Hip & Knee Osteoarthritis: Part 1 – Intro & Diagnosis
- Dr. Brian Abelson
- Aug 29, 2024
- 9 min read
Hip and knee osteoarthritis (OA) is a widespread condition, especially in older adults, significantly impacting daily life and mobility. Over 40% of people aged 45 to 55 are affected, and this number rises to over 80% by age 75.
My personal journey with hip OA, which led to a right hip replacement, has given me a deep understanding of the challenges and solutions for managing OA. While OA doesn’t shorten life expectancy, its effect on quality of life can be profound.
The Good News
Based on patient outcomes, we have observed a 90% success rate in reducing or eliminating pain and improving function. Combining manual therapy with targeted exercise, as part of our Motion Specific Release (MSR) methodology, can make a real difference in your life. While it may not reverse the progression of osteoarthritis, it can slow down its progression, alleviate pain, and enhance functionality.
Article Index
Note: Part 2 of this series covers manual therapy and exercise.
What is Osteoarthritis
Osteoarthritis (OA) is a progressive degenerative disorder where the protective cartilage that cushions the ends of bones in synovial joints gradually deteriorates. This condition doesn't just affect the cartilage; it also impacts the underlying subchondral bone and the synovium, which lines the joint capsule. As the rate of cartilage breakdown outpaces the body’s natural repair processes, it leads to chronic joint damage.
On a microscopic level, OA is characterized by the breakdown of essential components like proteoglycans and the death of chondrocytes, the cells responsible for maintaining healthy cartilage. This degradation results from a combination of disease-related (pathological) and mechanical stress factors.
Risk Factors for Osteoarthritis (OA)
Several factors can increase the likelihood of developing osteoarthritis (OA):
Age: As we age, the volume of cartilage in joints naturally decreases, along with a reduction in proteoglycans and blood flow. These changes contribute to cartilage degeneration and the onset of OA.
Diabetes: Evidence suggests that diabetes, particularly through altered lipid metabolism and hyperglycemia, may negatively impact cartilage health and the subchondral bone, potentially accelerating OA progression.
Genetics: A family history of arthritis can elevate an individual’s risk of developing OA, indicating a genetic predisposition.
Muscle Weakness: Weak muscles, particularly around weight-bearing joints, can accelerate OA progression. Inactivity exacerbates joint degeneration, making muscle strength critical in managing and preventing OA, especially in the knees.
Obesity: Obesity is strongly linked to OA due to increased mechanical stress on joints and the promotion of low-grade inflammation by adipose tissue cytokines. Weight loss can significantly reduce OA risk, particularly in the hip and knee joints.
Inflammatory Arthritis (IA): A history of IA, where the immune system causes joint inflammation, can predispose individuals to OA.
Previous Surgeries: Surgical procedures can alter joint mechanics, leading to compensations that increase stress, friction, and cartilage breakdown.
Repetitive Motion: Repetitive stress on joints, whether from occupation or activity, can exacerbate mechanical stress, contributing to OA.
Trauma: Past joint trauma is a significant risk factor, increasing the likelihood of OA development by up to 20 times.
Common Myths About Osteoarthritis
Osteoarthritis (OA) is widespread, yet several myths persist that can mislead those affected:
Myth 1: OA Inevitably Worsens Contrary to popular belief, mild to moderate OA does not always progress to severe, debilitating stages. With proper management, its progression can be slowed or even halted.
Myth 2: There’s Nothing I Can Do About OA This is false. While there is no cure, manual therapy and exercise have proven effective in reducing pain, improving function, and minimizing the risk of OA progression.
Myth 3: Resting is the Best Treatment for OA Resting and avoiding activity can actually worsen OA, leading to chronic pain and disability. Proper management, including movement and therapy, is crucial for preventing further damage.
Myth 4: Avoid Sports to Prevent OA Engaging in sports and physical activities does not necessarily lead to OA. In fact, regular exercise can be protective, and continuing to run or stay active is often beneficial, even if you have mild OA. It’s only when OA is severe that certain high-impact activities should be reconsidered.
Hallmarks of Osteoarthritis
Hip and knee osteoarthritis are common musculoskeletal conditions that significantly impact mobility and quality of life. Key symptoms include reduced joint range of motion, a grinding sensation known as crepitus during movement, and joint deformity. These signs reflect ongoing inflammation and damage within the joint. The pain and stiffness often lead to challenges in daily activities, making effective management essential to maintain function and comfort.
Knee Osteoarthritis Characteristics:
Persistent pain lasting over a month.
Morning stiffness that eases within 30 minutes.
Crepitus (grinding sensation) during active motion.
Joint tenderness upon palpation.
Noticeable bone enlargement at the joint.
Hip Osteoarthritis Features:
Pain persisting for more than a month.
Hip flexion limited to less than 115 degrees and internal rotation restricted to under 15 degrees.
Morning stiffness lasting less than 60 minutes.
Most commonly affects individuals aged 50 and above.
Stages of Progression
Stage One - Early OA
Sharp joint pain occurs occasionally with certain activities.
