Osteoarthritis

 Definition:-

Osteoarthritis is a degenerative, joint disease characterized by destruction of articular

cartilage of synovial joints and formation of new bone at the joint surface and margins.

• There are two types of OA….

1. Primary OA
2. Secondary OA
 1. Primary OA

• More common than secondary OA

• Exact cause is not known.
• Common in elders where there is no previous pathology.
• Its mainly due to wear and tear changes occurring in old
ages mainly in weight bearing joints.
• It commonly affects the knee joint.
• Eighty percent of people are affected by 40 years, but only
40 percent show symptoms.
• It causes varus deformity of the knee in the late stages.
 Causes:-

• Age more than 40 years.

• Female
• Hereditary conditions.
• Previous joint iniuries.
• Obesity
• Diseases of the joints.
•Poor posture.

• Occupational stress and strain.
 2. Secondary OA

•Secondary OA is more common in younger age groups.

•More severe than the primary.
 Predisposing causes such as:
•Obesity, valgus and varus deformities of the knee.
• Intra-articular fractures of the knee, etc.
•Rheumatoid arthritis, infection, trauma ,TB , Hyperparathyroidism.
•Hemophilia.
•Syringomyelia.
•Neurological disease like diabetes.
•Overuse of intra-articular steroid therapy.
 Complication:-

• joint deformities
• subluxation
• ankylosis
• intra-articular loose bodies
Stages of OA
 Management

• OA is a condition which progresses slowly over a period of many years and cannot
be cured.
• Treatment is directed at decreasing the symptoms of the condition, and slowing the
progress of the condition.

 prevention of OA
Regular exercise
Weight control

Prevention of trauma
 Physical therapy
Plan of care:
1) Pain management
2) Decreases the effect of stiffness

3) Decrease pain from the mechanical stress and prevent deforming forces
4) Increase ROM
5) Improve neuromuscular control, strength and muscle endurance
6) Improve balance

7) To retrain gait
8) Improve physical conditioning.

9) To maintain or improvement in functional independence, including participation in a

vocational activities.
⮚ Pain management

In early stages:
• Appropriate rest
• Find a balance between activity and rest and to correct biomechanical stress in order
to prevent, retard, or correct the mechanical limitations.
• Thermotherapy – local heat or cold as an adjunct therapy

In later stages:
• TENS

• IFT
• SWD
Decrease effects of stiffness
Active ROM
Joint-play mobilization techniques

Decrease pain from mechanical stress and prevent deforming forces

Bracing and assistive equipment to minimize stress or to correct faulty biomechanics.
Strengthen supporting muscles
Increase ROM
Stretch muscle or soft tissue restrictions with specific techniques.
Stretching of hip flexors, hamstrings and calf.
Improve neuromuscular control, strength and muscle endurance
Low-intensity resistance exercise
Multiple angle isometric in pain free positions
Increase repetition for endurance
Use of a pool to decrease weight bearing stresses
Improve balance
Balance training activities
Tai chi
Improve physical conditioning
Nonimpact or low-impact aerobic exercise such as walking, cycling and
swimming.
 Aids and appliances

• Braces/ splints
• Special shoes/insoles- lateral wedges

• Mobility aids- use of cane, sticks or other walking aids.

• Taping of patella in patella femoral OA
• Aids: dressing, reaching, tap openers, kitchen aids, raised toilet seat.
Deformity
Genu Valgum

• Genu valgum , commonly called "knock-

knee", is a condition in which the knees
angle in and touch each other when the
legs are straightened.

• Individuals with severe valgus

deformities are typically unable to touch
their feet together while simultaneously
straightening the legs.
Genu Varum

• A condition in which the knees stay

apart even when standing with feet
and ankles together, also known as
bowlegs.

• Maximum varus is present at 6-12

month of the age.
Coxa Vara

• Coxa vara is a deformity of the hip,

whereby the angle between the head
and the shaft of the femur is reduced
to less than 120 degrees.

• This results in the leg being shortened

and the development of a limp.

• It may be congenital and is commonly

caused by injury, such as a fracture.
Coxa Valga

• Femoral head sticks out from the shaft

of the femur at an angle of 120–130
degrees.

