Osteoarthritis of the knee: the care pathway
The care pathway for osteoarthritis of the knee needs to be global, multidisciplinary and tailored to the individual.
Have you been diagnosed with osteoarthritis of the knee? A variety of health professionals will be involved in your care. This will depend on the progression of the disease, but also your age, your general health, your lifestyle and your preferences.
It is generally the patient’s own doctor, usually a general practitioner, that makes the diagnosis of osteoarthritis of the knee (or gonarthrosis). It is your own doctor who knows you best, who centralises your medical information and who is responsible for coordinating your care. So it is preferable to consult your own doctor first. In the event of knee pain and/or stiffness, following a physical examination, you may be prescribed an X-ray(1).
The role of the radiologist is to X-ray the knee from several different angles. In the event of osteoarthritis, the image of the painful knee will show one or more typical signs: joint space narrowing (the gap between tibia and the femur is reduced), small bony outgrowths called osteophytes, or densification of the bone below the cartilage(2).
A general practitioner bases their diagnosis of osteoarthritis of the knee on a combination of validated criteria: pain, radiological signs, risk factors, joint stiffness with limitation of movements and “cracking” noises when the knee is moved(2).
Mild, early and uncomplicated cases of osteoarthritis can generally be managed by GPs. But if you wish, or in the event of more advanced forms, your GP can also refer you to a rheumatologist.
If the diagnosis is confirmed, the rheumatologist or general practitioner (depending on your choice) will explain the disease to you, the treatments envisaged and the lifestyle changes that you should preferably make (physical exercise, adaptation of activities, weight loss, etc.).
Your GP may also seek the opinion of a sports medicine specialist, a physical and rehabilitative medicine specialist or an orthopaedic surgeon.
For effective follow-up of osteoarthritis of the knee, regular visits to a doctor (GP or specialist) are recommended. Depending on the treatment decided upon jointly by your GP, specialist and yourself, various health professionals may then get involved.
· Non-medicinal treatments
The role of the physiotherapist is to advise you on appropriate exercises to be carried out regularly depending on your abilities, preferences and lifestyle1.
Weight loss – if necessary – can be initiated with the support of a general practitioner, an endocrinologist, a dietician or nutritionist1.
Orthopaedic insoles, knee braces and walking sticks may be recommended by your doctor, physiotherapist or orthopaedic surgeon. Adjustments to your home environment may also be suggested by an occupational therapist.
Complementary therapy solutions, such as acupuncture (performed by acupuncturists), electrotherapy (by physiotherapists), osteopathy (by osteopaths) or thermal spa therapy can relieve certain patients1.
· Medicinal treatment
Medication (painkillers, anti-inflammatories, slow-acting symptomatic anti-arthritic drugs, etc.) may be prescribed by your general practitioner or the specialist. Some treatments injected into the joint, such as corticosteroid or hyaluronic acid infiltrations, are usually performed by the rheumatologist.1
· Surgery if necessary
In the event of advanced OA of the knee that is resistant to treatments, you may be offered surgery. This is performed in a hospital or clinic by an orthopaedic surgeon, assisted by their medical team.
A nurse and a physiotherapist will handle your care after the surgery. A doctor specialised in physical and rehabilitative medicine may coordinate or manage a functional rehabilitation programme.
If you have any questions, ask your doctor for advice.