- See: - Osteoarthritis Menu:
- predisposing conditions
- pathology and histology
- clinical features
- Discussion:
- biomechanical considerations: (see kinematics and anatomy of knee
- thick cartilaginous surfaces of the knee helps to spread out joint reactive load over a wide area and helps contribute to cam
shape of condyles which maximizes extensor lever arm;
- in degenerative arthritis the quality of the articular cartilage is lost;
- early in the process, there may be discrete chondral injuries where as advanced changes include chrondal injuries on both
sides of the joint;
- as wear occurs, the patello femoral joint is reduced to a cylindrical outline;
- the mechanical outline is lost, but wear in the bone to bone contact area is reduced;
- reference: Does osteoarthrosis depend on growth of the mineralized layer of cartilage?
- mechanical malalignment:
- references:
- The role of knee alignment in disease progression and functional decline in knee osteoarthritis.
- The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease.
- Thrust during ambulation and the progression of knee osteoarthritis.
- synovial fluid
- Synovial fluid features and their relations to osteoarthritis severity: new findings from sequential studies.
- Synovial fluid crystals in osteoarthritis.
- The high prevalence of pathologic calcium crystals in pre-operative knees.
- meniscii
- Increased vascular penetration and nerve growth in the meniscus: a potential source of pain in osteoarthritis
- The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee
- Non Operative Treatment: (see narrated slide show)
- NSAIDS
- colchicine
- A randomized controlled trial to evaluate the slow-acting symptom modifying effects of a regimen containing colchicine in a subset of patients with osteoarthritis of the knee.
- A randomized controlled trial to evaluate the slow-acting symptom-modifying effects of colchicine in osteoarthritis of the knee: a preliminary report.
- steroid injection
- viscosupplementation: (hyaluronic acid)
- Supartz, Hyalgan, Synvisc, Orthovisc, Euflexxa;
- references:
- Granulomatous Inflammation After Hylan G-F 20 Viscosupplementation of the Knee
- Increased frequency of acute local reaction to intra-articular hylan GF-20 (synvisc) in patients receiving more than one course of treatment
.
- Clinical Trials of Hyaluronic Acid Reflect Significant Publication Bias
- reduction of cartilage impact loading: (typically this is 6 times body wt);
- cane (same side vs opposite side)
- rubber heel wedges (consider lateral wedges w/ medial compartment arthrosis);
- references:
- Medial knee osteoarthritis treated by insoles or braces: a randomized trial
- Immediate Coronal Plane Kinetic Effects of Novel Lateral-offset Sole Shoes and Lateral-wedge Insole Shoes in
- wt loss;
- valgus unloading knee brace; (see Donjoy and Breg)
- A Mechanical Theory for the Effectiveness of Bracing for Medial Compartment Osteoarthritis of the Knee
- Operative Treatment:
- total knee arthroplasty
- unicondylar replacement
- high tibial osteotomy
- alternatives to total knee replacement: autologous hamstring resurfacing arthroplasty
- arthroscopy of osteoarthritic knee
- arthodesis (limited indications in non infectious arthritis)
- fibular osteotomy:
- Medial Compartment Decompression by Proximal Fibular Osteotomy: A Biomechanical Cadaver Study
Osteoarthritis Slide Show
Cartilage Lesions - Treatment