Chapter 8: Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment 2 CCHs
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. 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. ● 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. Secondary etiologies for OA of the knee include post-traumatic or congenital malformation or malposition, postoperative 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 strongest 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 another 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.). Knee OA etiology OA has multiple risk factors: ● Age. ● Female sex. ● Obesity. ● Family history. 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 collateral ligament, the lateral collateral ligament, the anterior cruciate ligament, and
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.
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 interventions. As age increases, so does the likelihood of developing 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. 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). the posterior cruciate ligament. The medial and lateral collateral ligaments act to stabilize the knee in a medial to lateral direction or sideways movement of the knee; the anterior and posterior cruciate ligaments help to control the forward and backward translation motion of the knee joint. The tendons associated with the knee joint are the quadriceps tendon and the patellar tendon. The quadriceps tendon connects the quadriceps muscle to the patella; the patellar tendon attaches the patella to the tibia. These structures of the knee are not directly impacted by knee OA but may have subsequent damage and may contribute to the degeneration of the knee joint. The knee joint is stabilized by musculature surrounding the joint. The surrounding musculature is the quadriceps muscle, the hamstrings muscles, and muscles of the calf. The quadriceps muscle acts to extend the leg at the knee and flex the thigh at the hip. The hamstring muscle group works together to flex the leg at the knee. The calf muscles act as a flexor of the knee and a plantar flexor of the foot. Weakness of the muscles that surround the knee joint can lead to further degeneration and increase the rate of the progression of knee OA.
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