1 Osteoarthritis of the Knee Michelle Dalton RN, BSN University of Michigan
2 What is Arthritis? Arthritis is one of the most common diseases in the United States Arthritis is an illness that causes pain and swelling in your joints There are many types of arthritis, but the most common is osteoarthritis, also known as degenerative joint disease
3 What is Osteoarthritis? Osteoarthritis (OA) primarily affects cartilage, which is the tissue that cushions the ends of the bones within a joint. Osteo means bone and arthritis means joint damage and swelling (inflammation). OA occurs when cartilage begins to wear down between bones, and cause excess friction. OA can affect any joint in the body, but is most common in the hands, knees, hips, and spine.
4 Who has OA? Osteoarthritis is the most common form of arthritis Over 20 million people in the United States have OA More than half of people older than 65 have OA Before age 45, more men than women have OA, after age 45, more women have OA
5 Who has OA of the knee? OA of the knee is twice as common in women than men OA of the knee is more common in African Americans than White Americans OA of the knee is common in overweight people, especially women.
6 How does OA of the knee affect people? Symptoms (in one or more joints) Pain Stiffness Swelling Tenderness Financial burdens Cost of treatment Lost wages from disability Lifestyle Depression Anxiety Feeling helpless Job limitations Difficulty participating in activities as well as responsibilities
7 What causes OA of the knee? Although scientists are unsure of all the causes of OA, there are several reasons they think it may occur. OA may run in families OA of the knees may be caused by being overweight OA of the knees can be caused by injuries or overuse.
8 What causes OA of the knee? Normal Knee Joint consists of several parts: Bones Knee is where the thigh bone (femur) and shin bone (tibia) meet. The knee cap (patella) is another important bone of the knee. Cartilage A firm but slippery coating on the end of each bone. Synovium/synovial fluid A thin tissue inside the joint that contains a fluid which lubricates the joint and keeps the cartilage smooth. Ligaments, tendons & muscles Tissues that hold the joint in place and keep it stable, allowing the knee to bend and move. Note. From Total Knee Replacement July, American Academy of Orthopaedic Surgeons. p.1 Retrieved online on January 31, 2004 from: &topcategory=knee
9 What causes OA of the knee? Knee joint with OA Cartilage on the surface of the knee and/or underneath the knee cap is worn down causing extra friction on the joint. When cartilage is worn down a lot, bone may rub against bone. The bones of the upper and lower leg may respond by growing thicker and causing bone spurs. Synovium may swell, causing water on the knee. The muscles and ligaments of the knee become weak and thin, which can make the joint unstable. Note. From Total Knee Replacement July, American Academy of Orthopaedic Surgeons. p.2 Retrieved online on January 31, 2004 from: _id=9&topcategory=knee
10 How is OA of the knee diagnosed? Clinical History Your practitioner will ask you to describe your symptoms, when they started, how it feels, and how it s s affecting you. Physical Exam The practitioner will check your general health, test your muscle strength and reflexes, as well as touch and exam your knees, and observe your ability to walk and bend.
11 How is OA of the knee diagnosed? Continued X Rays X Rays show how much joint damage has been done, and confirm the diagnosis. They can show the amount of cartilage damage, bone damage and presence of bone spurs. However, an X Ray does not test the amount of pain and function a client has. Other tests The practitioner may perform blood tests to rule out other conditions, but there is no blood test for OA. The practitioner may also perform a joint aspiration, which involves drawing fluid from the joint and sending it for analysis.
12 Who treats OA of the knee? Primary care practitioners Rheumatologists (doctors who specialize in arthritis) Orthopaedists (doctors who specialize in bones and joints) Physical Therapists Occupational Therapists Dieticians Nurses Rehabilitation physicians Acupuncture therapists Massage therapists Psychologists Social Workers
13 Is there a cure for OA of the knee? There is no known cure for Osteoarthritis of the knee, except surgery to replace the joint. Focus of treatment is maintaining function and decreasing pain.
14 How is OA of the knee treated? Exercise Weight Control Rest and joint care Pain relief techniques Medications Alternative Therapies Surgery
15 How is OA of the knee treated? Exercise Research shows that exercise is one of the best ways to treat osteoarthritis. Exercise can also improve your mood, decrease pain, increase flexibility, improve blood flow, maintain weight and promote overall physical fitness.
