Thread by @1gregorross

Short thread on knee osteoarthritis (OA) and total knee replacements (TKR)

Spoiler, OA does NOT always lead to you needing a TKR.

Keep being active, whatever your preferred activity!

If you do end up needing a TKR they can be fantastic and you can return to being active

Knee OA is very common. Approximately 1 in 5 adults >45 y/o in England have knee OA.

cks.nice.org.uk/topics/osteoar…

Exercise should be a core treatment for knee OA

Try to lose weight

Stop smoking

Discussed pain relief with your GP

Consider an injection

If none of above helping over a reasonable period of time (months not weeks) consider surgery

nice.org.uk/guidance/cg177…

Knee OA is NOT wear and tear.

It is a complicated multisystem disorder, involving systematic and local inflammatory & metabolic pathways

Way beyond my full comprehension but don't be fooled by the allure of simple wear and tear

sciencedirect.com/science/articl…

Keep active.

Don't be afraid of impact.

And if you like running, keep running. 🏃‍♂️ 🏃‍♀️

Self selected running pace does not worsen knee OA on x-ray and may actually improve pain symptoms

You should go follow @hjluks if this triggers you

pubmed.ncbi.nlm.nih.gov/29728929/

Having a diagnosis of knee OA does not mean it will definitely get worse, either symptomatically or as it appears on an x-ray.

This study showed lifetime risk of having a TKR for someone with knee OA was 30%

oarsijournal.com/article/S1063-…

This UK study showed 37% of people with knee OA did not show worsening on x-ray over 15 years.

And over 15 years approx 5-7% of those who had OA at baseline progressed to have a TKR

onlinelibrary.wiley.com/doi/epdf/10.10…

But, if you do end up needing a TKR, the odds on good outcome are in your favour!

But first, get prepared!

Get/stay fit and strong, physically and mentally, because it's not a walk in the park.

Time spent getting strong now could speed up your recovery
link.springer.com/article/10.100…

NHS data shows 65% would rate their outcome as very good or excellent and that goes up to 90% if you include those rating their outcome as good 👍

app.powerbi.com/view?r=eyJrIjo…

But as I said, not a walk in the park, you can have some issues to manage postop.
27% will have some form of complication, such as wound ooze or infection, urinary problems, allergic reaction (probably includes side effects to analgesia eg nausea so ? not true 'allergy')

But once you come out the other side you can get back to a full and active life! 🏃‍♀️ 🚜🚲🛼😆🧑‍🍳👨‍🌾🧑‍🔬

And that can include skiing, golf, tennis and yes even running.

This study showed 85% returned to their chosen sport on average 5 months postop

sicot-j.org/articles/sicot…

How long will it last?

Latest data from NJR estimates risk of revision to be 6.4% at 17 years.

So 93.6% of TKRs done 17yrs ago haven't been revised.

And bear in mind surgical/anaesthetic/therapeutic input should be improving, so current ones will hopefully last longer

Summary;

Knee OA is NOT wear & tear + does not mean u will def need TKR.

Keep active, live your best life, try analgesics.

Don't be afraid of TKR if YOU feel your symptoms warrant.

#orthotwitter
#msk
#kneeoa

Feedback from the twitter pros welcome

But go easy, I'm new to this 'threaducation' thing 😆

@DrJN_SportsMed @kneeguyuk @bellkneesurgeon @ClinicianBetter @Retlouping @Irish_Physio @manchesterknees @BillingMartin