Knee OA - # clinic Flashcards

1
Q

RF knee OA

A
  • Genetic
  • Increasing age
  • Female
  • Obesity
  • Low bone density
  • Previous joint injury
  • Occupational or recreational stresses on joint
  • Reduced surrounding muscle strength
  • Any joint laxity/misalignment
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2
Q

Pain in knee OA

A
  • Felt around knee
  • Can radiate to thigh and hip
  • Exacerbated by exercise, relieved by rest
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3
Q

Exam for OA

A
  • Bilateral often
  • Reduced function and ROM
  • Crepitus
  • Fixed flexion deformity
  • Joint line tenderness/bony swelling (osteophytes)
  • Quadriceps muscle wasting due to loss of use
  • Varus deformity
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4
Q

Views for x-ray knee

A
  • AP and lateral
  • Can have skyline view of patella to see involvement

LOSS

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5
Q

Classifiying severity of knee OA

A

Kellgren and Lawrence system

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6
Q

Kellgren and Lawrence system

A
  • 0 - no radiographic features of OA present
  • 1 - unclear joint space narrowing and possible osteophytic lipping
  • 2 - definite osteophytes, possible joint space narrowing on AP weight bearing views
  • 3 - multiple osteophytes, definite joint space narrowing, evidence of sclerosis, possible bony deformity
  • 4 - large osteophytes, marked joint space narrowing, severe sclerosis, bony deformity
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7
Q

Management OA knee - initial

A
  • Lifestyle - weight loss, exercise, smoking cessation
  • Analgesia to ensure mobility using WHO ladder
  • Physio - slow disease progression

If not work, surgical

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8
Q

Surgical management knee OA

A
  • Total knee replacement - most pts
  • Partial (unicondylar) knee replacement - 10%
  • Osteotomy - considered in younger patients, realigns joint and redistributes mechanical force
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9
Q

Total knee replacement

A
  • Advanced OA
  • Plastic and metal inserts replace bone and cartilage in all sections of knee
  • Function for at least 10yrs
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10
Q

Partial knee replacement

A
  • Disease localised to medial or lateral compartment
  • More conservative = faster recovery time
  • May need conversion to total knee replacement at later date
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11
Q

Where does patella rest?

A

In trochlear groove on femur

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12
Q

Patellofemoral OA

A
  • OA affecting articular cartilage along trochlear groove and on underside of patella
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13
Q

RF for patellofemoral OA

A
  • Patella dysplasia - patella not fitting properly into trochlear groove
  • Previous patella #
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14
Q

Presentation of patellofemoral OA

A
  • Anterior knee pain
  • Worse with activities that put pressure on patella eg climbing flight of stairs
  • Use skyline x-ray view to see
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15
Q

Management patellofemoral OA

A
  • Conservative - same as knee OA
  • If unsuccessful - patellofemoral replacement
  • BUT this cannot be carried out if there is OA affecting other parts of knee - would need total knee replacement if this was the case
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16
Q

Diagnosing knee OA

A

Can diagnose without investigations if:
* patient is > 45 years
* has exercise related pain
* no morning stiffness or morning stiffness lasting > 30 minutes

17
Q

Analgesia OA

A
  • Topical NSAIDs first line
  • Oral NSAIDs if these do not cover pain - consider PPI
  • Paracetamol not recommended in current NICE guidelines
18
Q

Injections for knee OA

A
  • Intraarticular corticosteroid - limit to 3-4 injections per year to minimise cartilage damage - SHORT TERM PAIN RELIEF
  • Intraarticular hyaluronic acid - evidence mixed, may help some
19
Q

Sequence to view joint x-rays

A

ABCS
* Alignment
* Bone texture
* Cortices
* Soft tissue

20
Q

OA vs RA x-rays

A

OA:
LOSS
Loss of joint space = assymetrical
DIPJs and 1st CMJ

RA:
LESS
Loss of joint space = symmetrical
MCPJs and PIPJs

21
Q

Knee replacement success rate`

A

80-85% of people are happy
This means 15-20% are not

22
Q

Complications from joint replacement surgery to discuss

A
  • DVT/PE
  • Bleeding
  • Pain
  • Prosthesis loosening
  • Stiffness
  • Altered leg length
  • Urinary retention
  • Post op delirium
  • Infection
  • Keloid scarring
  • Tendon/bone/nerve/BV damage
  • Amputation
  • Death
23
Q

Procedure of knee replacement

A
  • Less than 1hr actual op - bit longer with anaesthetic to do etc
  • Tourniquet around leg - limit bleeding
  • Incision in middle of front of knee
  • Open capsule
  • Cut distal femur and proximal tibia
  • New proesthetic joint in
24
Q

Recovery from knee replacement

A
  • In hopsital for 1-2 nights
  • Daily exercises needed for weeks
  • First 2-4 weeks are hard
  • 10 weeks off work average
  • Drive within 4-6 weeks
  • Takes 3-9 months to fully settle
25
Q

Permanent things from knee replacement

A
  • Numbness from scar laterally on knee - severe infrapatellar branch of saphenous nerve
  • Uncomfy to kneel on knee forever - although can
26
Q

How long does knee replacement usually last?

A

10yrs at least

27
Q

Pre-theatre investigations

A
  • All baseline things - check status for surgery eg FBC, U&E, LFT, CRP
  • Group and save (+crossmatch if expect blood loss)
  • Height, weight
  • Basic obs inc BP
  • ECG and echo
  • MRSA screening
  • Spirometry if known chronic lung disease
  • Urine dip - UTI?
28
Q

Chemo Thromboprophylaxis for knee surgery

A
  • Aspirin for 14 days OR
  • LMWH for 14 days + antiembolic stockings until discharge
  • Have LMWH 6-12hrs after surgery
29
Q

Antibiotic prophylaxis for elective joint replacements with prosthesis

A
  • Check local guidelines
  • Kettering is Cefuroxime as long as no previous history of C.diff
  • Have at induction then 8hrs after, then 16hrs after
  • Need to have antibiotic that has longer half life than operation usually otherwise need rpt doses
30
Q
A