knee KNEE ARTHRITIS
DEFINITION:
- A destructive process resulting in loss of cartilage and subsequent narrowing of the joint space. (See illustration).
MECHANISM OF INJURY / HOW IT OCCURS:
- Osteoarthritis is the most common form and can be primary or a result of trauma, (previous fracture, meniscus tear, or ligament injury), amongst other causes.
SYMPTOMS:
- Individuals complain of gradual increase in pain exacerbated with weight bearing activities.
- Giving way episodes and a sensation of catching can occur.
- Getting up from a seated position, climbing stairs, and descending stairs can exacerbate symptoms.
- Intermittent swelling.
- Pain may become constant as arthritic process progresses with individuals experiencing pain at rest and at night.
DIAGNOSIS:
- Physical examination reveals decreased motion with discomfort on motion testing.
- Swelling.
- Joint line tenderness.
- A grating sensation (crepitation) with motion.
- May see an angular deformity, best appreciated in the standing position.
- Radiographs , including a weight bearing view, will confirm the arthritic process.
TREATMENT/REHABILITATION:
- Anti-inflammatory medications (NSAIDS).
- Activity modifications specifically avoiding impact activities.
- Ice or heat is as per individual preference.
- Neoprene sleeves help with control of swelling. Off- loading braces help concentrate pressure to less affected parts of knee.
- Rehabilitation to include non-impact activities such as cycling and swimming. Stretching and strengthening exercises to preserve motion and function. (See exercises for knee arthritis).
- Corticosteroid injections may afford temporary benefit.
- Viscosupplementation injections may be of benefit in mild cases.
- Surgical procedures such as arthroscopy (evaluating with a camera) or osteotomy (realignment by cutting bone) can be considered in certain situation.
- Ultimately total knee arthroplasty (replacement) surgery.