osteoarthritis of the knee - university of michiganespring/resumes/mdalton/osteoarthritis of... ·...

Osteoarthritis of the KneeOsteoarthritis of the Knee

Michelle Dalton RN, BSNMichelle Dalton RN, BSN

University of MichiganUniversity of Michigan

0202--0505--0404

What is Arthritis?What is Arthritis?

�� Arthritis is one of the most common Arthritis is one of the most common

diseases in the United Statesdiseases in the United States

�� Arthritis is an illness that causes pain and Arthritis is an illness that causes pain and

swelling in your jointsswelling in your joints

�� There are many types of arthritis, but the There are many types of arthritis, but the

most common is osteoarthritis, also known most common is osteoarthritis, also known

as degenerative joint diseaseas degenerative joint disease

What is Osteoarthritis?What is Osteoarthritis?

�� Osteoarthritis (OA) primarily affects cartilage, Osteoarthritis (OA) primarily affects cartilage, which is the tissue that cushions the ends of the which is the tissue that cushions the ends of the bones within a joint. bones within a joint.

�� ‘‘OsteoOsteo’’ means bone and means bone and ‘‘arthritisarthritis’’ means joint means joint damage and swelling (inflammation).damage and swelling (inflammation).

�� OA occurs when cartilage begins to wear down OA occurs when cartilage begins to wear down between bones, and cause excess friction.between bones, and cause excess friction.

�� OA can affect any joint in the body, but is most OA can affect any joint in the body, but is most common in the hands, knees, hips, and spine.common in the hands, knees, hips, and spine.

Who has OA?Who has OA?

�� Osteoarthritis is the most Osteoarthritis is the most common form of arthritiscommon form of arthritis

�� Over 20 million people in Over 20 million people in the United States have the United States have OAOA

�� More than half of people More than half of people older than 65 have OAolder than 65 have OA

�� Before age 45, more men Before age 45, more men than women have OA, than women have OA, after age 45, more after age 45, more women have OAwomen have OA

Who has OA of the knee?Who has OA of the knee?

�� OA of the knee is twice as OA of the knee is twice as common in women than common in women than menmen

�� OA of the knee is more OA of the knee is more common in African common in African Americans than White Americans than White AmericansAmericans

�� OA of the knee is OA of the knee is common in overweight common in overweight people, especially people, especially women.women.

How does OA of the knee affect How does OA of the knee affect

people?people?

�� Symptoms (in one or Symptoms (in one or more joints)more joints)

�� PainPain

�� StiffnessStiffness

�� SwellingSwelling

�� TendernessTenderness

�� Financial burdensFinancial burdens

�� Cost of treatmentCost of treatment

�� Lost wages from Lost wages from disability

�� LifestyleLifestyle

�� DepressionDepression

�� AnxietyAnxiety

�� Feeling helplessFeeling helpless

�� Job limitationsJob limitations

�� Difficulty participating Difficulty participating in activities as well as in activities as well as responsibilitiesresponsibilities

disability

What causes OA of the knee?What causes OA of the knee?

�� Although scientists are unsure of all the Although scientists are unsure of all the causes of OA, there are several reasons causes of OA, there are several reasons they think it may occur.they think it may occur.

�� OA may run in familiesOA may run in families

�� OA of the knees may be caused by being OA of the knees may be caused by being overweightoverweight

�� OA of the knees can be caused by injuries or OA of the knees can be caused by injuries or overuse.overuse.


�� Normal Knee Joint consists of several Normal Knee Joint consists of several parts:parts:

�� BonesBones

�� Knee is where the thigh bone (femur) Knee is where the thigh bone (femur) and shin bone (tibia) meet. The knee and shin bone (tibia) meet. The knee cap (patella) is another important cap (patella) is another important bone of the knee.bone of the knee.

�� CartilageCartilage

�� A firm but slippery coating on the A firm but slippery coating on the end of each bone.end of each bone.

