Osteoarthritis

Osteoarthritis is the progressive degeneration of the articular cartilage lining of the bone within a joint. Together with this are further changes in the bone underlying the cartilage, the soft cartilage of the joint, and as a result the peripheral ligamentous structures of the joint.

Osteoarthritis is simply the result of joint aging and every joint is genetically programmed to start to fail at a certain age.

A repetitive trauma or single large trauma creates post-traumatic osteoarthritis which accelerates the wear rate within a joint thus producing symptomatic osteoarthritis at an earlier age than a non-traumatised joint would have.

In the knee all three compartments, the patella-femoral joint, the medial compartment, and the lateral compartment, can develop isolated osteoarthritis of their own.  The knee can also have a combination of between one and three compartments involved.

Treatment

1. Activity Modification
   This is the first level of treatment and involves "making your knee fit your life and your life fit your knee". Try to avoid the activities that limit pain and activities that may accelerate wear such as running.
2. Medication
   1. Oral
      1. Paracetamol
         Very underestimated value in controlling osteoarthritic pain especial in conjunction with a NSAID
      2. Non-Steroidal Anti-Inflammatorys (NSAID)
         There are numerous NSAIDs and different ones work better for different people. Side effect profiles also vary.
      3. Opioid Derivatives (Codeine)
         More powerful painkiller. Causes constipation with prolonged use.
   2. Injectable
      1. Intra-articular Steroids
         Very powerful local anti-inflammatory effect. Can relieve symptoms for a very long time (8-24 weeks). Best reserved for severe exacerbation of symptoms or to provide sustained relief pain for important event.
3. Physiotherapy
   This helps decrease inflammation, maintain range of motion and, very importantly maintain muscle tone. Maintaining good lower limb and quadriceps muscle tone is proven to decrease symptoms and increase function.
4. Bracing and Orthotics
   Simple compressive bracing provides proprioceptive support and can significantly relieve symptoms in early Osteoarthritis.
   If the wear principally involves a single compartment of the knee, the worn half of the knee, paradoxically, ends up with all the body weight going through it. An 'unloader' brace re-aligns the skewed leg placing the body weight over the well preserved compartment of the knee.
5. Surgery
   The decision to proceed to surgery rests solely with the patient, and is based on, failure of conservative options to relieve pain and loss of function. The decision as to if and when to do surgery is the patients, and is not based on the X-Ray.
   
   Options:
   1. High Tibial Osteotomy
      
      
   2. Partial Joint Replacement
      
      
      
   3. Total Joint Replacement