What is osteoarthritis (OA) of the knee?

Osteoarthritis of the knee is reported to be a major health problem worldwide and the most common arthritis in Malaysia.

What happens in knee Osteoarthritis?

Knee osteoarthritis (OA) is a degenerative arthritis caused by overstresses affecting the bone cartilage of the knee that gradually wears away causing inflammation, pain and functional limitation. Knee cartilage that absorbs the shock during activity will gradually worsen due to the excessive loading. The condition progressively becomes critical in the older age due to lack of joint lubricant production.

Some of the major changes that occur in the knee joint of a person suffering from knee osteoarthritis (OA) include:

1. Narrowing of the joint space due to wear of the cartilage.

2. Formation of bony outgrowths (osteophytes) at the margin of the bone.

3. Decrease in production of joint lubricant.

4. Pain aggravated with weight bearing tasks due to friction of both ends’ bone and further bone erosion.

Source: Rheumatology.org

What are the symptoms of knee osteoarthritis?

• The main symptom is morning pain and stiffness.
• Reluctance in doing optimum activity leads to smaller and weaker legs muscles.
• ‘Clicks’ sound from margin of the bones associated with intense pain.
• Other symptoms are occasional swelling, effusion and reduced joint range.
• Limitation of the physical activity drops the person’s quality of life.

Risk factors for knee osteoarthritis?

• Age – 9.3% of adult Malaysians suffer with knee osteoarthritis of this, 23% of the adults are aged more than 55 years and 39% more than 65 years.

• Gender – More women suffer with knee OA compared to men.

• Sports injuries – The person with a history of knee injury is at a fivefold to six fold increased risk to develop knee osteoarthritis.

• Nature of daily activity – Person who is involved in vigorous heavy physical work with a lot of knee action like bending, squatting, kneeling

• Body Mass Index (BMI) – Overweight produces higher loads specifically to the knee compartment of both knees.

What you need to do during early stage of knee osteoarthritis?

Provide initial relief of pain follow the PRICE regimen:

1. Protection Assisted walking aids seems to reduce some load from the affected knee.

2. Rest Adequate rests need to be taken, stop doing any strenuous activity such as prolonged standing, climbing stairs, kneeling or squatting for some time.

3. Ice Applied up to 15 minutes for several times per day. Ice massage and cold packs will improve knee joint range, function and strength and decrease swelling. Some patients prefer the moist heat for pain relief.

4. Compression If swelling exists, wrapping with an elastic bandage to improve the circulation

5. Elevation will help in diminishing swelling.

What is the physiotherapy management for knee osteoarthritis?

1. Modalities – Heat and cold therapy is applied to enhance relaxation and reduces pain. Pulsed electrical stimulation can be useful to promote the blood circulation.

2. Exercise – Stretching and strengthening exercises need to be done regularly to maintain the endurance and flexibility. More unloading exercises will be prescribed to prevent further trauma of the knee.

   Example: Stretching and strengthening exercises

   Source: Unit Fisioterapi, Hospital Melaka

3. Balance training – Balance training is to train postural stability especially is the older adults with impaired balance.

   Example: Balance training

   Source: Unit Fisioterapi, Hospital Melaka

4. Joint protection – Flexibility, strength and joint sense are optimized in hopes of reducing joint stresses, decreasing shock impacts to the joint and maximizing joint movement and alignment.

   Example: Joint protection

   Source: Unit Fisioterapi, Hospital Melaka

5. Advice to patient

   1. Assist walking with cane or walker to minimize the hip and knee loading, thereby reducing pain. It may also prevent falls in patients with impaired balance.

   2. Avoid any strenuous daily activity that gives more trauma to the knee joint such as stairs climbing and hill hiking.

References

1. Corti MC, Rigon C. (2003) Epidemiology of osteoarthritis: prevalence, risk factors, and functional impact. Aging Clin Exp Res. 15, 359–363.

2. De Filippis L, Gulli S, Caliri A, et al. (2004) Epidemiology and risk factors in osteoarthritis: literature review data from “OASIS” study [in Italian] Reumatismo. 56,169–184.

3. Veerapan K, Wigley RD, Valkenburg H (2007) Musculoskeletal pain in Malaysia: a COPCORD survey. J Rheumatol 34(1), 207-213

4. Medifocus.com, Inc. Staff (2012) Medifocus Guidebook On: Osteoarthritis of the Knee ,18

5. Dr. Michel Bonnin & Pierre Chambat (2008) Osteoarthritis of the Knee , 225

6. Joel Alan DeLisa, Bruce Michael Gans & Nicholas E. Walsh (2005) Physical Medicine and Rehabilitation: Principles and Practice, 771

7. Walter R. Frontera, Julie K. Silver, M. D., Thomas D. Rizzo (Jr.) (2008) Essential of physical medicine and rehabilitation. Musculoskeletal disorders-Knee & Lower leg ?, 345

8. Veerapan K (1997) Osteoarthritis – Asian Perspective. In Howe HS, Feng PH. (Ed) Clinical Rheumatology. (pp 294-295) Singapore National Arthritis Foundation

9. Veerapan K (1992) Epidemiology of Rheumatic Diseases in Malaysia. In Nasution AR, Darwawan J, Isbagio H. Ed) Proceedings of the 7th APLAR Congress of Rheumatology: 13-18 September (397-399) Bali, Indonesia

10. Felson DT, Zhang Y, Hannan MT et al. (1995) The incidence and natural history of knee osteoarthritis in the elderly:the Framingham Osteoarthritis Study. Arthritis Rheum, 38,1500-1505.

11. Hunter DJ, March I, SAmbrook PN (2002) Knee osteoarthritis; the influence of environmental factors. Clin Exp Rheumatol, 20, 93-100.

12. Tovin BJ, Wolf SL, Greenfield BH et al. (1994) Comparison of the effects of exercise in the water and land on the rehabilitation of patients with intra-articular ACL reconstructions. Phys Ther , 74, 710-719

13. Walter R. Frontera, Julie K. Silver, M. D., Thomas D. Rizzo (Jr.) (2008) Essential of physical medicine and rehabilitation. Musculoskeletal disorders-Knee & Lower leg , 347

14. Yurtkuran M, Kocagil T. (1999) TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. Am J Acupunct. 27, 133–140.

15. Lehmann JF, deLateur BJ, Stonebridge JB et al. (1968) Therapeutic temperature distribution produced by altrasound as modified by dosage and volume of tissue exposed. Arch Phy Med Rehabil , 49, 28-30

16. Walter R. Frontera, Julie K. Silver, M. D., Thomas D. Rizzo (Jr.) (2008) Essential of physical medicine and rehabilitation. Musculoskeletal disorders-Knee & Lower leg , 349

Source image

1. (2013) Rhematology Image bank. Retrieved July 4 2013. http://images.rheumatology.org/viewphoto.php?albumId=77030&imageId=2897682

2. (2012) Unit Fisioterapi Hospital Melaka. Retrieved July 4 2013.