Functional limitations are minimal, but high-impact activities may provoke discomfort.
Stage Two - Mild OA
Joint pain becomes more frequent and lasts longer.
Some may experience the joint giving way or locking.
Pain begins to interfere with daily activities, particularly after prolonged sitting or upon waking.
Stage Three - Severe or Advanced OA
Pain becomes constant, ranging from a dull ache to intense discomfort.
Significant limitations in functionality arise, impacting mobility and quality of life.
It’s important to note that radiographic evidence doesn’t always align with the severity of symptoms. Some individuals may show significant joint damage with minimal pain, while others may experience severe symptoms despite little visible joint degeneration. Understanding the progression of OA helps healthcare providers design personalized treatment plans to reduce pain and improve function.
Examination and Diagnosis
For accurate diagnosis and assessment of hip or knee osteoarthritis (OA), a thorough orthopedic and neurological examination is essential, often complemented by appropriate imaging studies. This comprehensive evaluation provides healthcare providers with critical insights into the extent of joint degeneration, enabling them to develop tailored treatment plans that address each patient's unique condition.
Imaging
Imaging plays a pivotal role in diagnosing and managing osteoarthritis (OA), offering detailed insights into joint degradation, guiding treatment decisions, and monitoring disease progression.
Key Imaging Modalities:
Conventional Radiography: Standard X-rays, including anterior, posterior, and lateral views, are cost-effective and foundational in OA diagnosis. They reveal crucial details like osteophyte formation, joint space narrowing, and subchondral sclerosis, providing a clear picture of bone changes.
Magnetic Resonance Imaging (MRI): MRI offers a comprehensive view of both soft tissue and bone structures, detecting subtle changes in cartilage, ligaments, and other tissues that X-rays might miss. Although highly informative, MRIs are costly and may not be universally accessible.
Ultrasound: A non-invasive, radiation-free option, ultrasound is often used for evaluating muscle and tendon issues. While it’s not typically the first choice for joint evaluation in OA, it can offer valuable insights into soft tissue conditions surrounding the joint.
Orthopedic & Neurological Assessment
When evaluating a patient for OA, it's vital to exclude any red flags or non-musculoskeletal causes of pain. Typically, a comprehensive patient history precedes a thorough orthopedic and neurological examination. Various standard tests on the hip and knee can help determine the presence and extent of joint degradation. This information can guide treatment decisions and contribute to devising patient-specific care plans.
Hip Examination - Orthopaedic Testing
This video covers inspection and observation, palpation, Active and Passive Ranges of motion, and orthopedic examination of the Hip region.
Knee Examination - Effective Orthopaedic Testing
This video demonstrates some of the common orthopedic tests we use to examine our patient's knees.
Lower Limb Neuro Examination
The lower limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the lower limbs. This assessment helps to detect any impairment of the nervous system.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications.
Differential Diagnosis
A diagnosis of osteoarthritis (OA) should be viewed as an "evolving diagnostic hypothesis." This means that the diagnosis is not a fixed conclusion but rather a working theory that evolves as more information becomes available. Healthcare providers base their diagnosis on a combination of factors, including the patient's medical history, physical examination, imaging results, and other diagnostic tests. It’s crucial to consider potential differential diagnoses, such as:
Lumbar Radiculopathy: Pain radiating from the lumbar spine, often caused by nerve root compression.
Avascular Necrosis: Bone tissue death due to a lack of blood supply, often linked to chronic alcohol use, blood clotting disorders, or long-term steroid use. Conventional radiographs can help differentiate this condition.
Gout: An intensely painful, inflamed joint typically caused by the deposition of monosodium urate crystals.
Rheumatoid Arthritis (RA): An autoimmune inflammatory arthritis where the joint is often warm. Laboratory tests, including Rheumatoid Factor (RF), can assist in ruling out RA, especially when RF levels are elevated.
In cases of knee pain, it's important to consider referred pain from hip osteoarthritis, bursitis, Iliotibial Band Syndrome (ITBS), ligament injuries, or conditions like osteochondritis in younger patients. This comprehensive approach ensures that all potential causes are considered, leading to a more accurate diagnosis and effective treatment plan.
Hip & Knee Osteoarthritis Conclusion Part 1
Although osteoarthritis (OA) doesn’t shorten life expectancy, it can drastically diminish quality of life. The good news is that based on patient outcomes, we have observed a 90% success rate in reducing or eliminating pain and improving function. By combining manual therapy with targeted exercise, as part of our Motion Specific Release (MSR) methodology, we can significantly slow down the progression of OA, alleviate pain, and enhance joint function. While surgery may be necessary in some cases, many patients can achieve remarkable improvements through a personalized approach that integrates these therapies. This comprehensive strategy underscores the importance of proactive management and individualized treatment in overcoming the challenges of OA, ultimately leading to better daily functioning and an improved quality of life.
In part two of this series, we will delve deeper into the specifics of effective manual therapy and exercise strategies to manage osteoarthritis. These insights will provide you with the tools needed to take control of your OA management and improve your overall well-being.
Note: References are at the end of Part 2
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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