Knee Osteoarthritis Part 1 Anatomy
Today we're going to discuss osteoarthritis of the knee. We're going to answer your questions about knee osteoarthritis, such as what parts ofyour knee are involved. What happens to your kneeas osteoarthritis developsé What does your knee pain feel likeé When do you have pain,
and how does it limityou throughout the dayé How do we diagnose your osteoarthritisé What tests are important in evaluating your knee painé What are the nonsurgicaltreatment options for controlling your knee painé What are the surgical treatment options for alleviating yourosteoarthritic symptomsé
Why is physical therapy soimportant after surgeryé And finally, how to prevent and protect against continued knee painé Let's talk about the normal anatomy or the normal parts list. This is the front view of the knee. We have first the thigh bone, called the femur.
And this sits on top of the leg bone, called the tibia. On top of this leg bone there are two shock absorbers that are called the meniscus. I'm just drawing them in three dimension. The ends of the thigh bone, let's look at this end,
have on them a nice, smooth surface that's almost Teflonlike, nice and smooth and hard. This is the gristle onthe end of the thigh bone. And then the meniscus or gasket is horseshoe shaped. It's thick in the back, and it's thick in the front.
This is the shock absorber called the meniscus. This is the normal parts list. Let's talk a little bit about the abnormal parts list when we have osteoarthritis. Once again, here's theend of the thigh bone. And here's the top of the leg bone
Osteoarthritis of the knee Mr Robert Marston London Knee Specialists on knee osteoarthritis
This is a model of the knee. If we just remove the kneecap here, you willsee that there is a smooth white surface that covers the end of the thigh bone, the top of the shinbone and the back the kneecap. That's the bearing surface of the knee. It's very similar to the surface yousee on the end of a chicken bone. That that is the surface that becomesthinned when patients develop osteoarthritis.Arthritis can be very mild with a very small degree of scuffing of the cartilage
to areas of fullthickness cartilageloss such that there is exposed bone underneath. When one gets an area of exposed bone, say, on the femur and on the top the tibia here, that's extremely painful.In the earliest stage of osteoarthritis, we suggest that patients avoid running or jumping. Those exercises shockload the worn joint and worsenthe symptoms. Physiotherapy is occasionally a helpful
adjunct to normal walking. Walking is excellent activity since every step you take you're using the muscles around the kneein the way that they have evolved to be used.As the pain increases, many patients benefitfrom an injection. The most common injections used aresteroid and local anaesthetic injections. If these last for between 46 months, it is quite reasonable to repeat them untilsuch time as they no longer give benefit. There is a newer type of
injection available: these are calledvisco supplementation the are an injection of a rather oilyviscous material which acts both as a physical lubricantto the worn joint but being a protein supplement, they arealso thought to nourish the remaining worn cartilage. When a patient's pain and disability progressto a stage that, despite taking antiinflammatoriesor standard painkillers, their life is restricted. At that stage
it is necessary to think of undergoing ajoint replacement.