Case Study: Osteoarthritis in a 60-Year-Old Female with Past Trauma, Diabetes, and Hypertension

A 60-year-old housewife walks into the clinic, clutching her right knee, wincing in pain. She sighs as she lowers herself onto the chair, adjusting her posture with great difficulty.

“Doctor, my knees just don’t work like they used to!” she exclaims, frustrated by the persistent pain, stiffness, and difficulty walking.

This case study explores osteoarthritis (OA) of the knee, how biomechanical changes contribute to it, and how we can manage it effectively.

Demographic Data

• Name: Mrs. A
• Age: 60 years
• Gender: Female
• Occupation: Housewife
• Dominancy: Right-hand dominant
• Address: Urban residence

Chief Complaint

• Pain in the right knee for the past 3 years, progressively worsening.
• Stiffness in the morning, lasting around 15–20 minutes.
• Difficulty in climbing stairs and prolonged standing.
• Occasional “crackling” sounds (crepitus) during movement.

History

Present History

Mrs. A has been experiencing progressive knee pain over the past three years. Initially, it was mild and only appeared after long walks. However, over the last six months, the pain has intensified, limiting her daily activities.

She reports:
✅ Pain aggravated by prolonged standing, walking, and squatting.
✅ Pain relieved with rest and mild painkillers (NSAIDs).
✅ Mild swelling and stiffness after prolonged inactivity.

Past History

• 10 years ago, Mrs. A slipped in the kitchen and suffered a right knee injury.
• She recovered but never regained full strength and mobility.

Personal History

• Sleep – Frequently disturbed due to knee pain.
• Diet – Low in protein and calcium.
• Appetite – Normal.
• Addiction – No smoking or alcohol history.

Medical History

• Diabetes (Type 2) for 12 years – Poor wound healing and cartilage degradation.
• Hypertension for 8 years – Taking antihypertensive medication.

Surgical & Drug History

• No prior surgeries.
• Medications: Metformin (for diabetes), Amlodipine (for hypertension), NSAIDs (for pain management).

Occupational & Environmental History

• Spends long hours in standing positions while cooking and cleaning.
• Prefers sitting cross-legged on the floor.

Pain Assessment

On Observation

On Palpation

✅ Temperature – Normal.
✅ Swelling – Present over medial joint line.
✅ Spasm – Mild in hamstrings and quadriceps.
✅ Tenderness – Significant over medial femoral condyle.

On Examination

Radiological Findings (X-ray & MRI)

X-ray Findings

✅ Joint space narrowing – Medial compartment affected.
✅ Osteophytes (bone spurs) – Present along femoral and tibial edges.
✅ Subchondral sclerosis – Increased bone density under cartilage.

MRI Findings

✅ Cartilage thinning & loss – Especially in the medial compartment.
✅ Meniscal degeneration – Mild tear observed.

Correlation Between Osteoarthritis, Biomechanics, and Functional Impairment in a 60-Year-Old Female

Osteoarthritis (OA) of the knee is often seen as an “aging problem,” but in reality, it is a complex interplay of biomechanics, joint degeneration, and lifestyle factors. The case of Mrs. A, a 60-year-old housewife with a past trauma, diabetes, and hypertension, illustrates how biomechanical alterations accelerate joint wear and tear, leading to pain, functional limitations, and postural changes.

Let’s break it down: Why does OA progress the way it does? How does biomechanics play a role? And how can we intervene?

1. Biomechanical Changes in Osteoarthritis

Normal Knee Biomechanics: How the Knee Should Work

The knee is a hinge joint, primarily allowing:
✅ Flexion & Extension (Bending & Straightening).
✅ Minimal Rotation (Helps in knee stability during movement).

In a healthy knee:

• Cartilage absorbs shock, reducing wear and tear.
• The menisci distribute weight evenly, preventing excess pressure.
• The quadriceps and hamstrings stabilize the joint, controlling movement.

But when osteoarthritis sets in, everything changes.

