ession fracture of the lateral tibial plateau ture of the medial tibial plateau dylar fracture. plex bicondylar fracture with metaphyseal fracture  Associated Injuries with Tibial Plateau Fractur Injuries: Tibial plateau fractures can often be accompanied by tears of the anterior cruciate ligament (ACL), posterior cruciate ciate ligament (PCL), medial collateral ligament (MCL), or lateral collateral ligament (LCL). ries: The menisci, which act as shock absorbers in the knee, are also susceptible to tears during a tibial plateau fracture. ries: In severe cases, a tibial plateau fracture can damage the popliteal artery, which supplies blood to the lower leg, requiring urgical intervention. s: Injuries to the peroneal nerve, which controls the muscles in the lower leg and foot, can occur, leading to foot drop. t Syndrome: A dangerous condition where pressure builds up in the muscles of the lower leg, compromising blood flow and using tissue damage.  Diagnosis and Imaging X-Ray; anteroposterior AP, lateral, and oblique views, is the initial ste fracture patterns and d CT scans; advanced imaging modalities provide valuable information abo the extent of the fracture, involvement of the joint surface, and pre any additi MRI; may also be utilized to assess soft tissue damage and guide treatme ACL, PCL, menescial inju  Conservative Management Strategies mmobilization Ice and Compression Rehabilitation Exercises Partial Weight-Bea njured joint to rest Using ice packs and compression A tailored physical therapy program Gradually increasing w g it with bracing or compression wraps can help reduce helps restore range of motion, bearing as tolerated ca n the first step in reduce pain, swelling, and strength, and function in the injured promote bone and joi reatment. inflammation in the initial stages of joint over time. healing while avoiding stages of injury. injury. Surgical Indications and Techniques Assess Fracture Severity Determine if surgical intervention is necessary based on fracture pattern and displacement. Surgical Planning Evaluate imaging, select appropriate surgical approach, and plan implant placement. Surgical Exposure Use minimally invasive techniques to access the fracture site with minimal soft tissue disruption. Fracture Reduction Carefully restore the articular surface and align the proximal tibia using a anatomic reduction techniques. ns for tibial plateau fractures are based on the degree of articular surface involvement, metaphyseal comminution, and joint instability. The goal of sur of surgical management is to achieve anatomic reduction and stable internal fixation to allow early mobilization and prevent long-te  Minimally Invasive Approa Approa Arthroscopic Techniques Percutaneous Stabilizing fr Minimally invasive arthroscopic percutaneous scre arthroscopic methods allow for plates can provide s for visualization and treatment of fixation with minimal of tibial plateau fractures with disruption to the small incisions, reducing soft tissue tissue damage. Hybrid Techniques Combining arthroscopic assessment with limited open reduction fixation can optimize visualization and fractu Open Reduction and Internal Fixation n and internal fixation (ORIF) is a surgical technique used to treat complex tibial plateau fractures. This approach involves making an incision to dire to directly visualize and anatomically reduce the fractured bone fragments, then stabilizing them with internal fixation devices such as plates, s Exposure 1 Careful surgical dissection to access the fracture site Reduction 2 Anatomical realignment of the fractured bone segments Internal Fixation 3 Stabilization of the reduced fragments with plates, screws, and/or wire  External Fixation and Ilizarov Frames at is External Fixation? What is an Ilizarov Frame? fixators are devices that provide stabilization to a fracture by Ilizarov frames are a specific type of external fixator that u re by attaching pins or wires to the bone fragments and then rings and connecting rods to provide stability and allow then connecting them to an external frame. correction of bone d es in Tibial Plateau Fractures Advantages of External Fixation minuted fr. , open fracture, schatzker VI, associated vascular Advantages of external fixation include minimal soft tissue vascular injury & unstable patient. disruption, adaptability to complex fractures, and the abilit correct d isadvantages of External Fixation Advantages of Ilizarov Frames inconvenient for the patient, pin tract infection Ilizarov frames used as diffenet  Complications and Risks Infection Nonunion Compartment Syndrome Syndrome site infections are a Failure of the fracture to heal Articular surface sk, requiring prompt heal properly can lead to Increased pressure within the can progress to p biotic treatment and persistent pain and instability, the muscle compartments can traumatic osteoart ometimes additional instability, often requiring can compromise blood flow and causing chr procedures. revision surgery. and nerve function, requiring disability in t requiring emergency fasciotomy. fasciotomy. Rehabilitation and Post-operative Care rly Mobilization ients are encouraged to begin gentle range-of-motion exercises and partial weight-bearing as soon aring as soon as possible to prevent stiffness and promote healing. hysiotherapy omprehensive physiotherapy regimen is crucial, including strengthening, balance training, and ining, and functional rehabilitation to restore full mobility and function. adual Return to Activity ients gradually progress from assistive devices to full weight-bearing, with a focus on restoring toring normal gait patterns and adapting to daily living activities. ng-term Monitoring gular follow-up appointments and imaging studies are essential to monitor bone healing, detect aling, detect any complications, and optimize the long-term outcome. ong-term Outcomes with tibial plateau fractures often face long-term challenges, including persistent pain, limited mobility, and post-traumatic osteoarthritis. management and a comprehensive rehabilitation program are crucial to maximize functi Osteoarthritis Risk Up to 44% of patients develop post-traumatic arthritis wi Return to Work 50-80% of patients able to return to their previou Functional Limitations Many patients report ongoing limitations in activities like kneelin  Complications After Tibial Plateau Fracture arly Complications Intermediate Complications Long-term Complica ent Syndrome - Requiring Malunion - Improper alignment during Post-traumatic Arthritis - Progres y fasciotomy healing joint degeneration Nonunion - Failure of bone healing Chronic Pain - Persistent discomf Thrombosis - Risk of during activities embolism Joint Stiffness - Reduced range of Functional Limitations - Difficulty mplications - Including motion daily activities nd dehiscence nition and appropriate management of these complications is crucial for optimal patient outcomes. Regular monitoring and f and follow-up care can help prevent or minimize their impact on pati