Osteoarthritis

Osteoarthritis is more complex than wear and tear. It is a combination of multiple modifiable and non modifiable factors which have been identified including: Inflammatory and biomechanical processes, family history, age, obesity, diabetes, synovitis, innate immunity, lower limb alignment, joint shape and dysplasia, trauma and inflammation by metabolic syndrome.

• Pain – Usually worse in AM, or last thing at night and after period of sitting. Can disturb sleep.
• Swelling - after period of weight bearing.

• Exclude hip - painful ROM. If positive then need X-ray to exclude Hip OA
• Observation - joint effusion, muscle atrophy. Antalgic gait pattern. Joint alignment
• ROM – Loss of end range extension and flexion
• BMI - Over 30 risk of excessive force across knee.

X-ray to assess level of OA into min, mod or severe.

Lspine, hip.

• NHS Ayrshire & Arran. Osteoarthritis - what can I do?
• Keele University and Nice guidelines state that exercise should be first line of management regardless of age or severity of OA.
• NICE. Osteoarthritis in over 16s: diagnosis and management.
• Keele Health. Osteoarthritis resources clinicians.
• Versus Arthritis. While you're waiting.
• Patient education/Information to signpost toward information to enable/enhance understanding of condition,disease progression,management, self care and counter misconceptions about condition.
• Flippin' Pain. Rethinking pain.
• NHS Inform. Arthritis.
• Discuss benefits in achieving/maintaining ideal weight. Signpost to services: Dieticians, weigh to go, leisure services.
• Consider shock absorbent shoes and walking stick for pain relief.
• Pharmacology.
• Nice guidelines.
• Paracetamol for pain relief if appropriate.

• Diagnostically uncertain.
• Symptoms persist beyond 3 /12 and X-ray findings mod/sever OA. Good compliance with exercise BMI ideally between 30-35.
• Patient not happy with improvement gained through conservative measures and has insight into risk/benefits of surgical intervention.