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World J Orthop. Oct 18, 2013; 4(4): 175-177
Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.175
Multi-factorial sustainability approach is necessary to preserve knee function following osteoarthritis diagnosis
John Nyland, Roland Jakob
John Nyland, Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY 40202, United States
Roland Jakob, Orthopaedic Surgery, Hopital Cantonal, CH-1701 Fribourg, Switzerland
Author contributions: Both authors collaboratively conceived, designed and developed this editorial.
Correspondence to: John Nyland, EdD, DPT, Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 S. Jackson St., Louisville, KY 40202, United States.
Telephone: +1-502-8522782 Fax: +1-502-8527227
Received: May 7, 2013
Revised: July 23, 2013
Accepted: August 8, 2013
Published online: October 18, 2013

Knee function preservation following a diagnosis of osteoarthritis may benefit from healthy patient lifestyles, exercise or activity habits, and daily living routines. Underlying societal issues and social roles may contribute further to both ecological and knee function preservation concerns. Based on sustainability theory and social ecology concepts we propose that factors such as health history, genetic predisposition, socio-environmental factors and local-regional-global physiological system viability contribute to knee function preservation. Addressing only some of these factors or any one factor in isolation can lead the treating physician, surgeon and rehabilitation clinician to less than optimal treatment effectiveness. An example is presented of a 57-year-old man with medial tibiofemoral osteoarthritis. In the intervention decision-making process several factors are important. Patients who would benefit from early knee arthroplasty tend to place osteoarthritic knee pain elimination at the top of their list of treatment expectations. They also have minimal or no desire to continue impact sport, recreational or vocational activities. In contrast, patients who are good candidates for a knee function preservation treatment approach tend to have greater expectations to be able to continue impact sport, recreational or vocational activities, are willing and better able to implement significant behavioral changes and develop the support systems needed for their maintenance, are willing to tolerate and live with minor-to-moderate intermittent knee pain, and learn to become more pain tolerant.

Keywords: Knee surgery, Treatment planning, Comprehensive care

Core tip: Total knee arthroplasty likely provides the best chance for knee osteoarthritic pain elimination. What is less understood by the patient is the needed reduction in recreational sport or vocational activities that will likely follow this intervention and the negative impact that elimination of these activities will potentially have on local-regional-global physiological systems, psychosocial factors, and quality of life. Patient satisfaction regarding the selection of either early knee arthroplasty or knee joint preservation is largely based on their expectations and the likelihood that these expectations are realistic.