Osteoarthritis of the Knee:       

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 - Discussion:
    - biomechanical considerations: (see kinematics and anatomy of knee
           - thick cartilaginous surfaces of the knee helps to spread out joint reactive load
             over a wide area and helps contribute to cam shape of  condyles which
             maximizes extensor lever arm;
           - in degenerative arthritis the quality of the articular cartilage is lost;
                  - early in the process, there may be discrete chondral injuries where as advanced changes
                     include chrondal injuries on both sides of the joint;
                  - as wear occurs, the patello femoral joint is reduced to a cylindrical outline;
                  - the mechanical outline is lost, but wear in the bone to bone contact area is reduced; 
           - reference: Does osteoarthrosis depend on growth of the mineralized layer of cartilage 
    - mechanical malalignment:
           - references:
                  - The role of knee alignment in disease progression and functional decline in knee osteoarthritis.
                  - The influence of alignment on risk of knee osteoarthritis progression according to baseline stage
                    of disease.
                  - Thrust during ambulation and the progression of knee osteoarthritis.
    - synovial fluid
           - Synovial fluid features and their relations to osteoarthritis severity: new findings from sequential studies.
           - Synovial fluid crystals in osteoarthritis.
           - The high prevalence of pathologic calcium crystals in pre-operative knees.

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 - Non Operative Treatment: (see narrated slide show)
          - NSAIDS 
          - colchicine
                 - A randomized controlled trial to evaluate the modifying effects of a regimen containing colchicine
                    in a subset of patients with OA of the knee.
                 - A randomized controlled trial to evaluate the slow-acting symptom-modifying effects of colchicine
                    in osteoarthritis of the knee: a preliminary report.
          - steroid injection
          - viscosupplementation: (hyaluronic acid) 
                 - Supartz, Hyalgan, Synvisc, Orthovisc, Euflexxa;
                 - references:
                        - Granulomatous Inflammation After Hylan G-F 20 Viscosupplementation of the Knee
                        - Increased Frequency of Acute Local Reaction to Intra-Articular Hylan GF-20 (Synvisc) in
                           Patients Receiving More Than One Course of Treatment 
                        - Clinical Trials of Hyaluronic Acid Reflect Significant Publication Bias

          - reduction of cartilage impact loading: (typically this is 6 times body wt);
                 - cane (same side vs opposite side)
                 - rubber heel wedges (consider lateral wedges w/ medial compartment arthrosis); 
                         - Medial knee osteoarthritis treated by insoles or braces: a randomized trial
                 - wt loss;
                 - valgus unloading knee brace; (see Donjoy and Breg)
                         - A Mechanical Theory for the Effectiveness of Bracing for Medial Compartment
                           Osteoarthritis of the Knee

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- Operative Treatment: 
          - total knee arthroplasty 
          - unicondylar replacement
          - high tibial osteotomy 
          - alternatives to total knee replacement:  autologous hamstring resurfacing arthroplasty
          - arthroscopy of osteoarthritic knee: 
          - arthodesis (limited indications in non infectious arthritis);