| Knee Pain - Osteo Arthritis |
A Gp's Role is to make an accurate diagnosis and also to provide the majority of the conservative care for a patient. Once conservative management is no longer effective, a GP should evaluate fully and refer appropriately guidcance given below may help.
Conservative Treatment
• Paracetemol or nonsteroidal anti-inflammatory medication (NSAIDs), monitor for side effects
• Ambulatory assistive devices (cane, crutch, walker)
• Weight reduction
• Strengthening and range of motion exercises ( + / - Physiotherapy)
• Occasional knee orthosis or shoe modification
• Occasional arthrocentesis with intraarticular steroid injection
• Consider viscosupplementation e.g Hyaluronic Acid Injection ( Ostenil )
Duration of treatment will vary according to:
• age of patient
• level of symptomology
• risk/comorbidity
• impact on quality of life
When conservative managment is no longer working what are the options?
Indications for a TKR ( Total Knee Replacement )
1. Severe pain in the knee
2. Significant impact on quality of life
3. Non restful sleep because of knee pain
4. Patient willing to have surgery
5. No contraindications to surgery
So who is it for well basically if all the above criteria are met its important to undertake a weight bearing knee X-ray. This tells us how much joint space is left in the knee. If the patient has arthrisits in 2 or more compartments (remember the knee has 3, the medial, lateral and the compartment beneath the patella the patello femoral joint) then they may be a candidate for a TKR.
Unicompartmental Knee Replacement
This is for a younger more active patient whos arthritis is confined to the medial compartment and who has an acceptable alignment of the knee (< 10 degrees varus or < 15 degrees valgus).
I mean here the knee is pretty straight not valgus or varus aligned ( see images ). The ACL ( Anterior Crucuate Ligament ) should also be intact on clinical examination and the patient should not be obese.
Tibial Osteotomy
This is for a younger more active patient whos arthritis is confined to the medial compartment and who has a valgus knee alignment ( see image ). There should also be a reasonable amount of cartilage left on the inside of the knee. In this case a piece of bone is removed from the top of the leg just below the knee and the knee is realigned.
The recovery is quite long and this should be conveyed to the patient.
Arthroscopic debridement
This may be indicated for the treatment of patients with degenerative arthritis of the knee with mechanical symptoms ( mechanical knee pain is when a Patient experiences a feeling as though something is caught within the knee and is popping as the knee bends back and forth ).
Please bear in mind Neither arthroscopic lavage nor debridement is indicated for patients without mechanical symptoms.
The results are variable, but higher success rates are reported when:
• There is no gross malalignment or instability;
• There is some articular cartilage remaining; and
• Symptoms are well localised.
There are other options for patients with severe arthritis of the knee and if you are in any doubt as to the diagnosis please refer the patient to the MSK service, here one of our physicians will evaluate the patient fully and discuss the case before recomending a course of action.
|
|
