Osteoarthritis is a common type of arthritis in the United States. Also known as degenerative joint disease, degenerative arthritis, or osteoarthrosis, osteoarthritis is the wearing down of articular cartilage. Osteoarthritis develops over time from the accumulated wear of the articular cartilage. Prior knee injuries and meniscal tears can contribute to more rapid progression of cartilage wear.
The knee joint involves the articulation of three bones—the (1) femur, (2) tibia, and (3) patella. It is divided into three compartments that can wear out–the (1) medial compartment (between the femur and tibia), (2) lateral compartment (between the femur and tibia), and (3) patellofemoral compartment. Osteoarthritis can affect one, two, or all three of those compartments.
Individuals suffering from osteoarthritis of the knee often alter their gait to adjust for the pain and reduced mobility associated with the disease. These alterations to a patient’s gait can, in turn, contribute to joint and muscle pain and degeneration in other lower extremity joints.
Total knee arthroplasty (“TKA”) is performed for advanced degenerative changes when conservative treatment has failed. Conservative treatment prior to surgery includes physical therapy, braces, injections, NSAIDs, and a modification of physical activity. When significant pain persists despite these methods, knee replacement surgery is used to decrease pain and improve the patient’s quality of life.
Assessment of the patient prior to surgery includes obtaining a history, performing a physical exam, and analyzing radiographs of the knee. In addition to obtaining a history of the patient’s knee problems, past medical history including any relevant comorbidities, current medications, drug allergies, and social history are evaluated for potential impact on postoperative recovery. During the preoperative physical exam, the knee is assessed.
Components assessed during the physical exam include gait abnormalities, knee range of motion, areas of knee tenderness, abnormal knee alignment, prior knee scars, knee ligamentous stability, back and hip pathology that may impact knee function, and neurovascular status of the leg. X-rays are obtained prior to surgery to assess the severity of arthritis and for preoperative planning. Multiple views are obtained to evaluate the entire joint including weight-bearing antero-posterior, lateral, and skyline/Merchant views.
Prior to undergoing surgery, further testing is performed to minimize the risk of complications from other medical comorbidities. Depending on the patient’s age and medical history, preoperative evaluation can include lab work, chest x-ray, EKG, urinalysis, and medical evaluation/clearance by a primary care physician. Any medical comorbidities, such as diabetes, are optimized prior to surgery to decrease perioperative and postoperative risks.
Knee Osteoarthritis medical expert witness specialties include orthopaedic surgery, radiology, anaesthesiology, and sports medicine.