Oa Knee

OSTEOARTHRITIS OF THE
KNEE
KNEE OSTEOARTHRITIS (OA)
Knee osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear
and tear and progressive loss of articular cartilage.
It is most common in elderly people and can be divided into two types, primary and secondary:
TYPE OF OA KNEE
It is most common in elderly people and can be divided into two types, primary and secondary:
1.Primary knee OA is the result of articular cartilage degeneration without any apparent
underlying cause/ reason. This is typically thought of as degeneration due to age as well as wear
and tear.
2.Secondary knee OA is the result of articular cartilage degeneration due to a known reason.
Possible Causes of Secondary Knee OA:
Secondary osteoarthritis - is the consequence of either an abnormal concentration of force across the joint
like post-traumatic or abnormal articular cartilage, such as rheumatoid arthritis (RA).
SECONDARY CAUSES OF OA KNEE
Knee OA is classified as either primary or secondary, depending on its cause[3]:
• Obesity
• Generalized hypermobility like connective tissue disorders or instability, generalized
• Previous injury to the joint e.g. fracture along articular surface (tibial plateau fracture)
• Congenital defects - e.g. valgus/varus deformities of knee
• Immobilisation and loss of mobility
• Metabolic causes e.g. rickets, Pagets
• Inflammatory arthropathy
• Malignancy – Osteosarcoma
• Infective – Pyogenic or tuberculous
• Family history of OA
STAGES OF OA KNEE – Kellegren’s Lawrence Scale
SYMPTOMS OF KNEE OA
Common clinical symptoms include
•Knee pain that is gradual in onset and worsens with activity
•Knee stiffness and swelling
•Reduced ROM of knee – Flexion, extension, Medial and lateral rotation
•Pain after prolonged sitting or resting
•Crepitus or a cracking sound with joint movement
•Deformities – Genu Varun
DIFFERENTIAL DIAGNOSIS OF OA KNEE
Differential Diagnosis
• Referred lower back pain
•Meniscal pathology
•Gout and Pseudogout
•Rheumatoid arthritis
•Septic arthritis[16]
•Hip OA
•Ligament injuries - ACL or PCL rupture
DIAGNOSIS
The diagnosis can be established by clinical examination, and it can be confirmed by X-rays.
Knee OA can be sub-divided into 5 grades:
• Grade 0: This is the “normal” knee health
• Grade 1: Very minor bone spur growth and is not experiencing any pain or discomfort.
• Grade 2: This is the stage where people will experience symptoms for the first time. They will have pain
after a long day of walking and will sense a greater stiffness in the joint. It is a mild stage of the condition,
but X-rays will already reveal greater bone spur growth. The cartilage will likely remain at a healthy size.
• Grade 3: Moderate OA. Frequent pain during movement, joint stiffness will also be more present,
especially after sitting for long periods and in the morning. The cartilage between the bones shows obvious
damage, and the space between the bones is getting smaller.
• Grade 4: This is the most severe stage of OA. The joint space between the bones will be dramatically
reduced, the cartilage will almost be completely gone and the synovial fluid will be decreased. This stage is
normally associated with high levels pain and discomfort during walking or moving the joint.[11]
SPECIAL TEST FOR KNEE
Patellar Test –
• Patellar apprehension test
• Patellofemoral grind test
Meniscal test –
• Mc Murray
• Apleys
Ligament test - ACL,PCL,MCL,LCL

SPECIAL TEST FOR KNEE
INVESTIGATION
Blood Tests; to help determine the type of arthritis
Physical examination: see below
X-ray: A 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 obtain
visual information about the damage caused to the joint by the OA.
MRI. Magnetic resonance imaging (MRI). Provides a view that offers better images of cartilage
and other structures to detect early abnormalities typical of osteoarthritis[12].
Radiographic Findings of OA
Radiographic Findings of OA
•Joint space narrowing
•Osteophyte formation
•Subchondral sclerosis
•Subchondral cysts[1]
•Early stages of OA shows a minimal unequal joint space narrowing.
•In severe OA the joint line may disappear completely (see image 2).[10]
MEDICAL & SURGICAL MANAGEMENT
If conservative management is not sufficient at controlling pain, surgical interventions can be

explored. The most common forms of surgery for this condition are (from least to most invasive):
•Therapeutic Injections
•Arthroscopy - with the goal to remove osteophytes and any degenerative meniscal tears (this
should not be considered if no osteophytes are present on XR)[32]
•High tibial Osteotomy - if the patient meets the pre-operative functional level
•Patellofemoral joint arthroplasty - if only the patellofemoral joint is affected, and tibiofemoral
joints are healthy
•Unicompartmental knee arthroplasty - if only one compartment (medial or lateral) is affected
•Total knee replacements
CONSERVATIVE TREATMENT
Treatment for all patients with symptomatic knee osteoarthritis includes
 Patient education - about the condition, long term management and activity modification
 Pain Relief - Cell Repair , IFT, Ultrasound for specific tender point around the knee
 Exercises - Lower Kinematic chain exercises helps improve strength, proprioception and
balance. These benefits are lost after 6 months if the exercises are stopped
 Lifestyle modification – Weight loss is valuable in all stages of knee OA. It is indicated
in patients with symptomatic OA with a body mass index > 25. The best recommendation
to achieve weight loss is with diet control and low-impact aerobic exercise.
 Knee Braces - Offloading-type braces which shift the load away from the involved knee
compartment. This can be effective when there is a valgus or varus deformity.
OTHER TREATMENT OPTIONS
• Hydrotherapy - this may be particularly helpful if pain is very high and analgesia is not tolerated. It can be useful
to build up strength and reduce stiffness around the knee joint in a non-weight bearing position.[25] [26]
• Taping - works to offload the joint similar to bracing, this is useful in the short term. A systematic review shows
elastic taping leads to no significant change in WOMAC score for improvement of pain in patients with primary
knee osteoarthritis and alternative conservative treatments to elastic taping should be explored if OA knee pain
persists for more than 21 days.[27]
Manual therapy - effective to improve ROM[28]According to a systematic review, manual therapy (mobilisation
with movement, passive joint mobilisation, patellar mobilisation therapy ) and exercises effectively reduce knee
pain and increase functionality. However, further research is needed to determine the long-term effects of manual
therapy on knee OA.[29]
• Massage - may be useful to control pain in some subjects, but this has low evidence to show its effectiveness[30]
• Bracing – It helps offloading the weight, and thus help managing the discomfort in knee pain.
• Electrotherapy -such as muscle stimulation to improve quadricep strength and TENS as it has some evidence to
show it can help with pain reduction [31]
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OSTEOARTHRITIS OF THE

Ligament test - ACL,PCL,MCL,LCL

If conservative management is not sufficient at controlling pain, surgical interventions can be

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