Knee Osteoarthritis: Difference between revisions

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== Physical Therapy Management <br>  ==
== Physical Therapy Management <br>  ==


- <u>Exercise</u>: has proved to be effective as pain management and improving of physical functioning on short term. However<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; these exercises have to take place under supervision of for example a physiotherapist. When properly<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; instructed these exercises can be performed at home. However research has show that a group exercise<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; combined with home exercise is more effective than home exercise alone. <ref name="Peter et al" />,&nbsp;<ref>Supplementing a home exercise program with a class-based exercise program is more effective than home exercise alone in the treatment of knee osteoarthritis ,C. J. McCarthy, P. M. Mills1, R. Pullen, C. Roberts, A. Silman and,J. A. Oldham, Rheumatology 2004;43:880–886 (RCT quality level B)</ref>  
- <u>Exercise</u>: has proved to be effective as pain management and improving of physical functioning on short term. However<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; these exercises have to take place under supervision of for example a physiotherapist. When properly<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; instructed these exercises can be performed at home. However research has show that a group exercise<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; combined with home exercise is more effective than home exercise alone. <ref name="Peter et al" />,&nbsp;<ref>Supplementing a home exercise program with a class-based exercise program is more effective than home exercise alone in the treatment of knee osteoarthritis ,C. J. McCarthy, P. M. Mills1, R. Pullen, C. Roberts, A. Silman and,J. A. Oldham, Rheumatology 2004;43:880–886 (RCT quality level B)</ref><br>  


- <u>Hydrotherapy</u>: is recommended in international guidelines. Despite contradictory evidence hydrotherapy can be useful in<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; cases where pain is too grave to exercise on dry land. It can be a good preparation of exercise on dry<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; land.<ref name="Peter et al" /><br>


- <u>Manual actions</u>: achieving a passive motion in the joint: has proven effective to locate and eliminate factors like pain and<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; joint immobility, however it is only effective when combined with active exercise. This progress can<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; enable further or advanced exercises.<ref name="Peter et al" /><br>


- <u>Hydrotherapy</u>: is recommended in international guidelines. Despite contradictory evidence hydrotherapy can be useful in<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; cases where pain is too grave to exercise on dry land. It can be a good preparation of exercise on dry<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; land.<ref name="Peter et al" />
- <u>Massage</u>: is not effective in the case of osteoarthritis.<ref name="Peter et al" /><br>  
 
 
 
- <u>Manual actions</u>: achieving a passive motion in the joint: has proven effective to locate and eliminate factors like pain and<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; joint immobility, however it is only effective when combined with active exercise. This progress can<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; enable further or advanced exercises.<ref name="Peter et al" />
 
 
 
- <u>Massage</u>: is not effective in the case of osteoarthritis.<ref name="Peter et al" />  
 
 
 
- <u>Thermotherapy</u>: Can be used to warm up of tissue (for example very stiff joints) before exercise.<ref name="Peter et al" />  
 


- <u>Thermotherapy</u>: Can be used to warm up of tissue (for example very stiff joints) before exercise.<ref name="Peter et al" /><br>


- <u>Electrotherapy</u>: for example electro stimulation in improving quadriceps muscle strength is not proven effective. <ref>A Clinical Trial of Neuromuscular Electrical Stimulation in Improving Quadriceps Muscle Strength and Activation Among Women With Mild and Moderate Osteoarthritis, Riann M. Palmieri-Smith, Abbey C. Thomas, Carrie Karvonen-Gutierrez, MaryFran Sowers, Physical Therapy - Volume 90 Number 10  October 2010 ( RCT quality level C)</ref><br>  
- <u>Electrotherapy</u>: for example electro stimulation in improving quadriceps muscle strength is not proven effective. <ref>A Clinical Trial of Neuromuscular Electrical Stimulation in Improving Quadriceps Muscle Strength and Activation Among Women With Mild and Moderate Osteoarthritis, Riann M. Palmieri-Smith, Abbey C. Thomas, Carrie Karvonen-Gutierrez, MaryFran Sowers, Physical Therapy - Volume 90 Number 10  October 2010 ( RCT quality level C)</ref><br>  


