1. C24 Osteoarthritis of the Knee: A Closer Look
2018 WAERT
Student Symposium

2. Objectives Define osteoarthritis (OA) Identify risk factors
Explore diagnostic methods
Discuss treatment options
Evaluate expected outcomes

3. Osteoarthritis of the knee is a degenerative joint disease affecting millions of people due to obesity and the aging population; however, current treatment options provide relief from a painful and often debilitating disease.

4. Osteoarthritis Facts
Most common causes of pain and disability worldwide1
Researchers estimate by 2030, more than 67 million people living in the U.S. will have OA1
The knee is the most common site of OA1,2
Each year 4.1 million people living in the U.S. seek care for OA-related knee problems1
Due to obesity and the aging population, the prevalence of OA is increasing2
There is no cure
Both non-invasive and invasive treatment options are available
The knee is the most common site of OA

5. What is Osteoarthritis?
Degenerative condition, usually progresses slowly over many years
Most common form of arthritis; often associated with “wear and tear”
Occurs when the cartilage becomes rough and prevents a smooth gliding motion between articulating bones
Affects the medial, lateral, and patellofemoral compartments of the knee joint
Causes pain, swelling, decreased range of motion (ROM), and bone reshaping
Can be debilitating and lead to decreased mobility

6. Risk Factors Genetics Female Age
19% of the American adult population over the age of 45 and up to 40% of the population over the age of 60 are affected3
Body mass index (BMI)
There is a significant correlation between being overweight or obese and the development of OA1,2,3,4
Congenital bone conditions
Trauma and/or surgical intervention
Repetitive motion

7. Diagnosis Medical history
History of trauma or injury to the affected joints
Past medical conditions or surgeries
Unilateral joint pain
Progressive onset of symptoms
Factors that improve or exacerbate symptoms
Hands, hips, neck, and lower back are most common

8. Diagnosis Physical examination
Pain, swelling, tenderness, decreased ROM, palpable joint damage, and crepitation with joint flexion
Location and distribution of painful joints
Affects joints subjected to biomechanical abuse
Asymmetrical onset of symptoms
Laboratory tests
Blood tests
Urine sample
Synovial fluid analysis

9. Diagnosis Diagnostic imaging X-ray
The American College of Radiology states that knee radiography is an appropriate way to evaluate non-traumatic knee pain
Magnetic resonance imaging (MRI)
MRI may be used to help identify those at high-risk for developing OA and for diagnosing early-stage OA
Note: The American College of Rheumatology suggests that a diagnosis of OA may be determined without radiologic evidence by a clinician.2 However, American College of Radiology states that knee radiography is an appropriate way to evaluate non-traumatic knee pain.1

10. X-ray Cost effective and quick, but may not show signs of early OA
Presence of osteophytes
Joint space narrowing
Normal adult joint space measures 5-6mm
Sclerosis
Bone reshaping (two hallmark signs)
The formation of bone deposits along the joint edges, which can break off and cause additional damage and pain1,2
The formation of rounded deposits on the articular surfaces1,2
Bone reshaping causes two hallmark signs on radiographic images
Formation of bone deposits along the joint edges, which can break off causing additional damage and pain
Formation of rounded deposits on the articular surfaces, known as “lipping”
Since cartilage is radiolucent, what appears to be empty space between the femur and tibia is actually a surrogate measure of cartilage integrity
Typically, this space measures 5mm to 6mm wide in a healthy adult knee

11. X-ray
One of the most commonly used radiographic grading system for OA is the Kellgren and Lawrence Classification System, which characterizes the severity of OA on a scale of 0 to 4 (see Table 1)1,2,5
Table 1
Kellgren-Lawrence Osteoarthritis Classification System1,2,5
Grade
Description
No joint space narrowing or reactive changes 1
Doubtful joint space narrowing, possible osteophytic lipping 2
Definite osteophytes, possible joint space narrowing 3
Multiple osteophytes, definite joint space narrowing, sclerosis, and possible bone deformity 4
Large osteophytes, marked joint space narrowing, severe sclerosis, and definite bone deformity

