Posts tagged knee osteoarthritis
The Benefit Of Physical Therapy Before Knee Replacement Surgery

Knee arthritis is most effectively treated in its’ early stages with Physical Therapy including manual therapy and exercise interventions. These interventions have been shown to reduce pain and disability, as well as, prevent or post pone the need for future knee surgery. In later stages of disease progression, knee arthritis is most effectively treated with a total knee replacement. This major surgery involving the replacement of joint surfaces in the knee was first performed in the 1960s. Since this time it has become one of the most successful orthopedic surgeries due to its’ ability to improve pain and function among this end stage patient population. In our Boulder physical therapy practice, we often find patients who enter their orthopedic surgery with optimal range of motion, strength, and function have the best outcomes after surgery. A recent review article supports our clinical findings.

Authors in the journal Physical Therapy reviewed the available evidence on the use of pre operate Physical Therapy among patients electing for total knee replacement (Devasenapathy et al. 2019). They were interested in finding the importance of pre operative treatments on post operative function including gait speed, stair climbing, and function. Authors reviewed 12 studies and found an association between pre operative quadricep strength and post operative function. They noted pooling of information was limited in this meta analysis due to the different methodologies used in the available studies. They called for additional studies of higher methodological quality to improve predictor analysis.

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Hyaluronic Acid vs. Corticosteroid for Knee Osteoarthritis

Knee Osteoarthritis is a common condition affecting many middle aged adults which leads to pain, loss of range of motion, and decreased function.  Physical Therapy remains the primary choice for conservative treatment, but often these treatments are combined with injections to the knee joint.  Corticosteroids are an inexpensive injection designed to reduce pain and inflammation in the knee, but Hyaluronic Acid injections such as Synvisc are also on the rise.  These injections claim to cushion and lubricate the knee joint leading to reduced pain and improved function.  One downside of these injections is their cost ($250-$1000 per injection) which is often not covered by insurance.  In addition, the research on these injections has been compared to saline (placebo) injections instead of a head to head comparison with the corticosteroid.

Recently an article in the Journal of Bone and Joint Surgery examined the impact of a single corticosteroid or hyaluronic acid injection on 99 patients with knee osteoarthritis (Tammachote et al. 2016).  Patients were randomized to receive one of the two injections then followed over 6 months.  As you can see from the graph above both groups demonstrated similar outcomes in pain, function, and range of motion at 6 months.  Differences were noted in the short term with decreased pain and improved function noted in the first two weeks in the patients receiving the corticosteroid.  The authors called into question the cost of these expensive injections compared to the less expensive corticosteroid.  

Hip or Knee Strengthening for Knee Arthritis

Knee arthritis (knee OA) is the most common form of osteoarthritis and affects many individuals in middle to older age.  This condition can be found on x ray or MRI testing in both asymptomatic and symptomatic individuals.  The high rates of false positive imaging findings require a thorough subjective and objective examination in order to make a proper diagnosis.  Physical Therapy remains an effective first line treatment for patients with knee OA and has been shown to reduce or eliminate the need for a knee replacement.  At our Physical Therapy office, patients will receive manual therapy to reduce pain and improve mobility, as well as, exercises to strengthen the hips and knees.  Until recently we have known if working on the hip or knee was more effective. 

Lun et al. randomized 72 patients with knee OA to either a hip or knee focused exercise program consisting of stretching and strengthening exercises (Clin J Sp Med. 2015).  Patients exercises in clinic 3-5 times per week for 3 weeks then were placed on a 9 week home exercise program.  The impact of this 12 week program on the patients' symptoms and function was measured at the end of the trial.  The authors found improvement in both groups of patients, but no differences were found between groups focusing on either knee or hip exercises.  

This study adds to the positive impact of exercise in patients with knee OA.  In our experience, treating the entire lower quarter in patients with knee OA accelerates recovery and improves function.  To learn more about which exercises are most appropriate for your condition contact the experts at Mend.