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- Because the body's center of mass passes medially, causing greater load through the medial compartment
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- Kellgren and Lawrence classification - D/P/D
- Grade 0 = No OA
- Grade 1 = Minimal osteophyte lipping, doubtful joint space narrowing
- Grade 2 = Mild = definite osteophytes, possible joint space narrowing
- Grade 3 = Moderate = definite narrowing, multiple osteophytes
- Grade 4 = Severe = bone on bone contact
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- Patient lies supine with knees bent on foam, holds the cassette, and the X-ray beam is directed from caudal position
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- Key points:
- Rosenberg X-ray is a PA (not AP) view of the knee
- Patient stands against the X-ray cassette with knees bent to 45 degrees
- X-ray beam is angled 10 degrees toward the caudal direction
- It provides greater sensitivity than standard weight-bearing radiographs for detecting joint space narrowing
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- UK NICE 2019 Guidelines
- Analgesia - WHO ladder, oral and topical
- Weight loss and therapy
- Intra-articular steroid injections can be considered
- DO NOT OFFER - Glucosamine, acupuncture, intra-articular HA
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- 3 recommended - Activity modification, weight loss, analgesia
- 5 not recommended - Glucosamine and chondroitin, IA HA, acupuncture, arthroscopic debridement, lateral heel wedges
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- GAIT Trial 2008 in NEJM
- RCT of 1583 patients comparing placebo vs glucosamine+chondroitin. Results showed no difference between glucosamine and placebo except in a small subset with moderate-severe pain (22% of patients)
GAIT Trial.pdf221.4KB
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- Controversial
- NICE guidelines and JAAOS do not recommend it; however, Cochrane reviews 2006 suggest short-term benefits
- Cochrane reviews 2006
- 28 trials comparing IA steroids against IA HA
- Short-term benefits established for steroids
- Response to HA products appears more durable, but not consistent
- Cochrane reviews for viscosupplementation 2006 found effective treatment for OA with beneficial effects 5-13 weeks post-injection
- Henry et al. RCT
- Compared HA with NS injection - no difference
- JBJS review by Bhandari suggests possible favoring of HA
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- JAAOS CPG guidelines do not recommend arthroscopic surgery for OA knees
- NICE guidelines suggest selective use in very young patients with mechanical symptoms
- Key evidence: Moseley et al. NEJM 2002
- RCT of 180 patients divided into 3 groups – arthroscopic debridement, lavage, and placebo (with incisions and sound effects)
- No difference in outcomes
- Systematic review and meta-analysis by Thorlund et al. 2015
- Small benefit on pain at 3 and 6 months but not later up to 24 months
- No significant benefit on physical function
- Associated with DVT in 4 per 1000 patients
- Does not support arthroscopic surgery for middle-aged or older patients
- Counterpoint: Aaron et al. (JBJS 2006) - cross-sectional study of 122 patients
- 90% of patients with mild OA (joint space > 3mm and no deformity) improved with arthroscopic debridement
- Only 25% improved in patients with severe arthritis (joint space < 2mm)
moseley2002.pdf177.3KB
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The words of the wicked lie in wait for blood, but the mouth of the upright delivers them. Proverbs 12:6