Chapter 8: Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment 2 CC Hours
By: Lisa Augustyn, PT, DPT Learning objectives After completing this course, the learner will be able to: Describe the anatomy and function of the knee joint and how osteoarthritis impacts the mechanics of the joint. List common pathologies and etiology for osteoarthritis of the knee. Describe the diagnostic procedures in the diagnosis of osteoarthritis of the knee. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gen- der identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can mani- fest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assump- tions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can
Discuss evidence-based surgical and nonsurgical interventions for osteoarthritis of the knee. Describe how weight management impacts osteoarthritis of the knee. State the components of a typical physical therapy rehabilitation plan following a total knee arthroscopy. adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and aware- ness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Addi- tionally, implementing policies and procedures prioritizing equi- table treatment for all patients can play a pivotal role in reduc- ing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treat- ment regardless of their background or characteristics.
INTRODUCTION
Knee OA is prevalent in today’s society with the active aging population. Physical therapists play an important role in restoring function for these patients with nonsurgical and postoperative in- terventions. As age increases, so does the likelihood of develop- ing OA. Knee OA has been found to be the most common type of arthritis, occurring in 6% of all adults (Michael et al., 2010). OA at this point is not a curable disease, but nonsurgical interventions can prolong the need for a total knee arthroplastythat can aid in relief of symptoms associated with the disease. The main goals of both nonsurgical and surgical treatment for knee OA are to decrease pain and improve function. congenital malformation or malposition, postoperative problems because of a history of other knee surgeries, metabolic disorders, endocrine disorders, and aseptic osteonecrosis (Michael et al., 2010). Workers who perform repetitive kneeling are at significant risk for developing knee OA, including construction workers and floorers (Michael et al.). Hyaline cartilage of the knee joint is the target of the damaging influences that cause OA (Michael et al.). There is also a genetic component to knee OA, but the gene that contributes to the disease is not known. OA is a degenerative, chronic, and often progressive joint disease (Bhatia et al., 2012). other bone. When this cartilage degrades or degenerates, this can lead to joint pain and difficulty with movement (Bhatia et al., 2012). This degeneration of the articular cartilage leads to joint space narrowing or subchondral sclerosis, which leads to pain, immobility, and possible disability (Bhatia et al.). The menisci (medial and lateral) are two wedge-shaped pieces of cartilage that cushion the joint and act as shock absorbers (AAOS, 2014). The menisci are different from the aforementioned articular cartilage, as they are tough and rubbery, which helps cushion and stabilize the joint. The ligaments of the knee are the medial col-
According to Skou and colleagues (2015), more than 670,000 total knee replacements are performed annually in the United States. According to Nielsen and colleagues (2017), osteoarthritis (OA) is the most prevalent joint disease worldwide. Nielsen and colleagues also stated that OA is strongly associated with aging and obesity. Total knee replacements are the result of knee OA, which is a degenerative joint disease. Knee OA can lead to joint pain that can cause functional decline. Physical therapy can help patients with knee OA by focusing on restoring range of motion, flexibility, and strength to improve a patient’s functional abilities. But patients who have more moderate to severe knee OA with significant symptoms may require surgical intervention.
Knee OA etiology OA has multiple risk factors: ● Age. ● Female sex. ● Obesity. ● Family history.
● Mechanical factors that can result from trauma, occupational/ recreational wear, malalignment, and generalized laxity in the knee (Hussain et al., 2016). Knee OA can be classified as either primary or secondary. Sec- ondary etiologies for OA of the knee include post-traumatic or Anatomy of the knee joint in relationship to knee OA OA leads to inflammation of the knee joint, which may lead to pain, swelling, and stiffness. The knee is the largest and stron- gest joint in the body (AAOS, 2014). The knee joint is made up of bones, ligaments, muscles, tendons, and cartilage. The bony portions of the knee joint are the end of the femur, the upper end of the tibia, and the patella. These bones come together to form the knee joint. The bones are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones when the knee is bending or straightening (AAOS). The articular cartilage surrounds the bone where it comes in contact with an-
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