16 How is OA of the knee treated? Sample Exercises Straight leg raise (sitting) Get into the habit of doing this exercise every time you sit down. Sit back with good posture. Straighten and raise leg, hold it for a slow count of ten, and slowly lower it. Repeat this several time with both legs, at least 10 times a day. If this is done easily, add ankle weights. Note. From Osteoarthritis of the knee Arthritis Research Campaign. P.6 Retrieved on January 31, 2004 from
17 How is OA of the knee treated? Sample Exercises Get into the habit of doing this exercise every morning and night while you lie in bed. With one leg bent at the knee, hold the other leg straight and lift l the foot slightly up from the bed. Hold for a slow count of five, then slowly lower your leg. Repeat this with each leg five times every morning and evening. Straight leg raise (lying) Note. From Osteoarthritis of the knee Arthritis Research Campaign. P.6 Retrieved on January 31, 2004
18 How is OA of the knee treated? Sample Exercises At least once a day, do this exercise while lying down. Place a rolled towel under the ankle of the leg going to be exercised. Bend the other leg at the knee. In the leg you are exercising, use your leg muscles to push the back of the knee towards the bed. Hold for a slow count of five. Do not bounce leg or push down too firmly. Repeat with each leg five times. Muscle Stretch Note. From Osteoarthritis of the knee Arthritis Research Campaign. P.7 Retrieved on January 31,
19 How is OA of the knee treated? Many people with OA of the knee are overweight. Studies have shown that people who lose weight have less knee problems in the future, than those who do not. There is no special diet for OA, but it is always good to eat a balanced diet with lots of fruits and vegetables, chicken and fish and avoid high calorie foods. Weight Loss
20 How is OA of the knee treated? Rest It is important for you to recognize your body s limitations and need to stop or slow down. Scheduled rest is very important to reduce the strain on your joints and prevent increased pain. Splints or canes can be used to protect weak joints and keep pressure off of them.
21 How is OA of the knee treated? Medications Your practitioner will help you decide which medications are right for you. Some commonly used medications are: Acetaminophen (Tylenol) Pain reliever, does not reduce swelling May affect liver NSAIDs (e.g. Aspirin, Motrin, Advil, Naprosyn, Ketoprofen) Helps swelling and pain May irritate stomach
22 How is OA of the knee treated? Medications, continued COX-2 2 Inhibitors (e.g. Bextra, Celebrex, Vioxx) Newer versions of NSAIDs,, also helps swelling and pain Fewer stomach side effects Other Topical creams applied directly to skin Narcotics, effective for pain, but should be used short term due to addictive nature Corticosteroids are powerful antiinflammatories,, can be injected several times a year into joint, but oral medications should not be used for OA Hyaluronic Acid is a normal part of the joint, used for lubrication. May be injected into the joint.
23 How is OA of the knee treated? Alternative Therapies There are many alternative therapies for OA, however, many of them have not been proven through research and are expensive, therefore must be used carefully. Such therapies include: Acupuncture The use of acupuncture (placing needles in specific areas of the body) may be useful for some in reducing pain Folk Remedies Copper bracelets, herbal teas, mud baths, magnet therapy, special foods, etc Nutritional Supplements Glucosamine and chondroitin sulfate are among two of the supplements which are currently being researched for relieving symptoms of OA
24 How is OA of the knee treated? Surgery Although most people with Osteoarthritis of the knee will not need surgery, it is a possibility for those with severely damaged joints who are unable to walk. Surgery may involve a Total or Partial Knee Replacement, where the joint, or damaged parts of the joint are replaced with smooth metal or plastic pieces.
25 Other ways to help Self Care Take charge of your life & health! Keep using your knees! Wear cushioned shoes Avoid keeping your knees bent in the same position for a long time Take a warm shower Apply an ice or heat pack Keep a positive attitude! Focus on your abilities and strengths!
26 Monitoring Remember to follow up with your medical professionals to monitor how you are doing, and change treatment as needed.
27 Goals Relieve/Reduce pain Reduce stiffness Prevent further damage
28 References American Academy of Orthopaedic Surgeons (2001, July). Total knee replacement. Retrieved January 31, 2004 from category=knee Arthritis Research Campaign (2003). Osteoarthritis of the knee.. Retrieved January 31, 2004 from Gray, R.V. (1996). Family self-care. In P.J. Bomar (ed.) Nurses and family health promotion; concepts, assessment, and interventions. (2nd ed.) (p.83( p.83-93) Philadelphia: W.B. Saunders Co. Journal of American Medical Association (2003). JAMA patient page: Osteoarthritis of the knee.. Retrieved January 31, 2004 from S0SKCD&sub_ cat=403 National Institute on Aging (2002, January). Arthritis advice.. Retrieved January 31, 2004 from National Institute of Arthritis and Musculoskeletal and Skin Diseases (2001, July). Do I have arthritis?? Retrieved January 31, 2004 from National Institute of Arthritis and Musculoskeletal and Skin Diseases (2002, July). Handout on health: Osteoarthritis.. Retrieved January 31, 2004 from