OA Knee (Osteoarthritis of Knee)

Knee Joint

• joint most prone to injury due to location between two long bones (femur and tibia) over which body weight moves
• complex biomechanical activity of joint which rotates as it flexes and extends
• bone surfaces covered with resilient and smooth articular cartilage lubricated and nourished by synovial fluid (produced within knee joint); also, two c-shaped and elevated specialized cartilages (menis) both of which provide stability to bony prominences (condyles) of femoral head

OA Knee (Osteoarthritis of Knee)

• condition characterized by erosion of articular cartilage within knee and spur (osteophyte) formation at margins of joint (x-rays may reveal degenerative changes in moderate to severe cases); excess angulation of joint, resulting in instability, may occur
• synovial fluid in inflamed joint becomes less viscous, thereby diminishing lubricating properties

Physical Therapy Treatment

• early stage arthritis (minimal joint changes and pain) may be managed solely with anti-inflammatory and analgesic medications and program of strengthening and flexibility exercises
• application of electrotherapeutic modalities, as needed, helps to reduce inflammation and swelling
• gait analysis and assessment of foot-ankle alignment to identify muscle imbalance and malalignment factors
• bracing (e.g., Unloader™ brace – OTS or custom made) redistributes pressure within knee and, in cases of joint deformity, realigns joint permitting wearer to remain active and, possibly, avoid or delay need for surgery
• education re safety considerations and use of assistive aids (e.g., walker, crutches, cane)
• foot orthotics may be prescribed
• gradual strengthening (initially non-weight bearing, e.g., cycle and/or swim), stretching, and cardiovascular exercises assigned (respect pain)
• education re joint protection (body weight, biomechanics, footwear) and use of assistive devices (e.g., walker, cane, crutches, raised seating, etc) as required to avoid compensatory problems due to antalgic (pain-avoiding) gait (e.g., limping)

Other Treatments

• anti-inflammatory and analgesic medications; optional supplementation using Glucosamine Sulphate (a normal constituent of cartilage matrix and synovial fluid) +/- Chondroiton Sulphate -- positive anecdotal evidence but sparse and inconclusive clinical research substantiating claims lauding benefits of either supplement to cartilage health
• Synvisk^TM (mimics synovial fluid) injections may be considered
• Glucosamine Sulphate (normal constituent of cartilage matrix and synovial fluid) +/-Chondroiton Sulphate: positive anecdotal evidence but sparse and inconclusive clinical research re benefits to cartilage health; Synvisk^TM (mimics synovial fluid): injections may be considered
• acupuncture may afford pain relief
• surgery (knee replacement or resurfacing) considered in cases of severe pain and/or functional disability

Physical Therapy Treatment

Post-Surgical

• first 2 weeks post-op (weakened and vulnerable tissues): electrotherapeutic modalities and ice for inflammation and symptom control; manual therapy; easy active range of motion (e.g., cycle arcs), stretch and strengthening exercises; straight knee to be maintained at rest
• 3 weeks post-op: progressively more vigorous exercises (cardiovascular; functional rehabilitation commencing with posture, balance, and gait retraining) and mobilization
• hydrotherapy (exercises in shallow pool) offers advantages of low impact and fluid resistance workout augmenting land-based routine

Prognosis

• Non-surgical: typical pattern of occasional treatment sessions over time, as dictated by flares (pain and inflammation)
• Post-surgical: twice weekly attendances for treatment over 6 weeks