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Osteoarthritis of the Knee:

Osteoarthritis of the Knee October 13, 2013 Brooke Huval Patricia Mahler Jennifer Lopez

General Description:

General Description -Degenerative joint disease in which there is a loss of cartilage in the knee joint leading to bone exposure. -Most common knee joint disability and cause of musculoskeletal pain -Most commonly found in the medial tibiofemoral compartment

Knee OA Stages:

Knee OA Stages Stage 0: normal and healthy knee -no signs of OA Stage 1 : knee with minimal growth of bone spurs Stage 2: mild OA -increase in bone spurs -Adequate healthy cartilage space -no bones rubbing together -can first see OA symptoms

Knee OA Stages:

Knee OA Stages Stage 3: moderate OA -cartilage damage with joint space narrowing -increase in symptoms with movement and joint stiffness -possible swelling in the knee joint Stage 4: severe OA -significant decrease in joint space -near complete absence of cartilage between the bones -decline in joint synovial fluid

Signs & Symptoms:

Signs & Symptoms -Pain during or after joint movement -Light pressure tenderness at the joint -Morning stiffness or stiffness with inactivity -Decrease in ROM through the joint -Crepitus in the knee -Possible bone spurs

Incidence:

Incidence -12% of Americans over the age of 25; 80% of people over 75 years of age -1 in 2 people will develop OA of the knee -More common in obese people -27 million people in U.S suffer from OA

Diagnosis:

Diagnosis -knee tenderness -crepitus -fluid accumulation -decrease in movement -knee instability -X-ray & other imaging

Prognosis:

Prognosis -Progressive disease with poor prognosis -Differentiate depending on stage of disease -Common treatments: >Surgery >activity modification >patient education >weight loss >pharmaceuticals >external brace

Impact of Functioning:

Impact of Functioning -Difficulty with moving the knee joint -Pain with walking, running, bending, kneeling, squatting -Stiffness greatest in the morning and after prolonged sitting

Role of imaging:

Role of imaging Many imaging tools are used to find the severity of OA such as: -Articular cartilage disease -Degenerative changes in the bones -Synovial tissue damage >Fragments of dead cartilage cause acute inflammation

Radiographs:

Radiographs -Best tool for diagnosing OA -The most accessible tool for evaluation of OA -Typically evaluated in weightbearing with knee extended -Flexed knee used to improve intra-articular visualization -Used to evaluate osteophytes and joint space narrowing (JSN) with Kellgren-Lawrence grading scheme

Kellgren- Lawerence Grading Scheme:

Kellgren- Lawerence Grading Scheme -KL grade 0: no radiograph feature present -KL grade 1: possible osteophytic lipping; doubtful JSN -KL grade 2: definite osteophytes; possible JSN -KL grade 3: multiple osteophytes; definite JSN -KL grade 4: large osteophytes; marked JSN; severe sclerosis; definite bone deformity

MRI (Magnetic Reasonance Imaging):

MRI (Magnetic Reasonance Imaging) -Used to evaluate focal cartilage defects and to evaluate tissue contrast -Subchondral bone composition, lesions of the bone marrow or subchondral cysts show progression of disease -Changes are seen in subchondral bone on MRI usually before radiographs -Synovium assessment that has been correlated with pain in OA

Ultrasound:

Ultrasound -Cost effective and does not need contrast enhancement -Shows the synovial hypertrophy around suprapatellar, medial,and lateral pouch -Doppler allows detection of indirect evaluation of inflammatory activity with vascularity involvement

Image 1 (Stage 3 Radiograph):

Image 1 (Stage 3 Radiograph) This is an anteroposterior (AP) view revealing decreased joint space on the medial aspect of the bilateral knees. This patient shows stage 3 osteoarthritis with moderately impaired joint space and osteophytes. This is shown by the sharpening of the tibial spines. Stacy, G., Chew, F. Primary osteoarthritis imaging. Medscape . Available at: http://emedicine.medscape.com/article/392096-overview . Accessed on: October 11, 2013

Image 2 (Stage 3 MRI):

Image 2 (Stage 3 MRI) This is a TI MRI anterior/posterior view of the right knee. This shows cartilage loss on the medial tibiofemoral compartment of the knee. Osteophyte formation along the medial tibial plateau and medial femoral condyle. Hospital for special surgery staff. Diagnosing Osteoarthritis. Hospital for Special Surgery . Available at: http://www.hss.edu/osteoarthritis-diagnosis.asp . Accessed on: October 11, 2013.

Biomechanics for both images:

Biomechanics for both images -Knee valgus -Increased medial glide of tibia on femur -Increased regional load across medial compartment’s articular cartilage -Increased medial compartment pressure -Quadriceps weakness (further research needed to verify)

Questions:

Questions How would you treat a patient with stage 2 OA vs. stage 4 OA? At which point on the Kellgren-Lawrence grading scheme would you discuss with your patient possible surgery? Why?

References:

References Mayo Clinic Staff. Osteoarthritis. MyoClinic Website. 2013. Available at http://www.mayoclinic.com/health/osteoarthritis/DS00019/DSECTION=symptoms . Accessed October 11, 2013. King W. Treatment options for osteoarthritis in the knee. Palo Alto Medical Foundation Website. Available at http://www.pamf.org/sports/king/osteoarthritis.html . Accessed October 11,2013. Galbreath C. Half of adults at risk for painful knee arthritis. Medical News Today Website. 2008. Available at http://www.medicalnewstoday.com/releases/120298.php . Accessed October 11, 2013. Arthritis Research UK staff. Osteoarthritis of the knee. Arthritis Research UK Website. Available at: http://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis-of-the-knee.aspx . Accessed October 11, 2013.

References:

References Braun HJ, Gold GE, Diagnosis of osteoarthritis: Imaging, Bone (2011), doi: 10.1016/j.bone.2011.11.019. McKinnis L. Fundamentals of Musculoskeletal Imaging 3rd ed . Philadelphia: F.A..Davis; 2010. Teichtahl, A., Wluka, A., Cicuttini, F. Abnormal biomechanics: a precursor or result of knee osteoarthritis? British Journal of Sports Medicine. 2003; (37): 289-290. Holland K. Stages of osteoarthritis of the knee. Healthline Website. 2013. Available at: http://www.healthline.com/health/osteoarthritis-stages-of-oa-of-the-knee . Accessed October 11, 2013.