Osteoarthritis of the knee is a degenerative joint disease which affects the knee. It is typically the result of a progressive breakdown of the cartilages, thereby causing the bones of the knee to rub one another. If you want to be busy as an orthopedic surgeon, then you should focus on the knee as it is the most common type of arthritis being diagnosed. It is important to know that the bones that form joints are surrounded by periosteum which have pain receptors in them. The bones in the joints of the knee are surrounded by articular cartilages which absorb shock and enable the movement of the joint. The synovial membrane surrounds the articular cartilage and it produces the synovial fluid. Both the synovial membrane and the fibrous capsule makes up the articular capsule. The joints are stabilized by ligaments which helps to stabilize the joint. In the knee joint, a fibro-cartilages that supports movement, stabilizes the joint and absorb shock is known as meniscus.
Osteoarthritis in the knee can occur in three compartments which are the patellofemoral compartment, which is behind the knee cap and affects the patella, the tibiofemoral compartment which affects the lateral femur and lateral tibia as well as the medial femur and tibia, and the medial compartment. Knee osteoarthritis can be unicompartmental, bicompartment or tricompartmental arthritis. With Unicompartmental Osteoarthritis, any of the compartment is affected, when it comes to bicompartmental arthritis, two out of the three compartments are affected, and when it is tricompartmental arthritis as the name implies, the three sides are affected.
Assessing a patient with knee osteoarthritis has to do with identifying if it is degenerative, traumatic, or injured has to do with looking at the alignment. It is important to know that people with bow legged knee structures have medial compartment type of Osteoarthritis, people with knock-knee, rheumatoid vagus knee, have valgus lateral compartment osteoarthritis. It is important to access the alignment, looking at swellings, fixed flexion which is the inability to stretch or bend the knee fully, and ranged movement. Once the knee has been observed, it is important to check the joints above, to make sure that the hip and the spine are causing referred pain, same with the foot and ankle. When diagnosing, it is important to check the history of the patient. Allow the patient to explain how they feel pains in their knee, and how intense the pains are.
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Non-surgical treatment for knee Osteoarthritis is broad spectrum with different treatments. The core treatment of the knee with Osteoarthritis includes the right treatment, stretching and strengthening of the knee and paying attention to body mass index. Giving painkillers is important and they can be paracetamol, nurofen, and anti-inflammatory drugs. The parcetamol can be co-proxial codeine based tablets succh as co-codimol, and with anti-inflamatory, we mention naproxen, and meloxican. The outer layer treatments includes hot and cold transcutaneous electrical neural stimulation (tens), braces, knee replacement surgery, Osteotomy (knee arthroscopy is not a surgical treatment for knee arthritis anymore), targeted steroid injection, Platelet-rich plasma, and hyaluronic acid. The painkillers should not be Opioids. If the patients have been diagnosed with knee Osteoarthritis, it is important to identify the compartments and work on those compartments by checking on the biosocial activity of the patient, while surgery comes last, it cannot be ruled out.
Surgical options depends on the type of compartments and the age. A person with a unicompartmental Osteoarthritis can go with unicompartmental knee replacement surgery, or an osteotomy can be done. Osteotomy is a knee preserving procedure where the knee joint are still much functioning and that of the patient. A partial knee replacement can be done on patients as well. Other preservative procedures include meniscal repair surgery, ligament reconstruction, and articular cartilage treatment. In the case of diffuse damage, then joint sacrifice can be considered. Patients with patellofermoral Osteoarthritis would have to undergo rehabilitation. Patients who suffer from patellofemoral Osteoarhtritis are young people, and more common in females. it is typically bilateral and since there is a damage to the patella, the patients will exhibit lots of pain, and after the usual treatment, rehab is important so the young patient can understand and start to live with whatever treatment procedure was done. So many patients do not like their new knee as it doesn't feel like a part of them, so it is important to do a rehab before and after operation.
Knee replacement can have complications such as infection, stiffness, swelling, bleeding, blood clot and death in rare cases. It is important to first usu non-surgical core treatment for knee osteoarthritis as orthopedic doctors could get the result they need from a core treatment before going invasive with Osteotomy but in cases of severe cases, surgery is required and also for young people it is good to have a rehab first, and after the operation so they can be able to live with the changes on their knee.