Why: | Very common in aging population with high expectations |
| 40 000 UK knee replacements per year, set to double in 10 years time |
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How: | History
Pain, swelling; mechanical symptoms: locking, giving way Sleep disturbance and walking tolerance; quality of life
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| Examination
Swelling: exclude inflammatory cause; deformity: deteriorating valgus likely to need surgery Focal tenderness: medial and patello-femoral more likely to respond to non-operative measures Gait: severe osteoarthritis with poor mobility has worse outcome with joint replacement: Don't leave surgery too late
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| Investigation
Blood tests to exclude inflammatory arthritis if concerned +/− aspirate X-ray: weight bearing +/− Tunnel (for loose bodies) and ‘skyline’ patella (this is axial view through the patello-femoral joint, combined with the lateral it gives the two orthogonal views necessary to interpret the patello-femoral joint) Possible MRI: If early osteoarthritis to exclude meniscus tear
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What next and when: | GP treatment
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| If fails consider physiotherapy:
Guided exercises — especially for patello-femoral problem Knee brace — medial offload knee brace in medial osteoarthritis (this brace pushes the knee into valgus to ensure maximal weight goes through the less arthritic lateral compartment) Walking aid
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| If fails consider orthopaedic surgical opinion:
Out patient viscosupplimentation: Hylan G-F 20 Arthroscopy, and debridement When symptoms worse than radiographs and some cartilage is preserved (implies likely cartilage flap/tear); Osteotomy Young patient with heavy work (demands would cause rapid wear of artifical joint); Uni-compartmental knee replacement Patello-femoral replacement Total knee replacement Excellent long-term results for severe osteoarthritis in patients over 55 years Over 90% of replacement sound at 10 years
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Patient information: | Useful web links for patients: http://www.patient.co.uk/showdoc/1365 |
| Arthritis Research Campaign: osteoarthritis of the knee (printable information booklet): http://www.arc.org.uk/arthinfo/patpubs/6027/6027.asp |
| Arthritis Research Campaign: a new knee joint (printable information booklet): http://www.arc.org.uk/arthinfo/patpubs/6021/6021.asp |
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References/Web links: | Home-based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ 2002; 325: 752. http://www.bmj.com/cgi/content/abstract/325/7367/752 |
| Is glucosamine worth taking for osteoarthritis? Drug Ther Bull 2002; 40: 81–83 http://www.dtb.bmj.com/ |
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Who are you: | Mr P Julian Owen, consultant trauma and orthopaedic surgeon, Addenbrooke's Hospital, Cambridge |
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Date: | February 2008 |