Osteoarthritis in Young People: Difference between revisions

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== Definition / Description  ==
== Definition   ==
 
[[File:Runners-knee SAG.jpeg|right|frameless]]
Osteoarthritis intion young people has two components: ''osteoarthritis'', which means inflammation (itis) of the joint (arthro) and bones (osteo); the second component, namely ''young people'' is harder to define, because young is a relative conception.  
[[Osteoarthritis]] (OA) is one of the most devastating [[Chronic Disease|chronic condition]]<nowiki/>s that affect people around the world. Although the usual population associated with the condition is the [[Older People - An Introduction|elderly]] (who are mostly inactive), [[Athletes with difficult or longstanding neuromusculoskeletal symptoms|athlete]]<nowiki/>s and younger individuals are also susceptible.
 
It is considered that&nbsp; young people in combination with osteoarthritis means that patients are not older than 55 years of age.<ref name="dahl">W-Dahl A., Robertsson O., Lidgren L. Surgery for knee osteoarthritis in younger patients: A Swedish Register Study. (2010) Acta Orthopaedica, 81, 161-164 (B)</ref><ref name="okano">Okano K. et al. Joint congruency in abduction before surgery as an indication for rotational acetabular osteotomy in early hip osteoarthritis. (2010) International Orthopaedics, 34, 27-32 (B)</ref><ref name="nmj">Nieuwenhuijse MJ. et al. 5-year clinical and radiostereometric analysis (RSA) followup of 39 CUT femoral neck total hip prostheses in young osteoarthritis patients. (2012) Acta Orthopaedica, 83, 334-341. (B)</ref>


== Epidemiology / Etiology  ==
* Depending on the population, the etiology may differ; injuries, occupational activities, and [[obesity]] appear to be the most common causes of OA in young and athletic populations.
[[File:Hip Osteoarthritis.jpg|thumb|Hip osteoarthritis ]]
* Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased [[Pain Behaviours|pain]] tolerance.
There are two main classifications of OA
* However, the treatment of OA in these populations does not differ from its management in the general population<ref name=":1">Amoako AO, Pujalte GG. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039183/ Osteoarthritis in young, active, and athletic individuals.] Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2014 Jan;7:CMAMD-S14386.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039183/<nowiki/>(accessed 17.10.20210</ref>.
# Primary osteoarthritis: is the form where you don't know what could have triggered the disease, inferring history or clinical/radiographic examination.
# Secondary osteoarthritis: can be caused by trauma, metabolic disease, congenital malformations, premature menopause, etc. Developmental dysplasia of the hip (DDH) is one of the most common causes of secondary osteoarthritis in young adults<ref name="okano" />


The etiology of osteoarthritis is multifactorial, so it could be determined and/or developed by several risk factors including:
== Potential Causes ==
There are a whole range of potential causes of osteoarthritis in young adults (14-40). These include –


