CME/CE: Knee Osteoarthritis: Guidelines for Surgery

CME/CE: Knee Osteoarthritis: Guidelines for Surgery

According to current estimates, 27 million adults in the United States—or more than 10% of the adult population—have clinical osteoarthritis, a condition that ranks among the leading causes of hospitalization. Recent estimates show that approximately 9.9 million adults have symptomatic osteoarthritis (OA) of the knee. With life expectancy rates continuing to rise, it is anticipated that the prevalence of knee OA will increase in the coming years. The number of people older than age 65 is expected to increase to more than 77 million by the year 2040. The burden of OA of the knee is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. OA is the most frequent cause of disability among U.S. adults, and the burden is increasing due to the rising disease prevalence as well as higher expectations among patients to receive effective treatment. OA is the leading indication for joint replacement surgery. About 905,000 knee and hip replacements were performed in 2009, costing the healthcare system $42.3 billion. These estimates factor together direct medical, long-term medical, home modification, and nursing home costs.   OA Risk Factors & Disease Clinical studies have identified several factors that increase risks for developing OA of the knee to the point that surgery is required. These include joint degeneration over time due to hereditary vulnerability, large body mass, certain occupations, past joint traumas, and prior intraarticular damage. Knee OA also takes an emotional and physical toll on patients. Older adults with OA of the knee tend to visit their physicians more frequently and experience more functional limitations than others in the same age group....
Knee Osteoarthritis: Guidelines for Surgery

Knee Osteoarthritis: Guidelines for Surgery

According to current estimates, 27 million adults in the United States—or more than 10% of the adult population—have clinical osteoarthritis, a condition that ranks among the leading causes of hospitalization. Recent estimates show that approximately 9.9 million adults have symptomatic osteoarthritis (OA) of the knee. With life expectancy rates continuing to rise, it is anticipated that the prevalence of knee OA will increase in the coming years. The number of people older than age 65 is expected to increase to more than 77 million by the year 2040. The burden of OA of the knee is largely attributable to the effects of disability, comorbid disease, and the expense of treatment. OA is the most frequent cause of disability among U.S. adults, and the burden is increasing due to the rising disease prevalence as well as higher expectations among patients to receive effective treatment. OA is the leading indication for joint replacement surgery. About 905,000 knee and hip replacements were performed in 2009, costing the healthcare system $42.3 billion. These estimates factor together direct medical, long-term medical, home modification, and nursing home costs.   OA Risk Factors & Disease Clinical studies have identified several factors that increase risks for developing OA of the knee to the point that surgery is required. These include joint degeneration over time due to hereditary vulnerability, large body mass, certain occupations, past joint traumas, and prior intraarticular damage. Knee OA also takes an emotional and physical toll on patients. Older adults with OA of the knee tend to visit their physicians more frequently and experience more functional limitations than others in the same age group....
Resistance Exercise for Knee OA

Resistance Exercise for Knee OA

Research indicates that knee pain occurring with movement due to osteoarthritis (OA) strongly predicts the need for functional assistance and is the second leading cause of disability in the United States. Muscle strengthening through resistance exercise is one of the treatment options for OA-induced pain. According to Kevin R. Vincent, MD, PhD, most patients with knee OA experience pain and therefore do not want to be active. “This causes the muscles around the joint to become weaker, making the joint less stable and ultimately causing patients to become less functional,” he says. “Self-efficacy often decreases when patients feel like they’re not as functional as they once were or as they lose confidence in their own capabilities.” Beyond the functional benefits of resistance exercise, there are other benefits of muscle strengthening to consider, such as psychosocial well-being, cognitive function, and self-esteem. “These factors can all improve with resistance exercise,” Dr. Vincent says. “There may also be decreases in anxiety, depression, and negative stress-related emotions.” Stronger muscles can also lower the blood pressure response to exertion and improve glycemic levels. Overall, patients who participate in resistance exercise programs tend to enjoy better outcomes with many of the other treatments used for knee OA. Getting Started Several factors must be taken into account before starting patients on resistance exercise programs. “The level of disease severity and the overall health of the patient should be considered,” says Dr. Vincent. “Physicians should understand the willingness and ability of patients to participate in these programs and then tailor them based on whether they’ll be exercising at home or in a fitness center.” The key to...
Optimizing Patient Education in Knee Osteoarthritis Care

Optimizing Patient Education in Knee Osteoarthritis Care

The goals of knee osteoarthritis (OA) treatment are to improve health-related quality of life and limit the progression of joint damage. “The optimal management of knee OA requires that patients be given a combination of non-pharmacologic and pharmacologic treatments,” says Pekka Mooar, MD. “Educating patients about the nature of their condition and strategies to manage it is important when caring for these individuals.” Informing patients about the pros and cons of the various types of therapies to alleviate pain and improve function takes time, but Dr. Mooar says it is an important part of the process. “Recent guidelines from groups like the American Academy of Orthopaedic Surgeons have provided recommen­dations for the non-pharmacologic and pharmacologic management of knee OA,” he says. “These guidelines make recommendations that are based on only well-designed studies with placebo controls. They do not support many of our traditional or surgical treatment options. For clinicians, this can make patient education even more challenging. Patients must be treated on a case-by-case basis, depending on their specific characteristics.” Lifestyle Interventions One of the most important aspects of managing patients with knee OA, according to Dr. Mooar, is to provide education about the objectives of treatments and the importance of lifestyle changes. “Patients should recognize that they can take action to reduce their chances of requiring knee surgery or arthroplasty,” he says. “Lifestyle changes are among the most effective non-operative treatments, but these options are best used when patients with knee OA are identified early.” Guidelines recommend that patients with knee OA be encouraged to undertake regular aerobic, muscle strengthening, and range of motion exercises,” says Dr. Mooar....