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 population undergoing prescribed weight loss procedures (Bhatia et al., 2012). Overweight individuals may have issues with Treatment: Nonsurgical and surgical interventions Various types of nonsurgical and surgical interventions are available to individuals with knee OA to help relieve symptoms and restore 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. ● Improving mobility. ● Improving walking. Orthopedic aids, or orthosis, may be necessary to aid in the treatment 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 compartment. 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). 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 corticosteroids 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 Rehabilitation and physical therapy-based interventions The most widely used treatment for knee OA takes a rehabilitation and physical therapy approach. Physical therapy interventions can help patients with pain and limited mobility. Within the scope of physical therapy are several interventions that can help to alleviate symptoms associated with knee OA and help to improve functional activity tolerance in these patients. Several types of interventions have been studied to treat knee OA. Specific types of exercise programs include combinations of strength training, aquatic therapy, tai chi exercise, aerobic exercise, and hydrotherapy (Bhatia et al., 2012).
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.).
pain in OA; however, the effects are typically short lasting and do not provide long-term relief. 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. Lavage, 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 transplantation (OCT) procedures. Another joint-preserving procedure is a corrective osteotomy near the joint (Michael et al., 2010). The majority of intra- articular operations 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 performed 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 subchondral 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, enzymatically isolated and cultured ex vivo, and then putting it back into the joint at the site of cartilage defect, which is prepared before 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 defect 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 intermediate to long term (Michael et al., 2010). Exercise can take on many forms and has been widely studied as an intervention to improve the symptoms associated with knee OA. Exercise interventions aim to improve muscle strength, neuromuscular control, joint range of motion, and aerobic fitness (Fransen et al., 2015). Pain can be a barrier to participating in exercise, however, but enhancing strength of the lower limb may lessen internal knee forces, reduce pain, and improve physical function (Fransen et al.). Increasing muscle strength of the involved limb may also help to improve knee joint mechanics and decrease
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