Hip and Knee Osteoarthritis Guideline for Nonsurgical Management
Hello, I'm Norman Swan. Welcome to this programon the new guidelines for the nonsurgical managementof hip and knee osteoarthritis. It's a timely program, as we're broadcastingduring Arthritis Awareness Week. Arthritis, as you know, is a major causeof disability and chronic pain. There's around 100 different formsof arthritis, and osteoarthritis is the most common.
This program is the thirdin a series of four on the musculoskeletal guidelines that have been developedby the Royal Australian College of GPs and approved by the NH and MRC. This program will cover the diagnosisof osteoarthritis and discuss recommendednonpharmacological and pharmacological interventions in a multidisciplinaryprimary healthcare setting.
As always,you'll find a number of resources available on the Rural Health EducationFoundation's website: Let's meet our panel. Geoff McColl is a rheumatologistand professor of Medical Education and Trainingat the University of Melbourne. Welcome, Geoff. Thank you, Norman. Geoff is the current president ofthe Australian Rheumatology Association and was part of the working partydeveloping this guideline.
Rana Hinman is a physiotherapistand senior lecturer in the University of Melbourne Schoolof Health Sciences. Welcome, Rana. Rana has particular expertisein evaluating conservative treatments for osteoarthritis, and was alsoa member of the working party. Michael Yellandis a general practitioner and associate professorof Primary Health Care at Griffith University in Queensland.Welcome, Michael. His teaching and research interestsfocus on evidencebased diagnosis
and the treatmentof musculoskeletal pain. And David Ng, who's a pharmacist and director of the South Australianand Northern Territory Branch of the Pharmaceutical Societyof Australia. Welcome, David. Thank you, Norman. From the home of fish oil. That's correct. We'll talk about fish oil later to see whether or not it'sthe magic panacea for osteoarthritis.
Many myths about osteoarthritis,Geoffreyé There are many myths, Norman. Probably the best place to start is that this is an illness that you acquireas you grow old that you can do nothing about. You're just going to creak your wayto the wall at the bottom of the garden. Absolutely. There's a certain acceptancethat this is the way it will be. NORMAN:Are you telling me it's reversibleé
Knee Osteoarthritis Part 2 Symptoms Evaluation
(light rock music intro) Welcome back to The Art of Medicine. The diagnosis of osteoarthritis depends on carefulanalysis of your condition. Let's take a look at the common symptoms and how we evaluate your pain. Symptoms for osteoarthritis are three. Pain, swelling and stiffness.
They can all either bepresent at the same time or you can see each one individually in different degrees. The pain can either bebecause of particles flaking off and irritatingthe lining of the joint or increased pressure within the bone. Similarly, the stiffness can be because of fluid inside thejoint or it can just be
because of increased pressure in the bone because of not havingas much cushion there. Osteoarthritis is nothingmore than wearing away that gristle on the end of the bone and instead of havingseven to 10 millimeters of tread, you may have threeto four millimeters of tread. And the swelling caneither be because of fluid, which is an irritation tothe lining of the joint,
or it can be just because of thickening of the lining of the joint, both of which will cause limited motion. The common symptoms with osteoarthritis are more functional. They're difficulty with walking, ascending or descending stairs, particularly descendingstairs where you put
more force across the kneecap area, kneeling, bending,squatting, where again you're loading and compressingthe joint at its extreme, and driving often times where you have to hold that knee in one particular spot. The symptoms of osteoarthritis often times are made worse any time the knee is held in one position orcompressed in one position
for an extended period of time. All of these decrease the amount of motion across the knee and decreasethe amount of lubrication. On physical exam forosteoarthritis we're really trying to evaluate the nature of thepain, swelling and stiffness. We are looking forseveral specific findings. We're looking to see whereyou're pain is located, if your knee is swollen,