Osteoarthritis joint, usually causing pain and stiffness. Osteoarthritis

Osteoarthritis (OA) is an asymmetric rheumatic disease whichaffects the functional ability of a joint, usually causing pain and stiffness. Osteoarthritisis caused by progressive loss of hyaline cartilage, alteration of subchondralbone, synovial inflammation and local biomechanics (injuries, malalignment,limb length discrepancy, and joint overload). A normal knee joint is a very complex synovial joint whichprovides stability for load-bearing activities and allows frictionlessarticulation to occur. Synovial fluid is found at the centre cavity of thejoint acting as a lubricant and supplying oxygen and nutrients to thecartilage. Articular hyaline cartilage lines the end of each bone in the jointand at the lower levels of cartilage, away from the joint cavity, thiscartilage becomes calcified at a point known as the ‘tidemark’. This area fromthe ‘tidemark’ point to the bone marrow is known as the subchondral bone,comprised of a subchondral plate, an important structure for load transmission.Between the medial and lateral tibiofemoral joint surfaces lies crescent shapedtissues, known as menisci, which aid in the distribution of load,proprioception and stability at the knee joint as well as support lubricationof the joint. In an osteoarthritic knee joint there is degradation of thehyaline cartilage due to a breakdown of the collagen network, which results inthe formation of fibrillated areas and clefts on the cartilage surface.

Asprogression of the disease occurs, the sporadic loss of hyaline cartilage canexpose the underlying subchondral bone, causing eburnation. As loss ofcartilage continues to progress further, damage will transpire on thesubchondral bone, resulting in the formation of osteophytes and sclerosis. Cartilagefragments can sometimes be found in the synovial fluid and it is also commonfor meniscus damage or tears to ensue in OA patients.  Biomechanics of the knee joint are also importantto consider when examining the pathology of joint function, in particular jointalignment, ligamentous strength, and interaction of the peri-articular muscles.(Conaghan et al 2012) Malalignment of the knee results in an increase in loadthrough the medial aspect of the joint, therefore, influencing the structuraldegradation at the joint. Valgus or varus knees cause friction and againincrease the load on the joint, most noticeably during gait; in varus knees theground force reaction increases knee adduction, thus, resulting in medialcompartment compression forces, a cause of medical compartment OA.Biomechanical changes in the knee joint may also be a source of kneeinstability, decreased range of movement and strength and potential narrowingof the medical joint space. (Conaghan et al, 2012) Osteoarthritis is the most commonsynovial joint disorder in the Western world, with 8.

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5million affected in theU.K. and an estimated 27million patients in the U.

S.A. (Conaghan et al, 2015;Oral, A & Ilieva, E, 2011; Hart, J.

, 2008) It is a disorder of joint painand stiffness associated with locomotor disability, causing great impact on theindividuals quality of life (QoL). The knee joint is the most commonly affectedjoint, with 4 million new patient visits annually in the U.S.

(Lu et al, 2015; Harzyet al, 2009) According to the Centers for Disease Control and Prevention data,approximately 40% of individuals with OA of the knee noted “poor” or “fair”health in relation to the impact OA has on their QoL. OA is noted tobe more prevalent in females than males. (Conaghan et al, 2012) The prevalenceof OA increases due to age, with Reid et al noting 70% of individuals over65-year olds affected by knee OA. Due to the increasing age in the population,there is a corelating rise in the number of OA patients and thus, acorresponding stress put on the healthcare systems to provide treatmentservices. (Conaghan et al, 2012; Ng, Heesch & Brown, 2012) A 2004National report in the U.K.

found 2million individuals visit their GP annuallydue to OA, generating 3 million consultations. Similarly, there is a surgicalimpact due to OA treatment, with 44,000 hip replacements and 35,000 kneereplacements in the U.K.

the year 2000 costing the healthcare £405million.(Peat, McCarney & Croft, 2001) Some further indirect costs due to OAinclude community services, social services and the impact of lost workingdays.Themost prevalent symptom of OA is joint pain (Sinusas, K, 2012) The pathogenesisof OA consists of a ‘locking’ or joint instability and pain, morning stiffness(lasting no longer than 30 minutes), increased pain on exercises creatinglimits on individuals’ activities of daily living (ADLs), reduced QoL,crepitus, valgus or varus deformity and resulting gait changes. (Mayiero et al2017; Sinusas, K, 2012) Some of the risk factors for OA include age,overweight/obesity, family history of condition, prior joint injury or overuseand other medical conditions such as rheumatoid arthritis. (Hart, J 2008 ) Previousstudies have suggested there is a strong link between obesity and OA, with Masieroet al stating an estimated “29% of cases of knee OA may be prevented byreducing body mass index (BMI) from 30 to 25”. (Coggon et al, 2001; Gelber etal, 1999) Both OA and obesity have similar impact on an individuals’participation levels in physical activity, resulting in a further loss ofmuscle strength and increase in fat mass, creating a continuous cycle andreducing a patients QoL.

(Wildman et al, 2008; Abbate et al, 2006)The main goal of OA managementsis decreasing pain/stiffness, improving joint mobility and flexibility,limiting joint damage by slowing down the progression of disease, increasing musclestrength, decreasing functional activity limitations and therefore resulting ina greater quality of life. (Ng, Heesch & Brown, 2011; Hart, 2008) Therehave been several guidelines produced based on evidence for variousinterventions, such as OARSI and XXXXXX. These guideline protocols have dividedtreatment into 4 sub categories; surgical, non-pharmacological, pharmacologicaland finally complementary and alternative medicine (CAM) treatment. (Oral etal, 2011) The initial treatment for osteoarthritis aims to focus on self-helpand patient driven treatments rather than interventions delivered passively bya therapist or another health professional. Examples of non-pharmacologicaltreatment of knee OA, include patient education, self-management, weight lossinterventions, exercise programmes, manual therapy, braces and orthotics,hydrotherapy and balneotherapy.

(Oral et al, 2011)Weight loss intervention –Research conducted on gait analysis demonstrated weight loss can decrease loadin the knee joint resulting in a decrease in clinical symptoms and OAprogression. (Messier et al, 2005; Aaboe et al, 2011)


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