Osteoarthritis of the Knee: - Wheeless' Textbook of Orthopaedics

- See:
- Osteoarthritis Menu:
- predisposing conditions
- pathology and histology
- clinical features
- laboratory aspects

- Discussion:
- biomechanical considerations: (see kinematics and anatomy of knee
- thick cartilaginous surfaces of the knee helps to spread out joint reactive load over a wide area and helps contribute to cam shape of condyles which
                  maximizes extensor lever arm;
- in degenerative arthritis the quality of the articular cartilage is lost;
   - early in the process, there may be discrete chondral injuries where as advanced changes include chrondal injuries on both sides of the joint;
   - as wear occurs, the patello femoral joint is reduced to a cylindrical outline;
   - the mechanical outline is lost, but wear in the bone to bone contact area is reduced;
           - reference: Does osteoarthrosis depend on growth of the mineralized layer of cartilage

    - non operative treatment:
- NSAIDS
- steroid injection
- viscosupplementation: (hyaluronic acid)
                 - Supartz, Hyalgan, Synvisc, Orthovisc, Euflexxa;
                 - references:
                        - Granulomatous Inflammation After Hylan G-F 20 Viscosupplementation of the Knee
           - Increased Frequency of Acute Local Reaction to Intra-Articular Hylan GF-20 (Synvisc) in Patients Receiving More Than One Course of Treatment
                        - Clinical Trials of Hyaluronic Acid Reflect Significant Publication Bias

          - reduction of cartilage impact loading: (typically this is 6 times body wt);
- cane (same side vs opposite side)
- rubber heel wedges (consider lateral wedges w/ medial compartment arthrosis);
- wt loss;
- valgus unloading knee brace; (see Donjoy and Breg)
                        - A Mechanical Theory for the Effectiveness of Bracing for Medial Compartment Osteoarthritis of the Knee

    - operative treatment:
- arthodesis (limited indications in non infectious arthritis);
- arthroscopy of osteoarthritic knee:
          - Alternatives to Total Knee Replacement: Autologous Hamstring Resurfacing Arthroplasty
          - high tibial osteotomy
          - unicondylar replacement
          - total knee arthroplasty

Osteoarthritis Slide Show

Comparison Of An Antiinflammatory Dose Of Ibuprofen, An Analgesic Dose Of Ibuprofen, And Acetaminophen In The Treatment Of Patients With OA Of The Knee.

Corticosteroid Compared with Hyaluronic Acid Injections for the Treatment of Osteoarthritis of the Knee.

Correlation of sonographic severity with biochemical markers of synovium and cartilage in knee osteoarthritis patients.