How to treat Hip & Knee Osteoarthritis | Physiotherapy Guideline Review

Summary

The video discusses diagnosing and managing symptomatic osteoarthritis (OA) of the hip and knee without radiographs, based on a 2020 practice guideline. It emphasizes a detailed patient history and the role of physical therapy in managing OA. Patients are categorized into four groups based on treatment needs, ranging from simple advice to pre- and post-operative care. Exercise is strongly recommended for both physical functioning and recovery. Tailored exercises, patient education, and adherence to long-term programs are highlighted, while passive therapies like massage or ultrasound are discouraged except for temporary pain relief.

Takeaways

• 🦴 Symptomatic OA in the hip or knee can be diagnosed without a radiograph, as per 2020 guidelines.
• 🧠 Understanding the patient's history, pain onset, and functional limitations is crucial for diagnosis and treatment.
• 🦵 Hip and knee OA often don't require joint replacement; there are alternative management strategies.
• 📝 Physical therapists should ask about movement restrictions, pain patterns, and previous surgeries when diagnosing OA.
• 👟 Physical therapy benefits patients with OA when there are limitations in daily activities, categorized into four groups based on the level of care needed.
• 🏋️ Exercise, tailored to individual needs, is highly recommended for improving physical function, even pre- and post-operatively.
• ⚖️ Exercise programs should include muscle strengthening, aerobic training, and balance exercises, with specific frequency and intensity recommendations.
• 💡 Education on OA, lifestyle, and treatment options, including surgery, should accompany exercise programs.
• ❌ Treatments like massage, TENS, ultrasound, and thermal therapy generally should not be offered, except TENS for severe pain.
• ⏳ Long-term exercise adherence is key, supported by booster sessions for sustained results.

Q & A

What is the main focus of the video?

The video focuses on diagnosing and treating osteoarthritis (OA) in the hip and knee, based on the 2020 practice guideline. It emphasizes the role of physical therapy in managing OA symptoms and avoiding joint replacement when possible.

Is a radiograph necessary to diagnose symptomatic OA in the hip or knee?

No, a radiograph is not necessary to diagnose symptomatic osteoarthritis in the hip or knee, according to the guideline mentioned in the video.

What are some important questions to ask during history-taking for a patient with potential OA?

Important questions include: How did the pain start? Is it constant or intermittent? Is there pain on exertion, at night, or at rest? Are there any movement restrictions or muscle strength deficits? Is the joint swollen or hot? Has the patient experienced a sudden increase in pain?

What are some risk factors for OA that should be considered during diagnosis?

Risk factors include joint deformity, history of surgery or trauma, being overweight, congenital abnormalities, and OA symptoms in other joints.

How should physical therapists categorize OA patients to determine treatment plans?

OA patients can be categorized into four groups: 1) those who need advice or exercise instructions, 2) those needing short-term guidance and supervision, 3) those requiring long-term care, and 4) patients who are undergoing or have undergone surgery and need pre/post-operative care.

What type of exercise is recommended for OA patients?

The guideline recommends a combination of joint-specific exercises, general exercises, and aerobic activity. Patients should engage in at least two muscle-strengthening sessions per week and 30 minutes of aerobic exercise five times per week. Exercise should be tailored to individual goals and abilities.

What are the key components of a well-rounded exercise program for OA patients?

A comprehensive exercise program should include individual goals, muscle strengthening, aerobic exercise, and balance or coordination exercises. The program should progress based on the patient’s abilities and focus on long-term adherence to physical activity.

What should be done if a patient experiences joint pain after exercising?

If joint pain increases for more than two hours after exercising, the intensity of the exercise should be scaled down to avoid further irritation or injury.

Are there any other evidence-based treatments besides exercise that are recommended for OA?

Exercise is strongly recommended, but other treatments like massage, TENS, and passive mobilization are not recommended. However, short-term TENS may be beneficial for severe pain that impedes exercise.

Why is education important in the management of OA, and what should it include?

Education is crucial to help patients understand OA, manage their symptoms, and make informed decisions about treatments like surgery. It should cover topics such as the condition’s impact, the importance of exercise, healthy lifestyle choices, and available treatment options.