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knee

Osteoarthritis—“Twinges in all your hinges”

Teaser: 

Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL,1
Neelam Charania, BSc, MSc (OT),2

1 is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and https://ihopeyoufindthishumerusblog.wordpress.com/
2 has a Masters in Occupational Therapy from Boston University and involved in managing and rehabilitating patients with chronic osteoarthritis and disability.

CLINICAL TOOLS

Abstract: Osteoarthritis is most common form of arthritis. It is also very disabling. Fortunately, there is a long list of medical therapies including education, OTC meds, strengthening, braces, prescribed medications, standard and non-standard intra-articular therapies and some new experimental therapies. This article focuses on well known and well proven therapies like cortisone and hyaluronic acid injections into large joints like knees and hips. Large meta-analysis shows improvement in pain, physical function and stiffness in a simple well tolerated procedure with minimal side effects.
Key Words: osteoarthritis, arthritis, knee, hip, joint injections, steroid, hyaluronic acid.
OA symptoms include joint pain, morning stiffness <30min, reduced ROM, and possibly swelling.
The most common joints are knees, hips, fingers, thumbs, big toes and lumbar spine.
The key pathophysiology in OA is destruction of cartilage and bone formation, which reduces function and causes pain.
Simple x-rays are diagnostic. There is no need for advanced imaging like CT or MRI for OA.
A combination of therapy is key to successfully managing this condition.
If morning stiffness >30 minutes, stiffness and pain increases with rest, joint warmth or erythema, or three or more joints, you should think of inflammatory, septic, or crystal arthritis RATHER than osteoarthritis.
Don't forget about weight loss, bracing, topical agents, or non conventional medications like duloxetine or tramadol in osteoarthritis.
There is no maximum amount of cortisone injections in a joint but it is mainly used for stiffness, swelling and pain.
Hyaluronic acid intra articular injections manage symptoms of pain, stiffness, range of motion, and physical function. The best formulations are high MW and cross-linked because they last longer.
New experimental therapies like PRP, MSC, and ACI have limited evidence and are costly.
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Management of the Arthritic Knee in Older People

Management of the Arthritic Knee in Older People

Teaser: 

Geoffrey F. Dervin, MD, MSc, FRCS(C), Associate Professor, University of Ottawa and the Ottawa Hospital, Orthopaedic Division, Department of Surgery, Ottawa, ON.

Understanding the options for treatment of osteoarthritis of the knee will allow physicians to help their patients realize the physical and social demands of healthy life. Weight loss, physical therapy and unloading braces are clinically proven strategies in the early stages of the disease. Acetaminophen remains the analgesic of choice, while COX-2 NSAIDs are reserved for flare-ups and short-term use. Oral glucosamine and chondroitin sulfate also may be helpful. Persistently swollen knees may respond to aspiration and corticosteroid injection or viscosupplementation with hyaluronic acid derivatives. Those with acute onset of mechanical symptoms may respond to arthroscopic débridement and resection of unstable meniscal tears. Osteotomy of the tibia or femur are options for isolated unicompartmental disease in younger and more active patients. Arthroplasty of one or all compartments of the knee is the definitive procedure for end-stage arthrosis with very dependable results in most clinical settings.
Key words: osteoarthritis, knee, arthroplasty, acetaminophen, older people.