=== Modifiable ===
* Leading a sedentary (non-active) lifestyle
* Psychological and socio-economical factors
* Poor [[posture]] when sitting for long periods
* Sedentary lifestyle
* Heavy [[lifting]] (potentially with poor technique, but not necessarily)
* Biomechanical factors: malalignment, joint laxity, muscle weakness or reduced proprioception
* Doing an office job with large amounts of sitting at a desk/ computer
* Metabolic, and inflammatory processes: elevated levels of C-reactive protein, elevated levels of hyaluronic acid and atrophy of the bone
* Being overweight or clinically obese
* Overweight: Obesity in children and adolescents has been linked to musculoskeletal disorders, therefore, excess force or joint loading may lead to osteoarthritis in overweight teens.<ref name="sanjeev">Sanjeev Sabharwarl MD., Michael  Z. Impact of Obesity on Orthopaedics (2012) The Journal Of Bone And Joint Surgery, 94, 1045-1052 (A1)</ref>
* Being very active ([[Assessment of Running Biomechanics|running]] lots of marathons for example)
* Sports participation / occupation: High-impact, high-intensity, and repetitive athletics have a strong association with OA.<br>Power and team sports such as soccer, basketball, track and field, boxing, wrestling and weight lifting have been linked with the development of early-onset OA.<ref name="nicholson">Nicholson S. et al. Reducing Premature Osteoarthritis in the Adolescent Through Appropriate Screening. (2009) Journal of Pediatric Nursing, 24, 69-74 (B)</ref> These risk factors may lead to the development of premature osteoarthritis in a genetically susceptible person.<ref name="nicholson" /><ref name="yvonne">Yvonne M. et al. FUTURE SHOCK: Youth sports and osteoarthritis risk (2011) Lower extremity revieuw (ler). October  (B)</ref>
* Playing impact sports such as rugby or football
* [[Sport Injury Classification|Joint injuries]]
* Birth defects such as [[Hip Dysplasia|hip dysplasia]] or different length legs
* [[Hormones|Hormone]] disorders that affect growth
* [[Diabetes]]
* Osteoarthritis in the family<ref name=":0">Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. [https://www.jospt.org/doi/full/10.2519/jospt.2017.7286 Hip and knee osteoarthritis affects younger people, too.] journal of orthopaedic & sports physical therapy. 2017 Feb;47(2):67-79.Available: https://www.jospt.org/doi/full/10.2519/jospt.2017.7286<nowiki/>(accessed 17.10.2021)</ref><ref>Oddis CV. [https://www.sciencedirect.com/science/article/abs/pii/S0002934397895411 New perspectives on osteoarthritis]. The American journal of medicine. 1996 Feb 26;100(2):10S-5S.Available: https://www.sciencedirect.com/science/article/abs/pii/S0002934397895411<nowiki/>(accessed 17.10.2021)</ref>


=== Non-Modifiable ===
== Assessment ==
* Age
[[File:Towfiqu-barbhuiya-3AsiVDsZnHg-unsplash.jpeg|right|frameless]]
* Female gender
Assessment of OA in younger people should focus on a: 
* African American race
* Comorbidity (heart/lung, diabetes, articular disorders, poor vision, etc)
* Genetic predisposition: more than 50% of all cases of OA result from a hereditary disposition. The interleukin-1 gene cluster, a key regulator in several chronic disease processes, conferred a twofold risk of OA in those with a specific genotype. These findings support that OA is not just a disease of the older people.<ref name="yvonne" />


The most common joint site for OA is the knee. followed by hand, hip and in fouth place the ankle. Ankle OA is most often a result of trauma and is associated with chronic ankle instability.<ref name="nicholson" /><ref name="yvonne" />
* Patient-centred history, 
[[File:OA swollen knee.jpg|thumb|OA swollen knee]]
* Comprehensive physical examination,
* [[Outcome Measures|Performance-based measures]]
* Patient-reported outcome measures to enable monitoring of symptoms and function over time.


== Characteristics / Clinical Presentation  ==
Referral for [[Diagnostic Imaging for Lower Extremity|imaging]] should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA.


Nonspecific symptoms, mainly local:  
== Treatment Approach ==
* Pain
[[File:Nate-johnston-2gBpsNuHcyA-unsplash.jpeg|right|frameless]]
* Loss in ROM
The treatment of OA in these populations does not differ from its management in the general population.<ref name=":1" /> See
* Crepitation
* Stiffness / total blocking
* Morphological deformities
Pain is more likely caused by congenital hip dysplasia, athletic injuries, trauma, spondyloarthropathy, and by conditions that first appear during this stage of life, such as rheumatoid arthritis, osteoarthritis, intravenous drug use, alcoholism, or corticosteroid use.<ref name="troum">Troum OM., Crues JV. The Young Adult With Hip Pain: Diagnosis and Medical Treatment (2004) Division of Rheumatology, University of Southern California, 9-17 (C)</ref><br>Furthermore the more common characteristics of generalized osteoarthritis can be found in the young adult, mainly in the Hip and Knee.


