Osteoarthritis

Knee osteoarthritis (OA), often referred to as degenerative joint disease, can be brought on by wear and tear and a gradual degeneration of articular cartilage.

Knee discomfort that gradually develops and gets worse with activity, knee stiffness and swelling, pain after extended periods of sitting or resting, and crepitus, or a cracking sound with joint movement, are some common clinical symptoms.

Etiology

Depending on the underlying cause, OA's etiology can be characterized as either primary or secondary.

1. Articular cartilage degradation without a known cause is the cause of primary knee OA. Typically, this is seen as deterioration brought on by aging and general wear and tear.
2. Secondary knee OA results from known causes of articular cartilage degeneration.

Reasons for Secondary Knee OA:

Obesity, joint hypermobility or instability, joint misposition (such as valgus or varus posture), prior joint injury (such as a fracture along the articular surface, or tibial plateau fracture), congenital defects, immobility and loss of mobility, family history, and metabolic causes (such as rickets) are just a few of the risk factors.

Signs of knee OA include:

Moving causes pain

Stiffness, particularly in the morning

Restriction of movement

Chronic pain from sitting or laying

Palpable joint line pain

Increase in joint size

 Pathological Process

Normal chemical processes in articular cartilage keep it in a stable state of balance; however, as OA progresses, the reactions get interrupted, changing the cartilage's collagen.

1. Disruption of the balance, which leads to an unorganized collagen pattern and a reduction in the flexibility of the articular cartilage.
2. This causes the cartilage to crack and breakage, which causes the articular surface to erode.
3. Damaged cartilage is incapable of healing.
4. The cartilage will keep deteriorating.
5. Bony surfaces will begin to be damaged once the cartilage has worn down.
6. The bone will enlarge and grow spurs (osteophytes).

Diagnosis

There are five grades of knee OA:

• Grade 0 refers to "normal" knee health.
• Grade 1 refers to very minimal bone spur growth that is not painful or uncomfortable.
• Grade 2: This is the point at which people will start to feel symptoms. After a long day of walking, they will have pain and more joint stiffness. Even though the illness is still in a minor stage, X-rays will already show higher bone spur growth. The cartilage is expected to maintain its normal size.
• OA in grade 3 is moderate. Joint stiffness will also be more prevalent, especially after prolonged periods of sitting and in the morning. Frequent discomfort during movement. The gap between the bones is getting smaller and the cartilage between them clearly displays deterioration

Treatment/Management

Conservative and surgical therapy options are available for treating knee OA.

Conservative Approach

Exercise therapy in physiotherapy is the main conservative treatment for OA knee. Physiotherapy typically includes the following: Patient education; exercise treatment; activity moderation; weight loss advice; and knee bracing.

Patient education and physical therapy are the first-line treatments for all individuals with symptomatic knee osteoarthritis. The best outcomes have been demonstrated to be achieved when supervised exercises are combined with a home exercise regimen. If the exercises are abandoned, these advantages disappear after six months.

• Losing weight is beneficial at all stages of knee OA. It is recommended for people with symptomatic OA and a BMI of at least 25. Dietary control and low-impact aerobic activity are the best recommendations for weight loss.

In OA, knee bracing is one option. bracing that offload the load, taking it off the affected knee compartment. In cases of valgus or varus deformity, this may be helpful.

Physiotherapy Management

All patients with an OA diagnosis should begin physiotherapy.

Pain is a typical symptom that manifests in varying degrees depending on the individual and is not always correlated with the severity of OA development.

Exercise has been shown to increase physical functioning in the short term and be an effective pain treatment strategy. Initially, exercises must be conducted under the guidance of a physiotherapist; but, with the right instruction, these exercises can be carried out at home. Research has shown that group exercise combined with home exercise is more beneficial.

Role of Physiotherapy

Education

• Understanding osteoarthritis (OA) and its causes
• Describing pain
• Describing long-term management of OA
• Educating about activity modification
• Stressing the need of weight loss
• Promoting an active, healthy lifestyle.

 Exercise

Normalizes the range of motion in the knee joint and reduces knee pain and inflammation.

• Stabilizes the lower kinetic chain

Cardiovascular disease risk is decreased.

• Enhances balance, agility, and proprioception.
• Enhances physical performance.