Knee Osteoarthritis

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Original Editors - Hamelryck Sascha

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Search Strategy

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

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

  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

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.

Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

Symptoms:
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. (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

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

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Examination

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Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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