== Diagnostic procedures ==
[[:Category:Osteoarthritis|Category:Osteoarthritis]]
The diagnostic procedures for young people suffering from osteoarthritis is not different from people who are older. There are guidelines for diagnosis for different types of osteoarthritis, like [http://www.physio-pedia.com/Hip_Osteoarthritis hip] and&nbsp;[http://www.physio-pedia.com/Knee_Osteoarthritis knee] osteoarthritis.<ref name="rds">Royal Dutch Society for Physical Therapy (2010). KNGF Guideline for Physical Therapy in patients with osteoarthritis of the hip and knee. De Fysiotherapeut, V120, 1 (D)</ref>&nbsp;Main focus in both (and thus also in young patients) is the evolution of pain. The diagnosis itself is confirmed by radiography.


== Outcome Measures ==
Nonpharmacological approaches are core strategies for the management of  OA in younger people, and these include appropriate disease-related education, activity modification (including for [[Work-Related Musculoskeletal Injuries and Prevention|work-related tasks]]), physical therapist- prescribed [[Therapeutic Exercise|exercise]] programs to address identified physical impairments, and weight control or weight loss.  
Oftenly used tests to quantify “body function, activity and participation” are:
* Patient-specific complaints (PSC) questionnaire<ref name="rds" />
* [http://www.physio-pedia.com/Timed_Up_and_Go_Test_(TUG) Timed Up and Go (TUG)] test<ref name="rds" /><br>
In young subjects however, some of these tests should be adjusted for the age: difficult terminology should be avoided in questionnaires, score outcomes should be compared with subjects of the same age and exercise difficulty should be appropriate for the subject. <br>
 
== Examination ==
The examination should evaluate the patient’s functional performance.<ref name="rds" />&nbsp;The examiner should:
# Inspect posture and movement in daily activities, with special attention for the back, pelvis, ankles and feet. If walking aids are used, the upper extremity must also be inspected.
# Palpate for presence of swelling or raised temperature and muscle tone.
# Do active/passive functional testing
# Assess muscle strength
# Assess mobility
# Assess balance and stability
# Assess coordination <br>
 
== Medical Management ==
For patients with osteoarthritis there is variety of options for surgery. For young patient especially there is a special techniques which&nbsp; focusses on the level of activity after surgery. Autologous Chondrocyte Implantation is used for joint preservation. The chondrocytes are said to produce hyaline-like repair tissue. Early reports suggests that this procedure reduces symptoms and increases functions.<ref name="minas">Minas T et al. Autologous Chondrocyte Implantation for Joint Preservation in Patients with Early Osteoarthritis.(2010) Clinical Orthopaedics and Related Research, 468, 147-157 (B)</ref>&nbsp; Furthermore, more and more young patients are undergoing a total arthroplasty of hip or knee<ref name="dahl" /><ref name="nmj" />
 
== Physical Therapy Management ==
Physical therapy for young people suffering from osteoarthritis is still a novelty.&nbsp; There are indications that physical therapy for hip osteoarthritis consisting of muscle strengthening, muscle stretching and neuromuscular control exercises have positive results<ref name="wright">Wright AA. et al. Predictors of Response to Physical Therapy Intervention in Patients With Primary Hip Osteoarthritis. (2011) Physical Therapy, 91, 510-524. (A2)</ref><br>This is in agreement with another finding that says that the following physiotherapy techniques are valuable therapeutic adjuvants for the treatment of osteoarthritic symptoms.<ref name="reginster">Reginster et al. 'Osteoarthritis. Clinical and Experimental Aspects'. (1999) Springer, Verlag Berlin, Heiderlberg, 454 – 469 (A1)</ref>
* Muscle relaxing action
* Hot or cold application on osteoarthritic joint
* Proprioceptive reeducation
* [http://www.physio-pedia.com/Transcutaneous_Electrical_Nerve_Stimulation_(TENS) TENS]: may be beneficial to patient with knee OA)<ref name="mnc">Mascarin NC. et al. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis. (2012) BMC Musculoskeletal Disorders, 13, 182 (A2)</ref>
* Traction
* Range of motion exercises
* Strengthening exercises
* Stretching exercises
* Massage: Following KNGF-guidelines massage has lost its place to exercises, which should be the cornerstones in all therapy for OA.
* Hydrotherapy and Spa Treatment
 
