hi. yes i agree that for these patient TKR is the treatment of choice. but for those patients who donot go for surgery, v follow following protocol-

1) restriction of squatting and knee bending

2) Quadriceps and hamstring drill

3) analgesics

4) fomentation

5) glicosamine + diacerin combination

6) stick in same hand

in selective cases knee brace do help though i donot know how?

Studies have shown no correlation between radiographic and clinical changes in persons with knee osteoarthritis. You may try adding hip abductor and adductor strengthening, proprioception exercises, foot orthosis along with activity strategy training among others.

Dear Dhara,

The ultimate goal of exercise in OA is to prevent or delay disability. An exercise program should incorporate elements to lessen pain during activity and to

increase or at least maintain joint range of motion, periarticular muscle strength, joint stability, and aerobic capacity or level of conditioning.

Exercise in OA should be adapted according to the presence and severity of pain.

In painful episodes:

- Isometric exercise or exercise in a non weight-bearing

(e.g., biking, rowing with adapted tools) or

- In a partial weight-bearing position (e.g., aquatic ex) should be recommended.

In painless (or at least less painful) periods:

- Exercise program may include progressive muscle performance exercises.

The above exercise programs may delay disability but does not help regenerationof the cartilage. Hence, it can't recover the actual joint pathology, so the final choise of treatment will remain joint reconstruction or replacement surgery untill we get a new line of treatment.

Regards

Dear all, I agree with your line of management..

I think I find it difficult that specifically Indian rural people will follow this advies like use Western toilets, avoid cross leg sitting, squatting and kneel sitting..

I agree that there is a study published in 2006 which states that there is no correlation between xray finding pain and function in OA knee pt.

within the constraints of your rural population it would seem the 2 best possible options would be quadriceps strengthening in non weight bearing, a straight leg raise if the patellofemoral space is significantly involved and the simple 90-0 knee extension if it is not and assessment of weight bearing biomechanics to see if a simple adaptation to frontal or transverse plane knee motion, (orthotic as stated above), calcaneal varus or valgus tapping or strapping may help. As we so often hear, treat the patient, not the diagnostic report, good luck!

I can suggest the use of portable muscle stimulator if you have one,at the beginning to activate the muscles with atrophy

Best regards

Dear Juan thanks for your input..

I met many people like that who refuse surgeries and just want medications and physiotherapy, I agree totally with all above respected answers. But before that you should at least explain to such patient even in simple way that all these measures will not solve his problem. Change the beliefs and concepts of these patient should be the first priority of health care providers and this is need team work and focused programs. My messegae is our responsiblity towards such people are great and need more effort. Many thanks

Abdulrahman sir, I agree with your point of view..

I agree with Dr. Babaqi with regard to programms for education, etc. However, this is a reasonable solution in the long term and lasts decades. I also agree with the variety of symtomatic treatment modalities recommended above by the colleagues. I would add an old method for pain relief (rarely used today) - radiotherapy of the joint, which eliminates nerval endings for some time. You  should consult a radiologist for the appropriate dosage.

Although the question was on PT I would in this setting also focus on lifestyle factors which may affect symptoms, especially obesity and over weight.

Please continue physiotherapy as discussed by other colleagues . In addition , I would suggest Pulsed Electromagnetic field Therapy ( PEMF ) . PEMF relieves pain , reduces inflammation & heals tissues ( cartilage ) in knee osteoarthritis . At the Madras Institute of Magnetobiology ( MIM ) , we have found that patients have good relief from pain . It has been suggested that PEMF stimulates the calcium / calmoludin / nitric oxide / growth factor pathway by inhibiting inflammatory cytokines to reduce pain & inflammation & heals cartilage by stimulating TGF beta . This would be useful in patients who do not want surgery & do not tolerate NSAIDS . This is an adjuvant therapy & does not interfere with other therapies & is non invasive .