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Osteoarthritis Knee PowerPoint Presentation

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Description : This medical presentation titled "Osteoarthritis Knee" provides us an overview of the osteoarthritis of the knee (Epidemiology, Definition, and Risk Factors), shares clinical approach to knee pain, provides information on differential diagnosis of the osteoarthritis of the knee, its management (Lifestyle, Medical, and Surgical).

Tags : Osteoarthritis Knee, overview, Epidemiology, Definition, Risk Factors, clinical approach, knee pain, differential diagnosis, management, Arthritis, Arthrosis, Rheumatoid Arthritis

Published on : Apr 27, 2021 | Views : 2946 | Downloads : 16

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Slide 1-

Osteoarthritis Knee
Slide 2-

Osteoarthritis of The Knee Overview Epidemiology Definition Risk Factors Clinical Approach to Knee Pain Differential Diagnosis Diagnosis of Knee OA Management Lifestyle Medical Surgical
Slide 3-

Overview: Epidemiology Knee OA most common cause of disability in adults Decreased work productivity, frequent sick days Highest medical expenses of all arthritis conditions Symptomatic Knee OA More than 10 million Americans 1 More than 11% of persons > 64yo 2
Slide 4-

Overview: Definition Arthritis vs. Arthrosis Gradual loss of articular cartilage in the knee joint 3 articulations: Lateral condyles of the femur and tibia Medial condyles of the femur and tibia Patellofemoral joint Damage caused by a complex interplay of joint integrity, biochemical processes, genetics, and mechanical forces
Slide 5-

Anatomy of The Knee
Slide 6-

Anatomy of The Knee
Slide 7-

Overview: Risk Factors Age 3 Female Obesity Previous knee injury Lower extremity malalignment Repetitive knee bending High impact activities Muscle weakness 4
Slide 8-

Osteoarthritis of The Knee Overview Epidemiology Definition Risk Factors Clinical Approach to Knee Pain Differential Diagnosis Making The Diagnosis Management Lifestyle Medical Surgical
Slide 9-

Clinical Approach to Knee Pain “Hey Doc, my knee’s been hurting!” History SOCRATES pain questions Inflammatory sx e.g. fever, hot joint History of trauma or surgery Instability Functional loss Prior treatment
Slide 10-

Clinical Approach to Knee Pain Physical Exam Vitals, BMI Palpation: isolate tenderness, effusion, crepitus ROM: measure degree of flexion Stability: ligaments, menisci Alignment: genu varus or valgus Function: gait, duck waddle
Slide 11-

Clinical Approach to Knee Pain Varus Test (LCL) Valgus Test (MCL) McMurray Maneuver (menisci) Lachman Test (ACL) Duck Waddle (stability)
Slide 12-

Clinical Approach to Knee Pain Tests CBC, ESR, RF Arthrocentesis X-rays (3 views) Weight-bearing AP Lateral Tangential Patellar (Sunrise) MRI
Slide 13-

Osteoarthritis of The Knee Overview Epidemiology Definition Risk Factors Clinical Approach to Knee Pain Differential Diagnosis Diagnosis of Knee OA Management Lifestyle Medical Surgical
Slide 14-

Differential Diagnosis of Knee Pain Medial Pain OA MCL Meniscus Bursitis Diffuse Pain OA Infectious arthritis Gout, pseudogout RA Lateral Pain OA LCL Meniscus Iliotibial band syndrome Anterior Pain OA Patellofemoral syndrome Prepateller bursitis Quadriceps mechanism
Slide 15-

Osteoarthritis of The Knee Overview Epidemiology Definition Risk Factors Clinical Approach to Knee Pain Differential Diagnosis Diagnosis of Knee OA Management Lifestyle Medical Surgical
Slide 16-

Diagnosis of Knee OA Classic Clinical Criteria established by ACR, 1981 sensitivity 95%, specificity 69% knee pain plus at least 3 of 6 characteristics: > 50 yo Morning stiffness < 30 min Crepitus Bony tenderness Bony enlargement No palpable warmth 5
Slide 17-

Diagnosis of Knee OA Classification Tree Clinical symptoms Synovial fluid WBC<2000/mm3 Clear color High Viscosity X-rays Osteophytes Loss of joint space Subchondral sclerosis Subchondral cysts Confirmed by arthroscopy (gold standard) 6 No OA Sensitivity 94 %; Specificity 88 %
Slide 18-

Diagnosis of Knee OA
Slide 19-

Osteoarthritis of The Knee Overview Epidemiology Definition Risk Factors Clinical Approach to Knee Pain Differential Diagnosis Diagnosis of Knee OA Management Lifestyle Medical Surgical
Slide 20-