�� Synovium/synovialSynovium/synovial fluidfluid

�� A thin tissue inside the joint that A thin tissue inside the joint that contains a fluid which lubricates the contains a fluid which lubricates the joint and keeps the cartilage smooth.joint and keeps the cartilage smooth.

�� Ligaments, tendons & musclesLigaments, tendons & muscles

�� Tissues that hold the joint in place Tissues that hold the joint in place and keep it stable, allowing the knee and keep it stable, allowing the knee to bend and move.

Note. From “Total Knee Replacement” July, 2001. American

Academy of Orthopaedic Surgeons. p.1 Retrieved online on

January 31, 2004 from:

http://orthoinfo.aaos.org/booklet/thr_report.cfm?thread_id=9

&topcategory=knee

to bend and move.


�� Knee joint with OAKnee joint with OA�� Cartilage on the surface of the Cartilage on the surface of the

knee and/or underneath the knee and/or underneath the knee cap is worn down causing knee cap is worn down causing extra friction on the joint. extra friction on the joint.

�� When cartilage is worn down a When cartilage is worn down a lot, bone may rub against bone.lot, bone may rub against bone.

�� The bones of the upper and The bones of the upper and lower leg may respond by lower leg may respond by growing thicker and causing growing thicker and causing bone spurs.bone spurs.

�� SynoviumSynovium may swell, causing may swell, causing ““water on the kneewater on the knee””..

�� The muscles and ligaments of The muscles and ligaments of the knee become weak and thin, the knee become weak and thin, which can make the joint which can make the joint unstable.

Note. From “Total Knee Replacement” July, 2001.

American Academy of Orthopaedic Surgeons. p.2

Retrieved online on January 31, 2004 from:

http://orthoinfo.aaos.org/booklet/thr_report.cfm?thread

_id=9&topcategory=knee

unstable.

How is OA of the knee diagnosed?How is OA of the knee diagnosed?

�� Clinical HistoryClinical History

�� Your practitioner will ask you Your practitioner will ask you to describe your symptoms, to describe your symptoms, when they started, how it when they started, how it feels, and how itfeels, and how it’’s affecting s affecting you.you.

�� Physical ExamPhysical Exam

�� The practitioner will check The practitioner will check your general health, test your your general health, test your muscle strength and reflexes, muscle strength and reflexes, as well as touch and exam as well as touch and exam your knees, and observe your your knees, and observe your ability to walk and bend.ability to walk and bend.

How is OA of the knee diagnosed?How is OA of the knee diagnosed?

ContinuedContinued

�� X RaysX Rays

�� X Rays show how much joint X Rays show how much joint damage has been done, and damage has been done, and confirm the diagnosis. They can confirm the diagnosis. They can show the amount of cartilage show the amount of cartilage damage, bone damage and damage, bone damage and presence of bone spurs. presence of bone spurs. However, an X Ray does not test However, an X Ray does not test the amount of pain and function the amount of pain and function a client has.a client has.

�� Other testsOther tests

�� The practitioner may perform The practitioner may perform blood tests to rule out other blood tests to rule out other conditions, but there is no blood conditions, but there is no blood test for OA. The practitioner may test for OA. The practitioner may also perform a joint aspiration, also perform a joint aspiration, which involves drawing fluid from which involves drawing fluid from the joint and sending it for the joint and sending it for analysis.analysis.

Who treats OA of the knee?Who treats OA of the knee?

�� Primary care practitionersPrimary care practitioners

�� Rheumatologists (doctors Rheumatologists (doctors

who specialize in arthritis)who specialize in arthritis)

�� OrthopaedistsOrthopaedists (doctors (doctors

who specialize in bones who specialize in bones

and joints)and joints)

�� Physical TherapistsPhysical Therapists

�� Occupational TherapistsOccupational Therapists

�� DieticiansDieticians

�� NursesNurses

�� Rehabilitation physiciansRehabilitation physicians

�� Acupuncture therapistsAcupuncture therapists

�� Massage therapistsMassage therapists

�� PsychologistsPsychologists

�� Social WorkersSocial Workers

Is there a cure for OA of the knee?Is there a cure for OA of the knee?

