Management of Knee Osteoarthritis in the Younger, Active Patient: An Evidence-Based Practical Guide for Clinicians

165 Pages·2016·6.73 MB·English

by  David A. Parker (eds.)

David Parker
Editor
Management of Knee
Osteoarthritis in the
Younger, Active Patient
An Evidence-Based Practical
Guide for Clinicians
Management of Knee Osteoarthritis
in the Younger, Active Patient

David A. Parker
Editor
Management of Knee
Osteoarthritis in the
Younger, Active Patient
An Evidence-Based Practical Guide
for Clinicians
Editor
David A. Parker
Sydney Orthopaedic Research Institute
Sydney
New South Wales
Australia
ISBN 978-3-662-48528-6 ISBN 978-3-662-48530-9 (eBook)
DOI 10.1007/978-3-662-48530-9
Library of Congress Control Number: 2015959845
Springer Heidelberg New York Dordrecht London
© ISAKOS 2016
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Preface
As clinicians, how do we manage the 45-year-old man who has symptomatic
articular cartilage wear but wants to continue with his sports or the 35-year-
old woman who is having trouble with her normal daily activities due to post-
meniscectomy arthritis? Increasingly commonly, physicians are facing these
management problems: younger, active patients who are developing osteoar-
thritis which is impinging on the activities that they want or need to do.
Management of these patients is a major challenge and will always involve a
balance between optimising function and keeping expectations realistic. To
be able to provide such patients with optimal advice and management, the
physician or allied health professional needs to have a comprehensive knowl-
edge of the condition, its natural history, the various treatment options avail-
able, and the evidence base for each. This text has been created in order to
provide clinicians with the knowledge and resources to provide patients with
such a wholistic, optimal management plan to maximise each patient’s func-
tion and quality of life.
This new text comprehensively covers all areas relevant to the manage-
ment of osteoarthritis and localised articular cartilage pathology in younger
patients who are still wishing to maintain a high level of physical activity and
exercise. The earlier chapters address the basic science behind osteoarthritis,
including the defi nition, classifi cation, and epidemiology and natural history
of the condition. A clear understanding of this is obviously critical to its man-
agement. The aetiology of osteoarthritis is also discussed, particularly distin-
guishing between modifi able and non-modifi able risk factors and their
relevance to management. The subsequent chapter discusses the many non-
surgical treatment modalities available for osteoarthritis. In particular, each
treatment is discussed with special reference to the relevant evidence base,
and subsequently the appropriate recommendations for its use are provided.
A particular focus is placed on the importance of the multidisciplinary
approach to the effective management of osteoarthritis.
T he following chapters then address the role of surgical management. This
can be divided into techniques that attempt to preserve and possibly restore
the native knee joint and those that involve replacement of the joint. All of the
available surgical techniques are discussed in detail, once again focusing on
the evidence base to support each treatment, and provide the appropriate indi-
cations. Equally importantly, the text discusses the clinical scenarios for
which surgery is not appropriate. The surgical techniques involved in restor-
ing and retaining the native knee joint that are discussed include meniscal and
v
vi Preface
chondral surgery, arthroscopic debridement, and osteotomy for realignment
of the joint. The arthroplasty component of the text covers all areas of pros-
thetic resurfacing, including localised resurfacing, unicompartmental replace-
ment, and total knee replacement. Of particular signifi cance is the importance
of patient selection, technique, and prosthesis selection and providing the
appropriate recommendations for levels of activity post-arthroplasty surgery.
The longer-term prognosis of arthroplasty in the younger active patient is
carefully considered, to provide surgeons with the appropriate information to
give their patients accurate advice about their future.
Producing this textbook has involved collaboration between many authors
from a number of countries. Authors have been largely selected from the
Knee Committee of the International Society for Arthroscopy, Knee Surgery,
and Orthopaedic Sports Medicine, with additional contributions from the
