Osteo Arthritis (Knee)

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Osteo arthritis is one of the common loco motor problems. It is widely accepted as a degenerative disease. About 75% of people above the age of 65 years show the radiological changes of osteo-arthritis but only about 25% of them suffer from symptoms. Female – male ratio is 2:1.


Etiology 


Exact etiology is yet unknown. Genetic factors play role in onset and progress of the disease. Ageing adds to the further progress of osteo-arthritis. Degenerative changes are seen. Obesity or excessive friction in a joint due to developmental abnormalities may cause of osteo-arthritis e.g.. hips in miners, wicket keepers hand, ticket collector’s thumbs etc., Secondary osteo-arthritis may be due to


- Congenital & developmental eg. Femoral neck abnormality, perthe’s disease.


- Traumatic – eg. Intra-articular fracture.


- Inflammatory – eg. Rheumatoid arthritis.


- Metabolic – eg. Gout.


- Neuropathic eg. Diabetes mellitus.


- Endocrine eg. Hypothyroidism.


Pathology


Articular cartilage loses the integrity and large fissures and cracks may appear. They cause roughening of the articular surface. Friction of the articular surfaces cause increasing restriction of movements, gradual reduction of thickness of cartilage may expose the sub chondral bone beneath it. There is sclerosis and re modelling of subchondral bones. Osteophytes may appear at joint margins and limit the joint movement. Dislodged osteophyte may float in the synovial fluid as loose bodies (joint mouse). They may cause locking of joint. Synovium may show patchy inflammatory reaction. There is destruction of anatomy of the joint, impairing the functions.


Osteo-arthritis knee joint


This is the commenest disorder in the aged person. About 30% of the patients that come to our acupuncture clinic suffer from O.A.Knee symptoms develop around the age of 40-45 years. 

Knee being weight bearing joint, obese people are definite suffers. Patient gets pain which aggravates on walking or long standing. It is also interesting finding that if a patient starts walking after rest, he gets more pain during first few steps but the joint movement is more easy and pain lessens a bit in further steps. 


Movements of knee may be restricted and painful crepitus may be restricted and painful crepitus may heard or felt with movements of the joint.


O.A. of petello – femoral joint typically causes pain in flexion and on walking down stairs. Side to side movement of patella is painful and patella compression test may cause pain. 

O.A. of tibia-femoral joint, which is more common, causes pain in standing and walking and there may be tenderness on the sides of the joint. This is increased by obesity. Quadriceps wasting may occur.


Lax ligaments may cause valgus or varus deformity. Some patients develop a synovial cyst in the popliteal fossa called as Banker’s cyst. Joint may get swollen due to diffusion.


Rare complication is rupture of the capsule enabling extra vasation of synovial fluid in the calf causing red, tender and warm swelling of the calf which may be mistaken for deep venous thrombosis. In advanced causes of O.A.knee the main day to day distress may be inability to squat at toilet or sit on floor for ‘pooja’.

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