�� There is no known cure for Osteoarthritis There is no known cure for Osteoarthritis

of the knee, except surgery to replace the of the knee, except surgery to replace the

joint.joint.

�� Focus of treatment is maintaining function Focus of treatment is maintaining function

and decreasing pain.and decreasing pain.

How is OA of the knee treated?How is OA of the knee treated?

�� ExerciseExercise

�� Weight ControlWeight Control

�� Rest and joint careRest and joint care

�� Pain relief techniquesPain relief techniques

�� MedicationsMedications

�� Alternative TherapiesAlternative Therapies

�� SurgerySurgery


ExerciseExercise

�� Research shows that exercise is one of the best ways to Research shows that exercise is one of the best ways to

treat osteoarthritis.treat osteoarthritis.

�� Exercise can also improve your mood, decrease pain, Exercise can also improve your mood, decrease pain,

increase flexibility, improve blood flow, maintain weight increase flexibility, improve blood flow, maintain weight

and promote overall physical fitness.and promote overall physical fitness.


Sample ExercisesSample Exercises

�� Get into the habit of Get into the habit of doing this exercise every doing this exercise every time you sit down.time you sit down.

�� Sit back with good Sit back with good posture. Straighten and posture. Straighten and raise leg, hold it for a raise leg, hold it for a slow count of ten, and slow count of ten, and slowly lower it. Repeat slowly lower it. Repeat this several time with this several time with both legs, at least 10 both legs, at least 10 times a day.times a day.

�� If this is done easily, add If this is done easily, add ankle weights.ankle weights.

Straight leg raise (sitting)

Note. From “Osteoarthritis of the knee”. 2003. Arthritis Research Campaign. P.6

Retrieved on January 31, 2004 from

http://www.arc.org.uk/about_arth/booklets/6027/6027.htm



�� Get into the habit of doing this exercise every morning and nighGet into the habit of doing this exercise every morning and night t while you lie in bed.while you lie in bed.

�� With one leg bent at the knee, hold the other leg straight and lWith one leg bent at the knee, hold the other leg straight and lift ift the foot slightly up from the bed. Hold for a slow count of fivthe foot slightly up from the bed. Hold for a slow count of five, then e, then slowly lower your leg.slowly lower your leg.

�� Repeat this with each leg five times every morning and evening.Repeat this with each leg five times every morning and evening.

Straight leg raise (lying)

Note. From “Osteoarthritis of the knee”. 2003. Arthritis Research Campaign. P.6 Retrieved on January 31, 2004

from http://www.arc.org.uk/about arth/booklets/6027/6027.htm



�� At least once a day, do this exercise while lying down.At least once a day, do this exercise while lying down.

�� Place a rolled towel under the ankle of the leg going to be Place a rolled towel under the ankle of the leg going to be exercised. Bend the other leg at the knee. In the leg you exercised. Bend the other leg at the knee. In the leg you are exercising, use your leg muscles to push the back of are exercising, use your leg muscles to push the back of the knee towards the bed. Hold for a slow count of five. the knee towards the bed. Hold for a slow count of five. Do not bounce leg or push down too firmly.Do not bounce leg or push down too firmly.

�� Repeat with each leg five times.Repeat with each leg five times.

Muscle Stretch

Note. From “Osteoarthritis of the knee”. 2003. Arthritis Research Campaign. P.7 Retrieved on January 31,

2004 from http://www.arc.org.uk/about arth/booklets/6027/6027.htm


Weight LossWeight Loss

�� Many people with OA of Many people with OA of the knee are overweight.the knee are overweight.

�� Studies have shown that Studies have shown that people who lose weight people who lose weight have less knee problems have less knee problems in the future, than those in the future, than those who do not.who do not.

�� There is no special diet There is no special diet for OA, but it is always for OA, but it is always good to eat a balanced good to eat a balanced diet with lots of fruits and diet with lots of fruits and vegetables, chicken and vegetables, chicken and fish and avoid high fish and avoid high calorie foods.calorie foods.


