OSTEOARTHRITIS-KNEES

SUMMARY

1. Pain is usually worse with prolonged weight bearing & characterized as a deep ache superior to the patella or deep inside the knee.

2. Pain described as medial and inferior to the joint is more likely to be from pes anserine bursitis.

3. Suspect knee OA in: age > 50yrs, obesity, morning stiffness > 30 min, bony enlargements, halux varus/valgus, crepitus, non-inflammatory synovial aspirate, osteophytes on x-rays.

4. Treat knee OA with education (weight loss, exercise, and shoe insoles) and analgesics for pain relief.

5. Intra-articular glucocorticoids are useful in patients unable to tolerate NSAIDs/acetaminophen, and/or have only 1 or 2 painful joints. Limit intra-articular steroid injections to no more than 3-4 a year.

6. If the patient does not respond to the above therapies, knee replacement is indicated.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].