Osteoarthritis of knee is the most widespread health problem worldwide. The common causes of osteoarthritis of the knee are ageing (wear and tear), obesity, and previous knee trauma or surgery. Although there is some sign of inflammation, it is not primarily an inflammatory disease. OA is not purely a degenerative disease. Osteoarthritis has both the feature of destruction and repair.
SYMPTOMS OF OSTEOARTHRITIS OF KNEE:
- Morning stiffness lasts less than 30 minutes.
- Crepitus during active motion.
- Bony tenderness.
- Bony enlargement.
- Skin temperature is average.
- Restricted joint range of motion.
- Swelling of joint.
- Pain during staring or after use.
- Locking may occur.
Knowing the cause is very much crucial for treating osteoarthritis.
- Increase mechanical stress- in some parts of the joint. This stress may due to increase load or reduce joint space. (e.g., bow knee, knock knee)
- Trauma or any Inflammatory disease- may cause damage to articular cartilage because of inflammatory reaction, inflammatory mediator release, which suppresses the synthesis of proteoglycan.
- Inheritance- plays an important in OA.
- Gender- Postmenopausal women suffer more in OA and, the reason is estrogen level goes down. Estrogens influence different joint tissue metabolism at many crucial levels and through several complex molecular mechanisms.
- Obesity- If your body weight increase. Then joint pressure also increases. This pressure may lead to wear and tear, followed by OA.
OSTEOARTHRITIS OF KNEE TREATMENT:
The fundamental treatment of osteoarthritis is to eliminate the modifiable causative factor.
1.PHYSIOTHERAPY FOR OSTEOARTHRITIS OF KNEE:
Muscle-strengthening exercise helps to overcome the following problem: intra-articular and extra-articular inflammatory processes, reflex inhibition in response to pain and joint effusion, decreased protective muscular reflexes, and loss of mechanical integrity of joints.
Isometric exercise of quadriceps and hamstring muscle.
- Speedy type isometric exercise helps to reduce knee effusion.
- Slow and sustained type isometric exercise helps to reduce pain and improves muscle strength.
Isotonic exercise- Quadriceps, Hamstring.
Isokinetic exercise of the knee joint.
(Types of exercise choose according to the presence of pain and grades of OA)
Stretching of your Quadriceps, Hamstring, Calf muscle helps a lot.
c.)Range of motion exercise:
Here the patient sits at the plinth edge and actively flexes and extends the knee joint in a free-swinging movement within the pain limits.
Cardiovascular exercise or aerobic exercise help to improve physical fitness and cardiovascular fitness. (e.g., stationary cycle, walking, swimming).[N.B: Consult with a certified physiotherapist before doing the exercise ]
2.SHOE OR SOLE :
Most patients have medial compartment osteoarthritis knee because of genu varum or bow knee. We can correct this deformity using a lateral wedge insole. This lateral wedge insole reduces the pressure on the medial compartment of the knee. Arthritis shoe induces a good shock absorber, good mediolateral support, adequate arch support, calcaneal cushion.
A knee brace provides stability, support and reduces pain. This type of braces helps to reduce the force of the overloaded compartment. According to the American Academy of Orthopaedic Surgeons (AAOS), a knee unloading brace has a profound effect on the medial compartment osteoarthritis.
The person who is overweight has a greater chance of OA. Reduced body weight may help by reducing loads on weight-bearing joints (Felson 1996, Felson et al 1997; Messier et al. 2000; Toda et al. 1998). Normal body weight helps to improve overall physical health.
TIPS TO REDUCE BODY WEIGHT:
- Daily physical activity.
- Follow the proper diet.
- Sleep 7-8 hr (adult).
- Never miss breakfast.
- Drink enough water.
- Say no to alcohol.
5.PHARMACOLOGIC DRUG USED IN OSTEOARTHRITIS OF KNEE:
Drugs that help to reduce pain can assist in maintaining mobility and improving quality of life. Oral NSAIDs are primarily effective in limiting pain by their capacity to reduce inflammation and nociceptive pain through COX-2 inhibition.
Drugs frequently used are.
- Acetaminophen can be useful in the treatment of knee osteoarthritis.
- NSAIDs (celecoxib, diflunisal, etodolac, fenoprofen, glucosamine and chondroitin).
Canes help to reduce joint load and improve stability or balance. It prevents fall injury. Using the cane in the hand opposite your weakness shifts your body weight to the stronger side.
- Several studies have evaluated the effectiveness of PSWD for improving symptoms of osteoarthritis.
- Electroacupuncture had been found to reduce pain, stiffness associated with osteoarthritis.
- Interferential current ( IFT) also used.
Thi chi helps to pumps the blood and fluids of the body through the muscles, tendons and joints, this facilitates the removal of waste and replenish with nutrients. The Sun-style 24 forms Tai Chi exercise is effective in decreasing pain, stiffness, fear of falling and it improves balance, rising time, and knee joint motion.
Topical medication that has been used for OA of the knee includes salicylates, capsaicin, and NSAID. Salicylates have not been shown to be effective for pain relief in patients with OA.
10.INTRA-ARTICULAR CORTICOSTEROID INJECTION:
Intra-articular corticosteroid injections have been used extensively in the management of symptomatic osteoarthritis of the knee. Improvement using corticosteroid injection is not permanent it lasts up to two weeks. Intraarticular (IA) corticosteroid injections can be considered as an adjunct to core treatment for short term reduction of moderate to severe pain in people with osteoarthritis (OA).