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Physiotherapy & Exercise Physiology Penrith

Treatment of Knee Osteoarthritis

What is knee osteoarthritis?

Osteoarthritis is a chronic disease that affects many joints in the adult body, most commonly the knees, hips and hands. There is currently no cure for osteoarthritis, but there are many treatments and approaches to managing the long-term symptoms of this disease. Initially, osteoarthritis was considered to be a disease of articular cartilage, but recent research has indicated that the condition involves the entire joint. The loss of articular cartilage is often the primary change, but a combination of cellular changes and biomechanical stresses causes several secondary changes, including subchondral bone remodeling, the formation of osteophytes, the development of bone marrow lesions, change in the synovium, joint capsule, ligaments and periarticular muscles, and meniscal tears and extrusions.

What guideline do our physios and exercise physiologists use?

The RACGP Guideline in the Management of Hip and Knee Osteoarthritis provides advice and recommendations for the management of people with knee and/or hip osteoarthritis. The guideline has a strong focus on self-management and non-surgical treatments to improve the health of people with knee and/or hip osteoarthritis. The physios and exercise physiologists at Agility Physio & Ex Phys Penrith uses these guidelines to provide treatment of knee osteoarthritis, this approach provides the greatest benefit to those with osteoarthritis related knee pain, stiffness and weakness.

What are the symptoms of knee osteoarthritis?

Knee osteoarthritis is characterised by anterior knee joint pain, morning stiffness and swelling, and difficulty standing from seated position, descending stairs and will progressively affect walking and daily functioning. Knee osteoarthritis will often present as patellofemoral pain syndrome and these include pain on knee flexion, flexion contracture and cinema sign. Osteoarthritis most frequently occurs in people aged >55 years, although younger people can also be affected. Risk factors for osteoarthritis include joint injury, being overweight or obese, and older age.

Diagnostic criteria for knee osteoarthritis

Diagnosis criteria of knee osteoarthritis is based on history, physical examination, radiographic findings and laboratory findings:

  • knee pain

  • age over 50 years

  • less than 30 minutes of morning stiffness

  • crepitus on active motion

  • bony tenderness

  • bony enlargement

  • no palpable warmth of synovium

  • ESR <40mm/hour

  • rheumatoid factor (RF) <1:40

  • synovial fluid signs of osteoarthritis 

What other conditions could knee osteoarthritis be?

Patellofemoral pain syndrome, knee meniscal tear, chondromalacia of the patella, infrapatellar fat pad syndrome and bakers cyst.

What are the most appropriate outcome measures to evaluate the treatment of knee osteoarthritis

The Knee Injury and Osteoarthritis Outcome Score is a knee-specific instrument, developed to assess the patients' opinion about their knee and associated problems. The Knee Injury and Osteoarthritis Outcome Score evaluates both short-term and long-term consequences of knee injury.

Guideline-based treatment of knee osteoarthritis

The management of knee osteoarthritis at Agility Physio & Ex Phys is based on lifestyle and non-drug interventions that are strongly or conditional recommended:

  • Regular exercise is important for relieving pain and improving function in people with knee osteoarthritis. For knee osteoarthritis land-based exercise such as muscle strengthening exercises, walking and Tai Chi are strongly recommended.

  • Other land-based exercise that could be considered for some people with knee osteoarthritis include stationary cycling and Hatha yoga.

  • Weight management is strongly recommended for people with knee osteoarthritis who are overweight or obese.

  • Aquatic exercise may be considered for some people with knee osteoarthritis.

  • Cognitive behavioural therapy (CBT) could be considered for some people, particularly in conjunction with exercise, and taking into account existing mental health conditions, personal preference, cost and access.

  • Heat packs or hot water bottles may be applied as a self-management strategy.

  • Using a cane or other devices (eg walker, crutches) may be appropriate for some people with knee osteoarthritis to help improve pain, mobility and balance.

  • A short course of manual therapy or massage could be considered for some people with knee osteoarthritis as an adjunct to lifestyle management.

  • Transcutaneous electrical nerve stimulation (TENS) that can be used at home may be appropriate for some people with knee osteoarthritis

  • There is a conditional recommendation against the following treatments: therapeutic ultrasound, shockwave therapy, laser therapy, interferential therapy, footwear marketed for knee OA, cold therapy, valgus braces and lateral wedge insoles for medial knee osteoarthritis, patellofemoral braces and kinesio taping.

What guideline/consensus statements does Agility use in the treatment of knee osteoarthritis?

The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.

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