American Association of Hip and Knee Surgeons for the arthroplasty section
of the text. This has brought together an international faculty providing a true
global perspective on the topic. The authors have all initially constructed their
respective chapters based on a systematic review of the literature, coupled
with their own extensive clinical experience and expertise. The authors then
all met together over 2 days in the USA in March of 2015 to present their
reviews to the entire group for discussion, review, and refi nement, which gave
each author the opportunity to add contributions as appropriate to each topic.
Each author then fi nalised their chapter for editorial review and subsequent
provision to the publisher. The end result is I believe a text that provides a
practical and invaluable reference for clinicians managing patients with
osteoarthritis, which should ultimately improve the management of these
patients, allowing them to remain active and sustain their quality of life.
I sincerely hope that you fi nd this text useful in your clinical practice for the
management of these patients.
Sydney , Australia David A. Parker , FRACS
Contents
Part I Introduction, and Nonoperative Management
1 Osteoarthritis: Defi nition, Etiology, and Natural History . . . . 3
Elizabeth A. Arendt
2 Nonoperative Treatment Options
for Knee Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
David A. Parker and Corey Scholes
Part II Surgical Management
3 Meniscus Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Ashok Rajgopal and Attique Vasdev
4 Arthroscopic Debridement of the Knee
in the Presence of Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . . 43
Myles R. J. Coolican and Kunal Dhurve
5 Cartilage Preservation and Restoration
Techniques: Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . 51
Brian M. Devitt , Stuart W. Bell , and Tim S. Whitehead
6 Periarticular Knee Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Fernando Corbi , Rosa Ballis , Nicolas Gaggero ,
and Sebastien Lustig
7 Unicompartmental Knee Arthroplasty
in the Young Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Travis Loidolt and Brian Curtin
8 Total Knee Arthroplasty for the Young,
Active Patient with Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . 133
Tiffany N. Castillo and James I. Huddleston
9 New and Evolving Surgical Techniques. . . . . . . . . . . . . . . . . . . 149
Willem van der Merwe
10 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
David A. Parker
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
vii
Part I
Introduction, and Nonoperative
Management
1
Osteoarthritis: Defi nition,
Etiology, and Natural History
Elizabeth A. Arendt
Contents 1.1 Defi nition of Osteoarthritis,
Classifi cation,
1.1 Defi nition of Osteoarthritis,
and Epidemiology
Classifi cation, and Epidemiology 3
1.2 Etiology 5
Osteoarthritis (OA) is one of the most common causes
1.3 Risk Factors 5
of disability in adults. The prevalence increases with
1.3.1 Altered Mechanics 12
age, with a surprising 13.9 % of the population over
1.3.2 Impairments in Muscle Function 12
1.3.3 OA and Knee Injury 12 25 years old being affected and 33.6 % of the popula-
1.3.4 Sex 12 tion over 65 years old affected [1 ].
1.3.5 Heavy Physical Work 12
O ARSI (Osteoarthritis Research Society
1.3.6 Obesity 12
International) defi nes osteoarthritis as “a disorder
Conclusion 13 involving movable joints characterized by cell
References 13 stress and extracellular matrix degradation initi-
ated by micro- and macro-injury that activates
maladaptive repair responses including pro-
infl ammatory pathways of innate immunity.” This
in turn manifests initially as abnormal joint tissue
metabolism and subsequently by anatomic and
physiologic derangements. Clinically, this can
present as cartilage degradation, bone remodeling,
and osteophyte formation, with joint infl amma-
tion, pain, and loss of normal joint function.
The classifi cation of osteoarthritis is varied.
Classifi cation strategies include:
1. Classifi cation via radiographic imaging [2 ]
2. Classifi cation utilizing advanced imaging,
including whole-organ scoring [ 3 ]
E. A. Arendt , MD 3. Classifi cation emphasizing clinical symp-
Department of Orthopaedic Surgery ,
toms, including stiffness, swelling, knee range
University of Minnesota , Suite R200, 2450
of motion, and knee crepitus [4 ]
Riverside Ave. South , Minneapolis , MN 55454 , USA
e-mail: [email protected] 4. Combination of symptoms and imaging [4 ]
© ISAKOS 2016 3
D.A. Parker (ed.), Management of Knee Osteoarthritis in the Younger, Active Patient:
An Evidence-B ased Practical Guide for Clinicians, DOI 10.1007/978-3-662-48530-9_1