== Differential Diagnosis ==
The goal of the differential diagnosis of hip pain is to identify the location and underlying mechanism of the pain. An accurate history and physical examination may indicate whether the pain is intra-articular, extra-articular, or referred from more distal locations. Additional laboratory or imaging tests may be necessary to determine the exact cause. Fractures, infection, and ischemic necrosis should be ruled out early because they require immediate treatment to prevent damage to the joint.<ref name="troum" /><br>


# High-quality evidence has shown no benefit of [[Meniscal Repair|arthroscopy]] for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA.<ref>Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: management of osteoarthritis of the knee (nonarthroplasty). JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2022 May 1;30(9):e721-9.</ref>
# Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective.<ref name=":0" />
== Prevention  ==
== Prevention  ==
[[File:Mr-lee-f4RBYsY2hxA-unsplash.jpeg|right|frameless]]
The prevention of development of [[osteoarthritis]] in the adolescent can be achieved by reducing risk factors. 


The prevention of development of osteoarthritis in the adolescent can be achieved by reducing risk factors. Physiotherapists can promote the maintenance of a healthy weight, low-impact activities, giving exercices to improve joint stability to prevent joint injuries.<ref name="nicholson" /> They can have influence by preventing further progression or complications of a disorder and improving the patient’s self-efficacy.<ref name="rds" /><br>In case of malalignments (like: leg-length discrepancy, varus/valgus, …)&nbsp; young patients should be referred to a podiatrist for insoles to prevent the development of OA (in the hip or knee) at an older age.  
# Physiotherapists can promote the maintenance of a healthy weight, low-impact activities (eg [[aquatherapy]]) giving exercises to improve joint stability to prevent joint injuries.<ref name="nicholson">Nicholson S. et al. Reducing Premature Osteoarthritis in the Adolescent Through Appropriate Screening. (2009) Journal of Pediatric Nursing, 24, 69-74 (B)</ref> They can have influence by preventing further progression or complications of a disorder and improving the patient’s self-efficacy.<ref name="rds">van Doormaal MC, Meerhoff GA, Vliet Vlieland TP, Peter WF. A [https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1492 clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis]. Musculoskeletal Care. 2020 Dec;18(4):575-95. Availabe: https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1492<nowiki/>(accessed 23.10.2021)</ref>
 
# In case of malalignments ([[Leg Length Discrepancy|leg-length]] discrepancy, varus/valgus, etc.) young patients should be referred to a podiatrist for [[Introduction to Orthotics]] to prevent the development of OA (in the hip or knee).  
== Resources ==
# During the very early stages, physiotherapists can guide on strengthening the muscles of the knee joint which can reduce further damage to joint.  
Royal Dutch Society for Physical Therapy (2010). KNGF Guideline for Physical Therapy in patients with osteoarthritis of the hip and knee. De Fysiotherapeut, V120,<ref name="dahl" />
 
<br>
 
== References  ==
== References  ==


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[[Category:Osteoarthritis]]  
[[Category:Osteoarthritis]]  
[[Category:Paediatrics]]
[[Category:Paediatrics]]
[[Category:Paediatrics - Conditions]]

Latest revision as of 02:21, 7 December 2023


Original Editor - Anna Jansma

Top Contributors - Lucinda hampton, Oyemi Sillo, Claudia Karina, Kim Jackson, Lauren Lopez, Nupur Smit Shah, Lauren Heydenrych, Reem Ramadan, Anna Jansma and Evan Thomas ­ 
  

Definition[edit | edit source]

Runners-knee SAG.jpeg

Osteoarthritis (OA) is one of the most devastating chronic conditions that affect people around the world. Although the usual population associated with the condition is the elderly (who are mostly inactive), athletes and younger individuals are also susceptible.

