Knee Osteoarthritis
Knee Osteoarthritis
Risk factors
Clinical presentation
- Joint pain (most common)
– Insidious onset
– Variable intensity through the day
– May be intermittent & relapsing
– Increased by joint use & impact, relieved by rest
– Night pain may occur in severe OA - Stiffness
– In contrast to inflammatory arthritis, e.g. RA, stiffness in OA usually lasts only a few mins & almost always < 30 mins. - Swelling +- warmth & loss of function
- Gait disturbance (impaired function of a weight-bearing joint will cause added stress on the contralateral weight-bearing joint)
- Loss of muscle bulk (inactivity secondary to pain)
- Limb deformity e.g. ‘knock knees’ (valgus) or ‘bowing’ (varus)
- Clicking or grinding sensation
Physical examination
- Gait
- Tenderness
- Joint swelling (due to synovitis, synovial effusion or bony enlargement)
- Crepitus
- Limitation of movement
- Deformity
Diagnostic criteria
Often a clinical diagnosis.
Alternatively, can consider using EULAR or ACR criteria to aid in diagnosis
EULAR
ACR
Although knee OA is the most frequently encountered, OA can also involve the hands and hips which can be diagnosed by using the ACR criteria
🔍Investigations
Diagnosis is mainly clinical.
Plain radiography can be used and is still the standard imaging for assessment of OA.
– When radiography is required in hip and knee OA, it should be done in weight bearing position (AP, standing).
Classical features of OA on plain radiograph
- Narrowing of joint space
- Osteophytes
- Subchondral bone sclerosis
- Subchondral cysts
Kellgren-Lawrence Grading Scale
Non-pharmacological management
- Patient education
- Lifestyle modification – weight reduction
- Physiotherapy – exercise, transcutaneous electrostimulation (TENS), thermotherapy
- Occupational therapy – early referral may be considered for pain relief & improvement in activities of daily living.
💊Pharmacological treatment
Oral
- Simple analgesic – Paracetamol (PCM)
- NSAIDs &/or COX-2 inhibitors
- Weak opioid – Tramadol
- Nutraceuticals – Glucosamine, chondroitin
💉Intra-articular
i. Corticosteroids
- Intra-articular (IA) steroids may be used for short-term pain relief in acute exacerbation of knee OA.
- Oral steroid have no role in treatment of OA..
ii. Viscosupplementation (e.g. hyaluronic acid)
- Current guideline is unable to recommend the use of viscosupplementation in the treatment of OA.
📩Referral
Rheumatology opinion should be sought for evaluation of arthritis with unclear diagnosis.
Orthopaedic referral should be made if no improvement in symptoms despite adequate pharmacological & non-pharmacological treatment.
Algorithm
References
Ministry of Health Malaysia. (2013). Clinical practice guidelines: Management of osteoarthritis (2nd ed.). Ministry of Health Malaysia.