12. X-ray Kellgren-Lawrence Osteoarthritis Classification System

13. MRI Utilizes non-ionizing radiation
MRI can directly visualize articular cartilage and other soft tissues that compose the joint
Osteophytes
Cartilage defects
Subchondral bone marrow edema and synovial cysts
Meniscal and ligamentous abnormalities
Joint effusions
Synovitis
Expensive and time-consuming
Some patients may be claustrophobic

14. MRI Normal knee Abnormal knee

15. Non-Invasive Treatment Options
Self-managed care
Weight loss
Diet and exercise promotes weight loss, which can help control or reduce pain and improve joint mobility and function1,2,4
Heat therapy
Increases circulation and may relax tight joints and muscles
Cold therapy
Slows circulation and reduces swelling
Over-the-counter (OTC) medications
Acetaminophen to relieve pain
Non-steroidal anti-inflammatory (NSAIDS)

16. Non-Invasive Treatment Options
Complementary Alternative Medicine (CAM)
Bee venom acupuncture
The use of bee venom, with the help of glucocorticoids, may slow the progression of inflammatory arthritis
Since OA is degenerative, its effectiveness will vary
Chondroitin sulfate and glucosamine supplements
Chondroitin is a major component of cartilage
Glucosamine has anti-inflammatory properties and may promote cartilage regeneration
No scientific evidence that these supplements are effective

17. Invasive Treatment Options
Corticosteroid or cortisone injections
Reduce pain and inflammation directly in and around the joint space
To prevent adverse effects, such as permanent joint damage, injections should be administered every three to four months1,
Hyaluronic acid replacement therapy
Involves replacing lost synovial fluid via injection directly into the knee joint

18. Invasive Treatment Options
Surgical intervention
Arthroscopic debridement and lavage
Minimally invasive procedure that involves smoothing the joint surfaces
Does not alter the disease process and the benefits may be short-term1,2
Results may vary and outcomes are inconsistent1,2
Cartilage repair

19. Invasive Treatment Options
Surgical intervention
Osteotomies
A surgical procedure to reshape the knee joint to relieve pressure
Knee replacement (partial and total knee arthroplasty)
Partial knee replacement involves replacing the worn section of bone with artificial hardware
Total knee replacement involves the replacement of all three joint surfaces with artificial hardware

20. Outcomes
Treatment outcomes vary depending on the severity of the patient’s OA
Accurate diagnosis and appropriate treatment plans are essential for the best outcomes
According to the Arthritis Foundation, 66% of people obtained pain relief when using complementary and alternative medicine (CAM)1
Nearly 90% of patients report that knee replacement surgery reduced pain and improved their mobility and overall quality of life1

21. Conclusion
Each year 4.1 million people seek care for OA-related knee problems1
The rising obesity epidemic and aging population increases the prevalence of OA
Medical history, physical examination, laboratory tests, x-ray and MRI are key components to an accurate OA diagnosis and appropriate treatment plan
Osteoarthritis has no cure
Treatment options can provide relief from joint pain and restore mobility
Tie back to thesis statement,
Name treatment options, help with symptoms

22. References
Shagam J. Medical imaging and osteoarthritis of the knee. Radiologic Technology. 2011;83(1): November 2017
Lespasio MJ, Piuzzi NS, Husni ME, et al. Knee osteoarthritis: A primer. Permanente Journal. 2017;21: doi: /TPP/ February 2018
Verbeek J, Mischke C, Robinson R, et al. Occupational exposure to knee loading and the risk of osteoarthritis of the knee: A systematic review and a dose-response meta-analysis. Safety and Health at Work. 2017;8(2): doi: /j.shaw February 2018
Silverwood V, Blagojevic-Bucknall M, Jinks C, et al. Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthritis and Cartilage. 2015;23(4): doi: /j.joca February 2018
Kohn MD, Sasoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clinical Orthopaedics and Related Research. 2016;474(8): doi: /s February 2018