KNEE JOINT
SWELLING
OUTLINE
• Introduction
• Classification
• Anatomy
• Aetiology
• Pathology
• Management
INTRODUCTION
• Knee joint is a mobile, weight bearing joint, the function of which depends on the
structures around it
• Gross swelling around the knee will impair the joint movement
CLASSIFICATION
• Swelling of entire joint . Eg : septic arthritis, osteoarthritis
• Swelling in front of the joint . Eg : bursitis
• Swelling behind the joint . Eg : popliteal cyst
• Bony swelling . Eg : exostosis.
ANATOMY OF KNEE JOINT
AETIOLOGY
• Traumatic- fractures, dislocation
• Infective- septic arthritis, Tb arthritis, osteomyelitis
• Degenerative- osteoarthritis
• Inflammatory – rheumatoid arthritis
• Coagulopathy- hemophilia
• Bursitis- prepatellar, infrapatellar
• Tumors- benign or malignant
INFECTIVE(SEPTIC ARTHRITIS)
• Arthritis caused by pyogenic organisms
• S.aureus , Streptococcus, Pneumococcus , Gonococcus.
• Swelling, warmth and tenderness
• High grade fever
• Knee is flexed
• Movements are painful
• Treatment: Rest, antibiotics – empirical- ceftriazone, cloxacillin, - specific treatment, arthrotomy then
surgical debridement and closure with drain insertion
TUBERCULOUS ARTHRITIS
• Infection spreads hematogenously and settles in metaphysis or epiphysis of femur or tibia
• Limping and aching
• Mild flexion deformity
• Regional lymphadenopathy
• Pain aggravated at night
• Treatment:Anti TB drugs(12-18 months) surgical- synovectomy, surgical debridement,
arthrodesis
• Triple deformity
• Posterior subluxation
• External rotation of tibia
• Flexion of knee
OSTEOARTHRITIS
• Degenerative old age disease – primary and secondary Osteoarthritis
• Causes for secondary Osteoarthritis:
• Irregular articular surface due to trauma or disease
• Loose foreign bodies within joint
• Congenital maldevelopment of joint
• Genu Valgum or varum- mal alignments
• Pain – dull aching initially, later becomes cramp like- worsens with movement
• Joint stiffness
• Crepitus maybe felt
• Swelling is a late feature
• TREATMENT
• Local heat, counter irritants
• weight reduction
• Analgesics
• Chondroprotective agents: glucosamine, chondroitin sulphate
• Viscoprotective agents: sodium hydronon intrarticular injections
• SURGERY :
• Joint preservation surgery- early stages- Arthroscopic removal of loose bodies, osteotomy to relieve pain
• Knee replacement surgery- advanced stage to restore function
RHEUMATOID ARTHRITIS
• Chronic non suppurative inflammation of the synovial joints.
• Diagnostic criteria:
• Morning stiffness
• Swelling of three or more joints
• Swelling of joints in hand and wrist
• Symmetrical swelling
• Rheumatoid nodules
• Rheumatoid factor positive
• X ray changes – Erosion or peri articular osteopenia .
• STAGES OF RHEUMATOID ARTHRITIS :
• Stage 1 :- body attacks its own joint tissue
• Stage 2 :- antibodies produced and joint swelling
• Stage 3 :- bones start bending and deformed
• Stage 4 :- no joint is remaining and essentially fused .
Clinical features:
• Acute symmetrical polyarthritis
• Fever
• Knee effusion ,
• Synovial hypertrophy,
• Deformity .
CONSERVATIVE TREATMENT :
• NSAID
• DMARD
• Steroids
• SURGICAL TREATMENT- synovectomy, arthroplasty, arthrodeisis
PIGMENTED VILLONODULAR SYNOVITIS
• Thickening and overgrow of the synovium .
• Mass or tumor ( not cancerous )
• Slowly worsens and leads to bone damage and arthritis.
• TREATMENT : Arthroscopy
HAEMOPHILIC ARTHRITIS
• Occurs due to bleeding disorders
• Occurs in males
• X ray – widening of intercondylar notch
• TREATMENT:
• Acute – factor VIII supplemention ,rest.
• Chronic – bracing , physiotherapy.
BURSITIS
BURSITIS
• TYPES – Irritative and infective bursitis.
• Anteriorly – pre patellar bursitis , infra patellar bursitis
• Medially – bursa anserina ,cysts of medial meniscus
• Laterally-cyst of lateral meniscus
• Posteriorly-semimembranous bursitis,mordants baker cyst
• TREATMENT :
• Rest ,
• Aspiration ,
• Corticosteroids.
TUMORS OF KNEE JOINT
Benign –excision,osteoma of Tibia, chondroblastoma
Malignant: soft tissue sarcoma, osteoclastoma
Clinical feature characteristic of GCT-: egg shell crackling on palpation
Diagnosis: x ray of GCT-soap bubble lesion in epiphysis, eccentrically placed
Treatment of GCT- surgical- excision, extended curretage, excision with reconstruction