- <u>Ultrasound</u>: is not advised in the treatment of knee osteoarthritis. <ref name="Peter et al" /><br>  
- <u>Ultrasound</u>: is not advised in the treatment of knee osteoarthritis. <ref name="Peter et al" /><br>  


- <u>External support devices</u>: <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Braces: - total knee braces when being diagnosed with total knee ostearthritis<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; - lateral elevated orthopedic sole when being diagnosed with medial compartment <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; knee osteoarthritis. <ref name="Peter et al" /><br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Taping: has proven slightly effective in decreasing pain in patients with patellofemoral<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; osteoarthritis.  
- <u>External support devices</u>: <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Braces: - total knee braces when being diagnosed with total knee ostearthritis<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; - lateral elevated orthopedic sole when being diagnosed with medial compartment <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; knee osteoarthritis. <ref name="Peter et al" /><br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Taping: has proven slightly effective in decreasing pain in patients with patellofemoral<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; osteoarthritis.  

Revision as of 01:06, 30 December 2010

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Hamelryck Sascha

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy[edit | edit source]

Databases used: Pubmed, Web of knowledge, American college of rheumatology.

Keywords used: osteoarthritis, knee, treatment, definition, exercises, surgery, condition (or a combination of these words).

Definition/Description[edit | edit source]

Knee osteoarthritis is the occurrence of osteoarthritis (OA) in the knee joint. The OA can be diagnosed in 3 places within the knee:
a. Medial compartment
b. Lateral compartment
c. Patellofemoral compartment

Clinically Relevant Anatomy[edit | edit source]

  As mentioned above OA in the knee occurs in the patellofemoral joint as well as in the tibiofemoral joint. (Figure1.)


 Other important factors are:
 - Quadriceps strenght
 - Alignment of the femur and tibia ( valgus/varus)
 - (age and weight)

Epidemiology /Etiology[edit | edit source]

Osteoarthritis can be catalogued in 2 types:

Type I: this type of OA is mostly related to aging, there is no other disease or trauma causing the condition.
With age the water level in the articulate cartilage rises and makes the cartilage less solid. The production of proteins that are used in the maintenance of the cartilage also decreases, making the cartilage more vulnerable to ruptures.

Type II: In this type of OA there is another condition or disease causing the OA
for example: obesity, diabetes, surgery to joint structures, repeated trauma...

In the early stage in an osteoarthritis affected knee joint the cartilage will start show signs of wear, tiny crevasses or ruptures. If no effort is made to slow down or stop this process the cartilage will then further degenerate and pieces of the cartilage “cushion” between the bones of the affected joint will be gone. This will affect the functioning of the underlying bone, making them deform, form bone spurs and such endangering the function of the joint. (7)

Also the synovial membrane can be agitated and cause periodic inflammation. [1]

Characteristics/Clinical Presentation[edit | edit source]

add text here

Differential Diagnosis[edit | edit source]

add text here

Diagnostic Procedures[edit | edit source]


Symptoms: [1]
Primary:
- Pain
- (morning) stiffness
- Decrease in the abilities of daily functioning
Secondary:
- Loss of mobility in the affected joint
- Decrease in muscle power
- Instabillity of the joint
- Crepitations

Recently The European league against rheumatism developed diagnostic criteria for diagnosing knee osteoarthritis. The most important factors are stated in Figure 2. [2]

EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis, W Zhang, M Doherty, G Peat, et al., Ann Rheum Dis 2010;69:483–489. doi:10.1136/ard.2009.113100

X-ray: The basic X-ray is used to research breakdown of cartilage, narrowing of joint space , forming of bone spurs and to exclude other causes of pain in the affected joint.

Arthrocentesis: This is a procedure which can be performed at the doctor’s office. A sterile needle is used to take samples of joint fluid which can then be examined for cartilage fragments , infection or gout.

Arthroscopy: is a surgical technique where a camera is inserted in the affected joint to visually obtain information about the damage caused to the joint by the osteoarthritis.

