SPECIAL GUEST - All things Knee Osteoarthritis with Caitlin Scott - Physiotherapist

In this podcast, Gage sits down with Caitlin Scott (APA Sports and Exercise Physiotherapist/ Musculoskeletal Physiotherapist.), a Physiotherapist at Milton Physio and a close allied health colleague of ours.

Caitlin has had extesnsive experience in the physiotherapy world and discusses all things knee OA, specifically on physiotherapy principles and how and EP can integrate effectively into the care of the patient. A great multidisciplinary discussion! 

 

Show notes: 

 

- What is Knee OA?

o Knee OA is a progressive multifactorial degenerative joint disease involving the articular surface of the joint

§ progressive loss of articular cartilage

o There are 4 stages

§ early, mild, moderate, severe

o 3 key areas in the knee

§ tibiofemoral medial compartment

§ lateral compartment

§ patellofemoral compartment

 

- Prevalence:

o 653.1 million >40 y.o with knee OA worldwide (2020).

o 73% of those with OA >55 y.o, 60% female

o Knee most frequently affected, followed by hands and hip

o 16% >15 year old

o 22.9 %> 40 y.o

 

- Risk factors:

o Previous trauma/Surgery

o Obesity

o Female gender

o Laxity

 

- Diagnosis:

o Individualised subjective and objective assessment

§ Consideration of history, symptoms, other health conditions, physical assessment, functional levels

o Symptoms

§ Persistent knee pain, limited morning stiffness and reduced function

o Signs

§ Crepitus, restricted movement and bone enlargement

o When all 6 signs/symptoms present – 99% accuracy in diagnosis

o No imaging required – diagnosis can occur on assessment alone

o Imaging considered for other alternate diagnosis as clinically indicated

§ Considering insufficiency fracture, avascular necrosis, inflammatory

o Impact on function

§ WOMAC, KOOS o Osteoarthritis Knee clinical care standard

- Treatment pathways for knee OA – Surakanti et al 2023

o Conservative

§ Education

· Including pain management (Lesmond et al 2023)

§ Weight loss and exercise

§ Medication

· Research supports Exercise> NSAIDS

o However need to consider if patient having an acute painful flair – is medication required to maintain exercise levels Thorlund et al 2022

§ Individualised program

· Considering other comorbidities. Activity levels, goals

§ Physiotherapy/EP

· Promoting restoration/maintaining movement

· Identification of contributing factors

o Adding hip strengthening to quads exercises improves patient reported pain and function: Ref: Hislop et al 2020

o Unilateral OA: hip add is lower affected side, hip strength is lower bilaterally, dynamic balance lower bilaterally, patient reported pain associated with knee ext strength but not hip strength/dynamic balance: Ref: Hislop et al 2022 § GLAD program - Good Life with OsteoArthritis: Denmark Ewa Roos

· 2-3 patient education sessions and 12 supervised exercise sessions over 8 weeks

o Improved pain and objective outcome measures

§ Roos et al 2021

· Need to consider this is a group exercise program – it is better than nothing but we need to have individualised programs ideally

 

 

o Injections

§ Cortisone, hyaluronic acid, platelet-rich plasma

· Need to consider limitations – chondrotoxicity resulting in increased cartilage damage, increased risk of infection if injection 3/12 prior to surgery (Wernecke et al 2015)

o Surgical

§ Total knee arthroplasty

§ Uni-compartmental: unicompartment knee arthroplasty, High tibial osteotomy · McCormack et al 2021

§ Less likely to see arthroscopy’s

- Criteria for Surgery – Hawker et al 2023

o Considers the need, readiness/willingness, expectations and health status.

§ Do not want to wait until extended period of being inactive with reduced quads and gluteal function.

o Need

§ Evidence of knee OA on clinical and radiographic examination

§ Reports knee OA symptoms impacting on quality of life

· WOMAC, KOOS, 4 item arthritis coping efficacy Scale

§ Adequate trial of non-surgical OA treatment

· Exercise, physiotherapy, weight loss, medications, injections

o Readiness/willingness

o Patient expectations – Quote Quentin.

o Health status

 

- Realistic improvements – Quote Dr Quentin Scott – Specialist MSK Physiotherapist

o 3 months before you are starting to do well

o 6 months before you are pleased you did it

o 9-12 months before you have forgotten about it

o Key is individual – everyone will respond differently depending on reason for surgery, prehab

o Post operative response can be affected b