• If the angle is greater than 130

degrees, the condition is called coxa
valga, or a valgus hip.
TOTAL KNEE REPLACEMENT
 TOTAL KNEE REPLACEMENT
This is a relatively newer operation. In true sense, the term total knee replacement is a
misnomer, since unlike the hip replacement where a part of the head and neck are
actually removed and replaced with similar shaped artificial components, in the knee
only the damaged articular surface is sliced off to prepare the bone ends to take the
artificial components which 'cap' the ends of the bones. In a way, this could be more
appropriately called a knee resurfacing operation.
 Indications:
Like in the hip, painful disabling arthritis is the main indication of doing a total
knee arthroplasty.
It is contraindicated if there is a focus of sepsis, extensor mechanism is
insufficient or if the joint is neuropathic.
Relative contraindications are: a younger patient (less than 50 years), obesity and
those in physically demanding profession where results may not be as good.
 The Implant and the Procedure: The artificial knee joint consists of the
following parts.
a) U-shaped femoral component to 'cap' the prepared lower end of the femur.
b) A tibial base plate to cover the cut flat surface of the upper end of the tibia. Either
both cruciates or only anterior cruciate is excised.
c) A plastic tray inserted between the above two metallic components.
d) A patellar button made of polyethylene to replace the damaged surface of the
patella. The procedure consists of a series of steps based on specially designed jigs.
These jigs are used in a step by step manner. The whole idea is to prepare the ends
of tibia and femur to take the artificial components.
The important goal of the procedure is to achieve optimal alignment of the leg
and soft tissue balance between ligaments around the knee. This provides crucial
stability to the artificial joint. The most recent advance in knee replacement
surgery is use of computer navigation during surgery. This ensures accuracy It is
fair to expect 10-15 years of excellent functions after a properly executed total
knee replacement. The success of this operation depends upon proper selection
of the patient, technically perfect execution of the procedure and sincere
rehabilitation effort.
Parts of an artificial knee joint.
 Complication
• Infection
• Deep vein thrombosis
• Nerve palsy
• Fracture
• Extensor mechanism complications
• Knee stiffness
 PARTIAL KNEE REPLACEMENT
( Unicondylar Replacement )
This is a newer operation, done for a knee where only a part is damaged (partial
damage). Here the knee is opened using a small incision, a cap is put on top of
the damaged part without removing any ligaments, muscles, etc. In selected
cases, this works as well as the more invasive total knee replacement . It is
indicated in strictly partially damaged knee.
(TKR ) Management :
Preoperative measures
Evaluation - To evaluate a patient for TKR, the following points are noted: Pain,
deformity, ROM, gait analysis, muscle strength, status of the other joints, etc.
Education - The patient is taught the postoperative . physiotherapy regimen on the
normal side, isometrics and other exercises are indicated for the affected and normal
joints, reassurance, measures to counter DVT, edema, etc.
Postoperative measures
During the first 7 days
• Chest physiotherapy to prevent lung problems.
• The limb is kept elevated and positioned properly with a pillow beneath the heel
preventing rotation.
• Rotation is avoided at all costs
Isometrics to the quadriceps: - To begin with, it should be gentle and rhythmic.
- Sustained and slow contractions with reinforcement
by dorsiflexion of the ankle.
- Progress this to speedy exercises.
• Isometrics of the glutei, hamstrings are also begun.
• SLR with support with isometric contraction of the quadriceps and ankle
dorsiflexion is begun.
• By 4th or 5th day, patient is allowed to stand and ambulate with walker.
• Self-assisted slow passive flexion of the knee or CPM with one cycle/minute is
begun.
• The range of knee flexion should be less than 40" during the first 3 days.
• Active or active assist knee flexion can be commenced.
• Between 7-14 days
• Isometrics are made move intensive.
• Active, active assist and passive ROM exercises for knee flexion are also made
more vigorous. Knee flexion should be 90°
• SLR is also made intense.
• Partial weight bearing and ambulation is begun on crutches.

• After 3 weeks
• Knee flexion should now reach 110-120“
• Exercises over pedocycle or stationary bicycle are started.

• Partial weight-bearing with a crutch is progressed to full weight-bearing.

• Stair case walking is begun. Quadriceps drills are also begun.
• Hydrotherapy is beneficial.
After 45 days
• Patient should be encouraged to walk with a cane.
• Patient is taught to balance his weight evenly on both the knees.
• By 12 weeks, the cane should be discarded and the patient should be able to
resume all the normal activities.