|
Meet the Professor Session: Osteoarthritis
Suneil Kapur, MD, BSc, Stephanie Myckatyn, MD, BSc
An international group of rheumatological and orthopedic
healthcare professionals met with an osteoarthritis
expert to discuss the non-pharmacological therapy of
osteoarthritis. The workshop focused on the effects
of osteoarthritis on the local joint environment of
the knee. Few longitudinal studies have examined the
effect of modifying the local environment on the progression
of osteoarthritis.
Means of enhancing the local environment include:
• Strengthening periarticular muscle
(1)
• Unloading disease compartments (2)
• Improving proprioceptive acuity. (3)
Muscle strengthening is known to:
• Protect the joint
• Promote cartilage health and integrity
• Protect knee tissues from injury
• Provide joint stability.
Observational, cross-sectional studies have shown that
strengthening exercises improve pain and function. The
few longitudinal studies to date, focusing on strengthening
exercises and osteoarthritis progression, are conflicting.
Another consideration is unloading the diseased compartment
with bracing or wedge insole orthoses. These modalities
reduce stress by shifting the joint contact force away
from the diseased compartment. In a six-month prospective
study, the knee brace group scored better than control
on the WOMAC pain scale. While small, uncontrolled trials
have demonstrated improved pain and function with wedge
insole orthoses, no long-term studies exist.
Improvements in proprioceptive acuity lead to better
spatial and temporal coordination of limb position.
Methods include:
• Elastic bandages
• Braces
• Neoprene sleeves.
There are no long-term studies assessing the effect
of improved proprioception on disease progression.
Adjuncts to these modalities that may enhance impact
on pain and function include:
• Psychosocial support
• Education
• Medical therapy.
Overall, more longitudinal studies evaluating local
joint interventions are required.
|
References |
| 1. |
Sharma L, Lou C, Felson DT et al.
Laxity in healthy and osteoarthritic knees. Arthritis
Rheum 1999;42:861 - 870. |
| 2. |
Kirkley A, Webstr-Bogert S, Litchfield
R et al. The effect of bracing on varus gonarthrosis.
The Journal of Bone and Joint Surgery 1999;81A(4):539
- 548. |
| 3. |
Polo F. Bracing and heel wedging
for unicompartmental osteoarthritis of the knee.
The American Journal of Knee Surgery 1998;11:47
- 50. |
| 4. |
Van Baar ME, Assendelft WJJ, Dekker
J et al. Effectiveness of exercise therapy in patients
with OA of the hip or knee, a systematic review
of randomized clinical trials. Arthritis and Rheum
1999;43:1361 - 1369. |
| 5. |
Sharma L. Proprioceptive impairment
in knee osteoarthritis. Rheumatic Disease Clinics
of North America 1999;25:299 - 314. |
| 6. |
Ogata K, Yasunaga M, Nomiyama H.
The effect of wedged insoles on the thrust of osteoarthritic
knees. International Orthopedics (SICOT) 1997;21:
308 - 312. |
back to list of reports
|