2. How Biomechanics Changes in Knee Osteoarthritis

When Mrs. A first came in, her knee had structural and functional impairments that changed her movement pattern. Here’s what we found:

a) Joint Instability & Altered Load Distribution

🔻 Cartilage Thinning → Increased Bone-to-Bone Contact

• In healthy knees, cartilage prevents friction.
• In OA knees, cartilage wears down → leading to joint space narrowing.
• This shifts the body’s weight unevenly, leading to pain & stiffness.

🔻 Meniscus Degeneration → Poor Shock Absorption

• The meniscus distributes forces across the knee.
• In OA, it weakens or tears, causing localized pressure points on the bones.

b) Muscle Weakness & Postural Adaptation

🔻 Weak Quadriceps → Poor Knee Control

• Quadriceps control knee extension & prevent buckling.
• Mrs. A’s weak quadriceps (3/5 MMT) meant she struggled with stair climbing & standing up.

🔻 Hamstring Tightness → Increased Joint Compression

• Tight hamstrings pull the knee backward, increasing joint stress.
• Limited ROM in flexion & extension affects walking, sitting, and squatting.

🔻 Valgus Knee (Knock-Knee Posture) → Altered Weight-Bearing

• OA in the medial knee compartment leads to a knock-knee deformity (valgus alignment).
• This misalignment shifts body weight toward the inside of the knee, further damaging cartilage.

c) Gait Adaptation & Energy Expenditure

🔻 Antalgic Gait (Pain-Avoiding Walk) → Limping & Slow Steps

• Mrs. A limps to avoid pain, reducing weight-bearing on her right leg.
• This changes her walking mechanics → increasing strain on the opposite hip & knee.

🔻 Increased Ground Reaction Force (GRF) on Medial Knee

• Normally, weight distributes 50/50 on both knees.
• In OA, the medial side absorbs more force due to valgus knee & weak quadriceps.
• This accelerates degeneration and increases pain.

3. How Poor Biomechanics Leads to Further Joint Damage

🔴 The Cycle of OA Progression (Vicious Cycle of Joint Breakdown)

If this cycle isn’t broken, Mrs. A could eventually need a total knee replacement.

4. The Role of Physiotherapy in Correcting Biomechanical Deficits

✅ Quadriceps Strengthening → Improves knee extension & shock absorption.
✅ Hip Strengthening (Gluteus Medius Activation) → Improves knee stability & valgus alignment.
✅ Hamstring Stretching → Reduces posterior knee tightness.
✅ Postural Training → Corrects valgus knee & abnormal gait mechanics.
✅ Gait Training → Encourages proper heel-to-toe walking pattern.
✅ Orthotics & Bracing → Redistributes joint load to reduce pain.

Diagnosis: Osteoarthritis of the Knee (Medial Compartment OA – Grade 3)

Based on:
✅ Clinical Examination (Pain, stiffness, joint deformity).
✅ X-ray & MRI Findings.
✅ Biomechanical Alterations.

Physiotherapy Treatment Plan

1. Exercise Therapy with Biomechanics & Posture Correction

✅ Quadriceps Strengthening (Isometric holds, squats).
✅ Hamstring & Calf Stretching – To improve joint mobility.
✅ Weight-bearing & Balance Training – To improve gait stability.
✅ Postural Correction Exercises – To reduce valgus stress on the knee.

2. Electrotherapy for Pain Relief

✅ TENS (Transcutaneous Electrical Nerve Stimulation) – For pain relief.
✅ Ultrasound Therapy – To reduce inflammation.

3. Lifestyle Modifications & Home Program

✅ Weight Loss – Reduces knee stress by 4X per pound lost.
✅ Proper Footwear – Shock-absorbing soles to reduce joint impact.
✅ Avoid Sitting Cross-Legged – Prevents further joint misalignment.

Conclusion: Can We Slow Down Osteoarthritis?

Yes! While OA cannot be reversed, it can be managed effectively with exercise, therapy, and lifestyle modifications.

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