RestRest

�� It is important for you to recognize your bodyIt is important for you to recognize your body’’s s

limitations and need to stop or slow down.limitations and need to stop or slow down.

�� Scheduled rest is very important to reduce the strain on Scheduled rest is very important to reduce the strain on

your joints and prevent increased pain.your joints and prevent increased pain.

�� Splints or canes can be used to protect weak joints and Splints or canes can be used to protect weak joints and

keep pressure off of them.keep pressure off of them.


MedicationsMedications�� Your practitioner will help Your practitioner will help

you decide which you decide which medications are right for medications are right for you. Some commonly used you. Some commonly used medications are:medications are:

�� Acetaminophen (Tylenol)Acetaminophen (Tylenol)

�� Pain reliever, does not Pain reliever, does not reduce swellingreduce swelling

�� May affect liverMay affect liver

�� NSAIDsNSAIDs (e.g. Aspirin, Motrin, (e.g. Aspirin, Motrin, Advil, Advil, NaprosynNaprosyn, , KetoprofenKetoprofen))

�� Helps swelling and painHelps swelling and pain�� May irritate stomachMay irritate stomach


Medications, continuedMedications, continued

�� COXCOX--2 Inhibitors2 Inhibitors (e.g. (e.g. BextraBextra, , CelebrexCelebrex, , VioxxVioxx))

�� Newer versions of Newer versions of NSAIDsNSAIDs, also helps swelling and , also helps swelling and painpain

�� Fewer stomach side effectsFewer stomach side effects

�� OtherOther

�� Topical creams applied directly to skinTopical creams applied directly to skin

�� Narcotics, effective for pain, but should be used short Narcotics, effective for pain, but should be used short term due to addictive natureterm due to addictive nature

�� Corticosteroids are powerful Corticosteroids are powerful antiinflammatoriesantiinflammatories, can , can be injected several times a year into joint, but oral be injected several times a year into joint, but oral medications should not be used for OAmedications should not be used for OA

�� HyaluronicHyaluronic Acid is a normal part of the joint, used for Acid is a normal part of the joint, used for lubrication. May be injected into the joint.lubrication. May be injected into the joint.


Alternative TherapiesAlternative Therapies

�� There are many alternative therapies for OA, however, There are many alternative therapies for OA, however, many of them have not been proven through research many of them have not been proven through research and are expensive, therefore must be used carefully. and are expensive, therefore must be used carefully. Such therapies include:Such therapies include:

�� AcupunctureAcupuncture�� The use of acupuncture (placing needles in specific areas of theThe use of acupuncture (placing needles in specific areas of the

body) may be useful for some in reducing painbody) may be useful for some in reducing pain

�� Folk RemediesFolk Remedies�� Copper bracelets, herbal teas, mud baths, magnet therapy, Copper bracelets, herbal teas, mud baths, magnet therapy,

special foods, etcspecial foods, etc

�� Nutritional SupplementsNutritional Supplements�� GlucosamineGlucosamine and and chondroitinchondroitin sulfate are among two of the sulfate are among two of the

supplements which are currently being researched for relieving supplements which are currently being researched for relieving symptoms of OAsymptoms of OA


SurgerySurgery

�� Although most people with Osteoarthritis Although most people with Osteoarthritis

of the knee will not need surgery, it is a of the knee will not need surgery, it is a

possibility for those with severely possibility for those with severely

damaged joints who are unable to walk.damaged joints who are unable to walk.

�� Surgery may involve a Total or Partial Surgery may involve a Total or Partial

Knee Replacement, where the joint, or Knee Replacement, where the joint, or

damaged parts of the joint are replaced damaged parts of the joint are replaced

with smooth metal or plastic pieces.with smooth metal or plastic pieces.

Other ways to helpOther ways to help

Self CareSelf Care

�� Take charge of your life & health!Take charge of your life & health!

�� Keep using your knees!Keep using your knees!

