The severity of radiographic knee OA only moderately correlates to symptoms like pain and stiffness. Up to 50% of those with radiographic changes are asymptomatic. However, advanced imaging confirms structural deterioration does relate to functional decline. Radiographs best identify macroscopic OA progression rather than symptomatic changes.
In summary, serial radiographs looking for joint space narrowing provide the standard diagnostic imaging for knee OA. Correlation with advanced imaging and clinical findings allows optimal assessment of disease status.
Joint stiffness and reduced range of motion frequently accompany OA. Contracture first develops in knee extension, followed by flexion loss in late-stage disease. Heberden’s nodes visible at the finger joints reflect an underlying generalized limitation in mobility. Morning gelling and difficulty initiating movement are common complaints. Range of motion declines approximate 1-3 degrees yearly as OA progresses.
In summary, the cardinal symptomatic features of knee OA include chronic pain, progressive functional impairment, episodic instability, and worsening stiffness or mobility loss. These symptoms often severely reduce quality of life and ability to remain active. Understanding the typical clinical presentation is key for appropriate management.
Avoiding high-impact activities helps prevent OA exacerbations. Pacing and scheduling rest periods makes tasks more tolerable. Assistive devices facilitate weightbearing activities like standing or walking. Activity modification aims to maintain current function rather than worsening symptoms.
In summary, a combination of nonsurgical treatments offers the best results for knee OA. Patient participation in the management plan is key. Surgery is reserved for severe, refractory cases or joint failure.
The longer duration of HA effect allows less frequent repeat injections, with typical spacing of 6 months. PRP requires more frequent repeating, often at intervals of 3-4 months, due to faster waning of benefits. Over 2-3 years, patients receive 30-50% fewer HA injections compared to PRP. This makes HA potentially more cost-effective long-term.
In summary, both HA and PRP offer comparable symptomatic relief in knee OA. PRP works faster, but HA provides more sustained benefit. The choice involves balancing onset versus duration when determining injection frequency. Further study on optimizing PRP preparations may prolong its effects.
Documented risks of knee bracing include skin irritation, added stresses to other joints, and muscle atrophy if overused. These issues can limit tolerance. Braces are also costly and often not covered by insurance plans. Careful patient selection and treatment goals are warranted.
In summary, compartment unloader braces can provide symptomatic relief for knee OA short-term, but long-term superiority over other conservative measures is unproven. Appropriate patient selection, education, and monitoring are necessary to maximize benefits while minimizing potential downsides of bracing.
A contralateral healthy knee or UKA allows better comparison and rehabilitation after UKA. Patients with prior contralateral TKA do worse with UKA on the opposite side and should match with TKA instead.7 Limb asymmetry after different procedures should be avoided.
In summary, UKA offers advantages for younger, active patients with isolated unicompartmental osteoarthritis and lower BMI. TKA remains preferable for older, less active patients with multipartite disease, high BMI, or prior knee replacements. Thorough assessment provides optimal implant selection.
Identifying family members or friends who can provide transportation to appointments, assistance at home, and emotional encouragement optimizes the support system. Preparing the post-discharge home environment also facilitates rehabilitation.
In summary, preoperative TKA preparation encompasses medical, physical, educational, and social dimensions. Addressing modifiable risks and enlisting social support improves patient outcomes during the surgical episode of care. Thorough preoperative optimization is invaluable.
The arthrotomy is closed, followed by deep dermal and skin closure. Local anesthetics are injected around the joint. Sterile dressings and compressive bandages are applied to complete the procedure.
In summary, precise bone cuts, soft tissue balancing, and methodical trialing allow accurate placement of TKA components in proper alignment for pain relief and restoration of function. Attention to each step optimizes clinical outcomes.
Robotic systems involve high capital, disposable, and service costs. The charges add thousands of dollars per case compared to traditional TKA methods. It is unclear if the clinical benefits of robotics justify the added expense for hospitals and payers.
In summary, robotic guidance improves component positioning in TKA but long-term superiority over conventional techniques remains unproven. Comparative functional outcomes, complications, revisions rates, and cost-effectiveness require further study to justify routine adoption of robotic platforms.
Continued adherence to hip and core strengthening, cardiovascular exercise, and neuromuscular training helps maintain outcomes from TKA over years. Weight management optimizes joint loading. Preventing other joint problems promotes lifelong activity. Periodic follow-up helps track function. Most patients see benefits for 15-20 years postoperatively.
In summary, rehabilitation progresses through phases focused on mobility, strength, conditioning, and skills training. Patient participation is key for optimizing outcomes after TKA surgery. Physical therapy facilitates lasting functional gains.
Careful cleansing and protection of open wounds, skin ulcers, or infections remote from the TKA prevent seeding deep infections. Small cuts should be monitored for signs of infection and treated promptly. Good hygiene is important.
In summary, maintaining wellness and immunity coupled with early infection detection optimizes prevention of late TKA infections. Patient education on precautions and prompt reporting of symptoms is key for successful long-term arthroplasty results.
Kinematic alignment has a high rate of intraoperative crossover to conventional alignment when ligament releases fail to adequately balance the knee. Patient-specific guides function as cutting blocks so do not have conversion issues, but alignment may still be suboptimal.
In summary, both new techniques aim for more anatomically aligned TKA. Kinematic principles show early promise to improve function but remain challenging. Patient-specific guides have not proven superior despite higher costs. Long-term implant survival data is needed.
Patients who actively participate in and adhere to postoperative rehabilitation have substantially higher functional gains from 6 weeks to 2 years after surgery. Compliance with exercise and mobility activity maximizes results.
In summary, patients with worse baseline function and fewer comorbidities tend to experience the greatest functional improvements from TKA. However, controlling expectations, avoiding complications, and commitment to rehabilitation play pivotal roles in optimizing individual outcomes.