Rheumatology Book

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Knee Osteoarthritis Management

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  1. See Also
    1. Knee Osteoarthritis
    2. Osteoarthritis
  2. Management: General Measures
    1. Lower Extremity Strengthening Exercises
      1. Educate patient regarding importance of Exercise
      2. Exercise knees 20-30 minutes per day
      3. Physical Therapy to teach low extremity strength
        1. Quadriceps strengthening
        2. Gait training
        3. Active range of motion of hip, knee, and ankle
        4. Instruction in use of cane
        5. Graded elastic band use
      4. Pool Therapy
      5. Re-Evaluate after 4-6 weeks
      6. Modestly effective in reducing Knee Pain
        1. Thomas (2002) BMJ 325:752
    2. Unloader knee brace (valgus) for medial Knee DJD
      1. Kirkley (1999) J Bone Joint Surg Am 81:539
    3. Lateral 5 degree heel wedge for medial knee arthritis
    4. Knee taping
      1. Upper tape for medial/AP tilt and medial glide
      2. Lower tape to protect pes anserine bursa
      3. Hinman (2003) BMJ 327:135
    5. Progressive Walking Program
      1. Reevaluate monthly over 3-6 months
    6. Adjust prior activities
      1. Avoid high knee impact activities
        1. Running
        2. Stair Climbing
      2. Avoid prolonged standing, kneeling, or squatting
      3. Consider Biking, Swimming
  3. Management: Analgesia
    1. Local Cold Therapy
    2. Local Heat Therapy
    3. Acetaminophen 1000 mg PO tid-qid prn (<4 grams/day)
    4. Cautious use of NSAIDS in the elderly
      1. COX2 Inhibitors offer no benefit over standard NSAIDs
    5. Sodium hyaluronate or Hyaluronic acid (Synvisc)
      1. Variable study results
      2. Study supporting use
        1. Intra-articular viscosupplementation
        2. Effectively decreases pain and increases function
        3. Petrella (2002) Arch Intern Med 162:292
      3. Studies suggesting minimal to no benefit
        1. Lo GH (2003) JAMA 290:3115
        2. Arrich (2005) CMAJ 172:1039
    6. Intra-articular Corticosteroid
      1. Offers short-term relief
        1. Reserve for special occasion (e.g. pre-vacation)
      2. Depot glucocorticoid (triamcinolone hexacetonide)
      3. For persistent pain not relieved with above
      4. Avoid more than 3 times per year
    7. Glucosamine Sulfate and Chondroitin sulfate
      1. Some studies suggest as effective as NSAIDs
  4. Management: Chronic Unrelenting Pain
    1. Topical Capsaicin Creams
    2. Transcutaneous electrical nerve stimulation
    3. Local massage
    4. Acupuncture
      1. Decreases pain scores by 40% and improves function
      2. Berman (2004) Ann Intern Med 141:901
    5. Amitriptyline (Elavil)
    6. Pain management counseling and support groups
  5. Management: Assistive Devices
    1. Physical Therapy
      1. Unloader knee brace (valgus) for medial Knee DJD
      2. Knee sleeve
      3. Cane
      4. Walker
    2. Occupational Therapy home visit
      1. Bath benches
      2. Raised toilet seat
      3. Grab bars
      4. Object reachers
  6. Management: Surgery
    1. Arthroscopy
    2. Total Knee Replacement
  7. References
    1. (1997) Postgrad Med 102(5):167

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