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Strategies for the prevention and management of osteoarthritis of the hip and knee

https://doi.org/10.1016/j.berh.2006.08.013Get rights and content

Osteoarthritis (OA) is one of the most common forms of musculoskeletal disorders and incurs significant economic, social and psychological costs. OA increases in prevalence and also progresses with aging.

Clinically OA is characterised by joint pain, crepitus, stiffness after immobility and limitation of movement. Many cases are ‘idiopathic’ (disease or condition of unknown course or which arises spontaneously), but OA can also be the end result of several other conditions or due to the combination of several other factors. There are various lifestyle factors that increase the risk of developing OA. Preventable or modifiable risk factors include obesity, occupational factors, sports participation, muscle weakness, nutritional factors and hormonal influence.

Pharmacological therapies reduce pain and may reduce joint damage. Surgical interventions correct altered biomechanics to prevent OA. For severely damaged joints, partial or total replacement of the joint is possible for all of the large joints that are commonly affected by OA.

OA is commonly associated with a limited function that can be improved with a wide variety of rehabilitative interventions: joint specific exercises, physical fitness, physical modalities. Education and self-management are very important to prevent overuse and to use the joints in the most adequate way.

Introduction

Osteoarthritis (OA) is the most common joint disorder and accounts for more disability among the elderly than any other disease. The prevalence of OA increases indefinitely with age, because the condition is not reversible. The impact of OA on the individual relates to pain and loss of motion of affected joints, which limits activities such as manual dexterity and mobility. It is the major contributor to lower limb disability. It affects independence and psychosocial functioning and, in addition, leads to financial loss.

When considering preventative possibilities, an evaluation of risk factors for the incidence and progression of OA is of relevance. At risk are those aged over 50 years and those with obesity, abnormal biomechanics or previous joint damage. Interventions recommended for those at risk include lifestyle, pharmacological interventions, surgical interventions and rehabilitative measures.

The aim of this paper is to give different preventative and treatment options, strategies for patients at risk and for those with different stages of OA in order to reduce the enormous impact of OA on the population. These have been largely developed as part of the European Bone and Joint Health Strategies Project.33

Section snippets

Size of the problem?

OA is a slowly progressive musculoskeletal disorder that can occur in any joint, but is most common in selected joints of the hand, spine and the lower limb weight-bearing joints: the hip, knee and feet. It is the most common joint disorder and accounts for more disability among the elderly than any other disease. OA is characterised by changes to the structure of the entire joint. There are focal areas of fibrillation, fissures, ulceration and full thickness loss of articular cartilage,

Consequences for the near future

It has become clear from the data given above that effective treatment of OA by reducing pain and improving function will have a major impact on the individual as well as on society. How realistic is this goal in the near future?

OA increases in prevalence and also progresses with age. The aging of the population will significantly increase the burden due to OA. Obesity is increasing and is associated with the development and progression of OA. This is bad news at the level of both the

Prevention

When considering preventative possibilities, an evaluation of the risk factors for the incidence and progression of OA is of relevance. Age is the strongest predictor of the development and progression of radiographic OA. Some types are hereditary – in particular of the finger joints. Congenital abnormalities such as congenital dislocation of the hip or hip dysplasia are also risk factors for the development of OA. Obesity (high body mass index) is a risk factor for the development of OA of the

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