  • Depending on the population, the etiology may differ; injuries, occupational activities, and obesity appear to be the most common causes of OA in young and athletic populations.
  • Diagnosing OA in athletes and young individuals is sometimes challenging because of their increased pain tolerance.
  • However, the treatment of OA in these populations does not differ from its management in the general population[1].

Potential Causes[edit | edit source]

There are a whole range of potential causes of osteoarthritis in young adults (14-40). These include –

  • Leading a sedentary (non-active) lifestyle
  • Poor posture when sitting for long periods
  • Heavy lifting (potentially with poor technique, but not necessarily)
  • Doing an office job with large amounts of sitting at a desk/ computer
  • Being overweight or clinically obese
  • Being very active (running lots of marathons for example)
  • Playing impact sports such as rugby or football
  • Joint injuries
  • Birth defects such as hip dysplasia or different length legs
  • Hormone disorders that affect growth
  • Diabetes
  • Osteoarthritis in the family[2][3]

Assessment[edit | edit source]

Towfiqu-barbhuiya-3AsiVDsZnHg-unsplash.jpeg

Assessment of OA in younger people should focus on a:

  • Patient-centred history,
  • Comprehensive physical examination,
  • Performance-based measures
  • Patient-reported outcome measures to enable monitoring of symptoms and function over time.

Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA.

Treatment Approach[edit | edit source]

Nate-johnston-2gBpsNuHcyA-unsplash.jpeg

The treatment of OA in these populations does not differ from its management in the general population.[1] See

Category:Osteoarthritis

Nonpharmacological approaches are core strategies for the management of OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss.

  1. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA.[4]
  2. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective.[2]

Prevention[edit | edit source]

Mr-lee-f4RBYsY2hxA-unsplash.jpeg

The prevention of development of osteoarthritis in the adolescent can be achieved by reducing risk factors.

  1. Physiotherapists can promote the maintenance of a healthy weight, low-impact activities (eg aquatherapy) giving exercises to improve joint stability to prevent joint injuries.[5] They can have influence by preventing further progression or complications of a disorder and improving the patient’s self-efficacy.[6]
  2. In case of malalignments (leg-length discrepancy, varus/valgus, etc.) young patients should be referred to a podiatrist for Introduction to Orthotics to prevent the development of OA (in the hip or knee).
  3. During the very early stages, physiotherapists can guide on strengthening the muscles of the knee joint which can reduce further damage to joint.

References[edit | edit source]

  1. ↑ 1.0 1.1 Amoako AO, Pujalte GG. Osteoarthritis in young, active, and athletic individuals. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2014 Jan;7:CMAMD-S14386.Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039183/(accessed 17.10.20210
  2. ↑ 2.0 2.1 Ackerman IN, Kemp JL, Crossley KM, Culvenor AG, Hinman RS. Hip and knee osteoarthritis affects younger people, too. journal of orthopaedic & sports physical therapy. 2017 Feb;47(2):67-79.Available: https://www.jospt.org/doi/full/10.2519/jospt.2017.7286(accessed 17.10.2021)
  3. ↑ Oddis CV. New perspectives on osteoarthritis. The American journal of medicine. 1996 Feb 26;100(2):10S-5S.Available: https://www.sciencedirect.com/science/article/abs/pii/S0002934397895411(accessed 17.10.2021)
  4. ↑ Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: management of osteoarthritis of the knee (nonarthroplasty). JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2022 May 1;30(9):e721-9.
  5. ↑ Nicholson S. et al. Reducing Premature Osteoarthritis in the Adolescent Through Appropriate Screening. (2009) Journal of Pediatric Nursing, 24, 69-74 (B)
  6. ↑ van Doormaal MC, Meerhoff GA, Vliet Vlieland TP, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care. 2020 Dec;18(4):575-95. Availabe: https://onlinelibrary.wiley.com/doi/abs/10.1002/msc.1492(accessed 23.10.2021)
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