Management: Lifestyle Weight loss Nutrition referral Exercise Program PT referral Quadriceps strengthening ROM exercises Low impact activities e.g. swimming, biking 7 Ambulatory assist devices Cane Walker Insoles Unloader knee braces
Slide 21-

Management: Lifestyle Varus (bowlegged) vs Valgus (knock-kneed) G2 Unloader Brace
Slide 22-

Management: Medical Glucosamine/Chondroitin Acetaminophen NSAIDs Cox-2 inhibitors Opioids Intraarticular injections Glucocorticoids Hyaluronans
Slide 23-

Management: Medical Glucosamine/Chondroitin 1500 mg/1200 mg daily ($40-50/month) Glucosamine: building block for glycosaminoglycans Chondroitin: glycosaminoglycan in articular cartilage GAIT study, NEJM, Feb 23, 2006 Multicenter, double blind, placebo-controlled, 24 wks, N=1583 Symptomatic mild or moderate-severe knee OA Infrequent mild side effects e.g. bloating For mild OA, not better than placebo For moderate-severe OA, combination showed benefit 8 Patient satisfaction
Slide 24-

Management: Medical Acetaminophen Indication: mild-moderate pain 1000 mg Q6h PRN Better than placebo but less efficacious than NSAIDs 9 Caution in advanced hepatic disease NSAIDs Indication: moderate-severe pain, failed acetaminophen GI/renal/hepatic toxicity, fluid retention If risk of GIB, use anti-ulcer agents concurrently Agents have highly variable efficacy and toxicity
Slide 25-

Management: Medical NSAIDs 10
Slide 26-

Management: Medical Cox-2 inhibitors Indication: mod-severe pain, failed NSAID, risk of GIB OA pain relief similar to NSAIDs Fewer GI events e.g. symptomatic ulcers, GIB Celecoxib 200 mg daily GI/renal toxicity, fluid retention Increased risk of CV events? APC Trial: 700 pts each assigned to placebo, 200 BID, 400 BID Increased risk at higher doses 11 CLASS Trial: 8,000 pts compared Celecoxib vs Ibuprofen Similar risk to Ibuprofen 12
Slide 27-

Management: Medical Opioid Analgesics Indication: Moderate-severe pain Acute exacerbations NSAIDs/Cox-2 inhibitors failed or contraindicated Oxycodone synergistic w/ NSAIDs 13 Tramadol/acetaminophen vs codeine/acetaminophen Similar pain relief 14 Avoid long-term use Caution in elderly Confusion, sedation, constipation
Slide 28-

Management: Medical Intraarticular Injections Glucocorticoids Indication: pain persists despite oral analgesics 40 mg/mL triamcinolone (kenalog-40) Solution: 5 mL (lidocaine 4 mL + kenalog 1 mL) Limit to Q3months, up to 2 yrs Effective for short-term pain relief < 12 wks Acute flare w/in 48 hrs post-injection 15
Slide 29-

Management: Medical Intraarticular Injections Hyaluronans (e.g. Synvisc) Indication: pain persists despite other agents Synthetic joint fluid Pain relief similar to steroid injections 2 mL injection Qwk x 3, $560-760/series Medicare reimburses 80%, Medi-cal $455.90 60-70% patients respond, relief up to 6 months Patient satisfaction 16, 17
Slide 30-

Management: Medical Intraarticular Injections Technique 22 gauge 1.5 inch needle Approach accuracy: Lateral mid-patellar 93% 18 Patient supine Leg straight Manipulate patella Angle needle slightly posteriorly Inject after drop in resistance or fluid aspirated
Slide 31-

Management: Algorithm Lifestyle Modifications Acetaminophen PRN NSAIDs PRN Opioids PRN Celecoxib Steroid Injections Hyaluronan Injections Surgical Referral
Slide 32-

Management: Surgical When to Refer Knee pain or functional status has failed to improve with non-operative management Types of Procedures Arthroscopic Irrigation Arthroscopic Debridement High Tibial Osteotomy Partial Knee Arthroplasty Total Knee Arthroplasty
Slide 33-

Management: Surgical High Tibial Osteotomy Indication: Unicompartmental arthritis Genu varus or valgus Realign mechanical axis Age < 60yo < 15 degrees deformity19
Slide 34-

Management: Surgical Partial Knee Arthroplasty Indication: Unicompartmental arthritis Ligaments spared Increased ROM Faster recovery Prosthesis 10-yr survival: 84% 20
Slide 35-

Management: Surgical Total Knee Arthroplasty Indication: Diffuse arthritis Severe pain Functional impairment Pain relief > functional gain ACL sacrificed PCL also may be sacrificed Prosthesis 10-yr survival: 90% 21