Traditionally, osteoarthritis (OA) was diagnosed by the use of radiography, and joint arthroplasty was regarded as the only effective treatment. However, the results of the past 20 years of research have changed our thinking about the disease, and about how and when to treat it.
Many patients tolerate pain, and many health-care providers accept pain and disability as inevitable consequences of OA and ageing. Often, health-care providers passively wait for final 'joint death', necessitating knee and hip replacements. Instead, OA should be viewed as a chronic condition, where prevention and early comprehensive-care models are the accepted norm, as is the case with other chronic diseases.
Orthopedic Surgeon
Primary and secondary prevention strategies are necessary to prevent increased rates of OA resulting from ageing and increasing rates of obesity and physical inactivity, but strategies that are developed for knee OA might not be transferable to other joints, because of anatomical and other differences.
Primary prevention strategies are intended to prevent the onset of specific diseases via risk reduction, by altering behaviours or exposures that can lead to disease, or by enhancing resistance to the effects of exposure to a disease agent. Preventing knee injury and obesity during adolescence are examples of strategies that are relevant to knee OA.Â
Secondary prevention includes the detection and treatment of risk factors for progression in individuals who are already at risk. Examples relevant to knee OA include the detection and monitoring of weight gain and impairments in proprioceptive acuity, dynamic joint stability and muscle function, and subsequent intervention with weight management and targeted exercise therapy in those who already have sustained a knee injury.Â
OA is a heterogeneous disease with a large number of risk factors, which often interact with each other. Three important risk factors, which show promise for both primary and secondary intervention, are obesity, trauma and impaired muscle function
Each 8 kg increase in weight as a young adult (aged 20–29 years) is associated with a 70% increase in the risk of knee OA.Â
Around 50% of individuals who sustain an ACL injury develop KOA in 10–15 years, whether or not they have undergone surgery.
Knee OA cannot solely be considered a disease of the cartilage, and other contributing factors such as muscular impairments must be take into account.
• To prevent osteoarthritis development, the onset and interaction of multiple osteoarthritis risk factors should direct preventive strategies, for example, weight gain after menopause and muscle strength loss after joint trauma.
• Behavioral strategies, such as Motivational Interviewing, should be applied to explore the internal motivation for lifestyle changes in individuals at risk for osteoarthritis development.
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