�� Wear cushioned shoesWear cushioned shoes

�� Avoid keeping your knees bent in the same Avoid keeping your knees bent in the same position for a long timeposition for a long time

�� Take a warm showerTake a warm shower

�� Apply an ice or heat packApply an ice or heat pack

�� Keep a positive attitude! Focus on your abilities Keep a positive attitude! Focus on your abilities and strengths!and strengths!

MonitoringMonitoring

�� Remember to follow up with your medical Remember to follow up with your medical

professionals to monitor how you are doing, and professionals to monitor how you are doing, and

change treatment as needed.change treatment as needed.

GoalsGoals

�� Relieve/Reduce painRelieve/Reduce pain

�� Reduce stiffnessReduce stiffness

�� Prevent further Prevent further

damagedamage

ReferencesReferences�� American Academy of American Academy of OrthopaedicOrthopaedic Surgeons (2001, July). Surgeons (2001, July). Total knee replacementTotal knee replacement. .

Retrieved January 31, 2004 from Retrieved January 31, 2004 from http://orthoinfo.aaos.org/booklet/thr_report.cfm?thread_id=9&tophttp://orthoinfo.aaos.org/booklet/thr_report.cfm?thread_id=9&topcategory=kneecategory=knee

�� Arthritis Research Campaign (2003). Arthritis Research Campaign (2003). Osteoarthritis of the kneeOsteoarthritis of the knee. Retrieved January 31, . Retrieved January 31, 2004 from 2004 from http://www.arc.org.uk/about_arth/booklets/6027/6027.htmhttp://www.arc.org.uk/about_arth/booklets/6027/6027.htm

�� Gray, R.V. (1996). Family selfGray, R.V. (1996). Family self--care. In P.J. care. In P.J. BomarBomar (ed.) Nurses and family health (ed.) Nurses and family health

promotion; concepts, assessment, and interventions. (2nd ed.) (promotion; concepts, assessment, and interventions. (2nd ed.) (p.83p.83--93)93)

Philadelphia: W.B. Saunders Co.Philadelphia: W.B. Saunders Co.

�� Journal of American Medical Association (2003). Journal of American Medical Association (2003). JAMA patient page: Osteoarthritis of the JAMA patient page: Osteoarthritis of the kneeknee. Retrieved January 31, 2004 from . Retrieved January 31, 2004 from http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSZhttp://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSZS0SKCD&sub_S0SKCD&sub_cat=403 cat=403

�� National Institute on Aging (2002, January). National Institute on Aging (2002, January). Arthritis adviceArthritis advice. Retrieved January 31, 2004 . Retrieved January 31, 2004 from from http://www.niapublications.org/engagepages/arthritis.asphttp://www.niapublications.org/engagepages/arthritis.asp

�� National Institute of Arthritis and Musculoskeletal and Skin DisNational Institute of Arthritis and Musculoskeletal and Skin Diseases (2001, July). eases (2001, July). Do I Do I have arthritishave arthritis? Retrieved January 31, 2004 from ? Retrieved January 31, 2004 from http://www.niams.nih.gov.hi/topics/arthritis/tengo/english.htmhttp://www.niams.nih.gov.hi/topics/arthritis/tengo/english.htm

�� National Institute of Arthritis and Musculoskeletal and Skin DisNational Institute of Arthritis and Musculoskeletal and Skin Diseases (2002, July). eases (2002, July). Handout Handout on health: Osteoarthritison health: Osteoarthritis. Retrieved January 31, 2004 from . Retrieved January 31, 2004 from http://www.niams.nih.gov/hi/topics/arthritis/oahandout.htmhttp://www.niams.nih.gov/hi/topics/arthritis/oahandout.htm

http://orthoinfo.aaos.org/booklet/thr_report.cfm?thread_id=9&topcategory=knee

http://www.arc.org.uk/about_arth/booklets/6027/6027.htm

http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZSZS0SKCD&sub_

http://www.niapublications.org/engagepages/arthritis.asp

http://www.niams.nih.gov.hi/topics/arthritis/tengo/english.htm

http://www.niams.nih.gov/hi/topics/arthritis/oahandout.htm

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