by previous knee injury (Silverwood et al., 2015) The force across the knees is three to six times a person’s body weight, which means that people who have more mass cause extreme forces on their knees. The increase in force on the knee joint can lead to the early onset or steady progression of knee OA (Bhatia et al., 2012). A study by Mao-Hsiung Huang and colleagues (2000) reported that pain reduction and improvement in walking speed in various degrees of severity of arthritis was observed in the OA popula- tion undergoing prescribed weight loss procedures (Bhatia et al., 2012). Overweight individuals may have issues with circulation, which may lead to a cartilage growth problem or a bone problem, which in turn can lead to cartilage breakdown or affect the bone underneath the cartilage, which can lead to knee OA (Bhatia et al.). If a patient continues to have persistent clinically significant OA or symptomatic OA despite conservative treatment, then the patient may have to undergo joint-preserving surgical treatments. La- vage, shaving, and debridement are all types of joint-preserving surgical treatments that aim to address the symptoms associated with knee OA. Drilling, microfracturing, or abrasion arthroplasty are bone-stimulating types of joint-preserving treatments. Joint surface restoration procedures include autologous chondrocyte transplantation (ACT) and autologous osteochondral transplanta- tion (OCT) procedures. Another joint-preserving procedure is a corrective osteotomy near the joint (Michael et al., 2010). The majority of intra-articular op- erations are performed through an arthroscope. The advantages of these types of procedures include minimal operative trauma and a very low infection rate (Michael et al.). The purpose of arthroscopic lavage is to rid the joint of detritus and inflammatory mediators, according to Michael and colleagues (2010). The probability of the success of an individual procedure is difficult to assess because these procedures generally are per- formed together with other intra-articular procedures during the same operation. Shaving , also called a chondroplasty, involves removal of the frayed and fragmented cartilage and smoothing the edges. But this has been found to have only short-term benefits (Michael et al., 2010). Debridement also is performed to clean out the joint and can be used in the treatment of meniscal damage, removal of free- floating bodies within the joint, and the reduction of symptomatic osteophytes (Michael et al., 2010). Bone-stimulating techniques are performed to open the subchon- dral cartilage to bring stem cells to the surface “where they are supposed to form fiber bundles under the influence of mechanical and biological forces” (Michael, et al., 2010, p. 159). ACT is performed by taking cartilage cells from the joint, enzy- matically isolated and cultured ex vivo, and then putting it back into the joint at the site of cartilage defect, which is prepared be- fore the cultured cells are added (Michael et al., 2010). Long-term results of this treatment are not available at this time. With OCT, cylinders of cartilage and bone are taken from a part of the joint that is not affected and then inserted into the cartilage de- fect with press-fit technology. The reported results for this type of procedure have been found, in general, to be promising (Michael et al., 2010). Corrective osteotomy near the knee joint is performed to change the joint mechanics and redirect the weight-bearing axis toward the portion of the joint that is largely still intact. The results overall have been shown to be in general good over the intermedi- ate to long term (Michael et al., 2010).
it was likely found to be more associated with greater functional decline. Excess weight Increased weight can have a negative impact on joint integrity and is a risk factor for the development of knee OA. Weight re- duction is one way to reduce knee OA and limit the progression of the disease. Nielsen and colleagues (2017) reported that out of the risk factors for knee OA – obesity, previous knee injury, and family history of OA – obesity is believed to be the most impor- tant among the three. “Studies of OA have constantly shown that overweight people have higher rates of knee OA than nonover- weight control subjects” (Bhatia et al., 2012). In one systematic review, researchers found that the onset of OA knee pain in individuals who were over the age of 50 was related to excess weight or obesity in 25% of cases; only 5% were caused Treatment: Nonsurgical and surgical interventions Various types of nonsurgical and surgical interventions are avail- able to individuals with knee OA to help relieve symptoms and re- store function. These types of interventions can be broken down into conservative measures, joint preserving surgical treatment, and joint replacement surgery (Michael et al., 2010). The goals for conservative management include the following: ● Relieving pain. ● Improving quality of life. ● Delaying progression of osteoarthritis (Michael et al., 2010). Types of conservative management include the following: ● Physical and physiotherapeutic measures. ● Orthopedic aids. ● Weight loss. ● Pharmacotherapy. ● Intra-articular corticosteroid injections (Michael et al., 2010). General measures during the conservative management phase of knee OA should include patient education, lifestyle adjustments, and if indicated weight loss interventions. A patient may need to change her mode of exercise to decrease stress or load on the knee joint to slow the progression of the disease and decrease symptoms. Orthopedic aids, or orthosis, may be necessary to aid in the treat- ment of knee OA. The goal of using an orthosis is to reduce pain and improve function – the common theme among treatments for knee OA. A patient who has unicompartmental arthritis is the best candidate for an orthosis that can unload the affected com- partment. For example, a knee brace can be used to improve the biomechanical axis of deformity, which in turn can unload the joint, or to improve the perception of the instability (Hussain et al., 2016) Other aids are cushioned heals, wedges to elevate the inner or outer side of the shoe, and knee orthoses, which attempt to relieve pain and improve joint function (Michael et al., 2010). ● Improving mobility. ● Improving walking. Pharmacotherapy or pharmacologic management can help to manage the symptoms associated with knee OA. Types of medications used in the treatment of this disease include the following: ● Analgesics/anti-inflammatory agents. ● Glucocorticoids. ● Opioids. ● Symptomatic, slow-acting drugs for osteoarthritis. ● Anticytokines. ● Nonsteroidal anti-inflammatory drugs: NSAIDs are prescribed when the patient presents with exacerbation of pain and a swollen knee (Hussain et al., 2016). ● Intra-articular corticosteroids: Use of intra-articular cortico- steroids is indicated when symptoms persist despite the use of NSAIDS (Hussain et al.). There is evidence that promotes the use of intra-articular corticosteroids to reduce pain in OA; however, the effects are typically short lasting and do not pro- vide long-term relief.
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