Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Osteoarthritis

SYMPTOMS

There is gradual onset of diffuse or localised exercise-induced pain and effusion of the knee. The knee is usually stiff and more painful in the morning than in the afternoon. In severe cases there is pain during rest. There are periods of better and worse symptoms. Clicking, crunching and pseudo-locking can occur. It usually affects the gait.

AETIOLOGY

Osteoarthritis is a major problem for the general population and affects most weightbearing joints. It is often secondary to previous trauma such as ACL ruptures and previous meniscus surgery. A typical patient is a footballer or rugby player who continues to play 10 to 15 years after an ACL reconstruction. Primary osteoarthritis is usually bilateral and hereditary. Osteoarthritis is a progressive disease affecting both the soft tissues and the cartilage of the knee joint. According to the Outerbridge scale, which is arthroscopic, osteo arthritis is graded from I (chondromalacia) to IV (bare bone) and correspondingly in a radiological score (as seen by X-ray) from 0-4.

CLINICAL FINDINGS

Depends on the severity. There is effusion in around 70 per cent of cases. Deformation of the knee and protruding osteophytes can be found. A systematic and thorough approach in the clinical examination is crucial to a successful outcome. Tests of core stability, proprioception, muscle strength and balance and the flexibility of the entire kinetic chain must be thoroughly evaluated to assist in rehabilitation.

INVESTIGATIONS

Weight-bearing x-ray can help to grade the severity but there could be major localised cartilage damage before X-ray will show a decreased joint space. Since this is a gradual disorder, many patients only seek medical advice in situations where the knee is particularly bad. Often meniscal tears suddenly occur, locking the knee or causing symptoms in an already sore knee. Arthroscopy is an excellent diagnostic tool to verify the extent and location of osteoarthritis as well as sorting out the meniscal problem. Shifting the load from a medial osteoarthritis to an unaffected lateral compartment may relieve symptoms over a long period of time.

TREATMENT

There is no definite cure for this condition. However, there is a range of symptomatic treatments available: physiotherapy and exercise modifica tion, NSAID, injections of synovial fluid derivates, cortisone, arthroscopic debridement, excision of loose bodies and trimming of blocking osteophytes, various forms of osteotomies for unilateral compartment osteoarthritis and, as an end range measure, knee replacement. A modern knee replacement will last for 10 to 20 years.

REFERRALS

These patients are very much helped by being evaluated clinically by their physician, Dr Kevin Yip, consultant senior orthopaedic surgeon and physiotherapist in close collaboration.

EXERCISE PRESCRIPTION

Cycling, walking, freestyle swimming and low-impact sports like golf are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Monitoring of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Meniscal tears, OCD, loose bodies, chondral injuries, reactive arthritis.

PROGNOSIS

Fair-Poor. Due to the progressive development of symptoms, this condition often ends a sporting career.

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