Outcome Measures[edit | edit source]

add links to outcome measures here (also see Outcome Measures Database)

Examination [1][edit | edit source]

If a patient is referred to you by a Doctor, it is most likely he performed a medical examination. It is imperative to look at his/her findings when examinating the patient.
- Inspection: mind the position of the joints when in rest, and how the patient moves.
This can be accomplished by making the patient perform simulations of daily activities like: getting up from and down on a chair, stair climbing, ...

- Palpation: mind: swelling, temperature differences, muscle tonus.
Also be weary of possible bone spurs (osteocyts) that have formed on the edge of the joint.
These osteocyts are a serious indication towards osteoarthritis.

- Examination of basic functions: Testing of muscle power, coordination, mobility, balance and also stability of the joint.
These factors can be tested by active test like standing on one leg, and passive manual tests.
When testing stability of the joint muscle strength and proprioception are of significant importance.

Medical Management [1]
[edit | edit source]

- Anti-inflammatory medication to counter periodic inflammation
- Surgical replacement of knee joint when damage to natural structures is to grave.

Physical Therapy Management
[edit | edit source]

- Exercise: has proved to be effective as pain management and improving of physical functioning on short term. However
                 these exercises have to take place under supervision of for example a physiotherapist. When properly
                 instructed these exercises can be performed at home. However research has show that a group exercise
                 combined with home exercise is more effective than home exercise alone. [1], [3]

- Hydrotherapy: is recommended in international guidelines. Despite contradictory evidence hydrotherapy can be useful in
                       cases where pain is too grave to exercise on dry land. It can be a good preparation of exercise on dry
                       land.[1]

- Manual actions: achieving a passive motion in the joint: has proven effective to locate and eliminate factors like pain and
                          joint immobility, however it is only effective when combined with active exercise. This progress can
                          enable further or advanced exercises.[1]

- Massage: is not effective in the case of osteoarthritis.[1]

- Thermotherapy: Can be used to warm up of tissue (for example very stiff joints) before exercise.[1]

- Electrotherapy: for example electro stimulation in improving quadriceps muscle strength is not proven effective. [4]

- Ultrasound: is not advised in the treatment of knee osteoarthritis. [1]

- External support devices:
                                       Braces: - total knee braces when being diagnosed with total knee ostearthritis
                                                   - lateral elevated orthopedic sole when being diagnosed with medial compartment
                                                     knee osteoarthritis. [1]
                                       Taping: has proven slightly effective in decreasing pain in patients with patellofemoral
                                                   osteoarthritis.

- Post-operative exercise:  is very much recommended. Exercises to improve the function of the new joint and muscle
                                       strengthening are most effective.


Key Research[edit | edit source]

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources
[edit | edit source]

add appropriate resources here

Clinical Bottom Line[edit | edit source]

add text here

Recent Related Research (from Pubmed)[edit | edit source]

see tutorial on Adding PubMed Feed

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References[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 (1) KNGF-richtlijn Artrose heup-knie, W.F.H. PeterI, M.J. JansenII, et al. Supplement bij het Nederlands Tijdschrift voor Fysiotherapie, Jaargang 120 • Nummer 1 • 2010
  2. ↑ (3) EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis, W Zhang, M Doherty, G Peat, et al., Ann Rheum Dis 2010;69:483–489. doi:10.1136/ard.2009.113100 ( Quality level C : literature study)
  3. ↑ Supplementing a home exercise program with a class-based exercise program is more effective than home exercise alone in the treatment of knee osteoarthritis ,C. J. McCarthy, P. M. Mills1, R. Pullen, C. Roberts, A. Silman and,J. A. Oldham, Rheumatology 2004;43:880–886 (RCT quality level B)
  4. ↑ A Clinical Trial of Neuromuscular Electrical Stimulation in Improving Quadriceps Muscle Strength and Activation Among Women With Mild and Moderate Osteoarthritis, Riann M. Palmieri-Smith, Abbey C. Thomas, Carrie Karvonen-Gutierrez, MaryFran Sowers, Physical Therapy - Volume 90 Number 10 October 2010 ( RCT quality level C)


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