orthopedics.Osteoarthritis.(dr.ariwan)

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orthopedics.Osteoarthritis.(dr.ariwan)

  1. 1. Osteoarthritisosteoarthroses
  2. 2.  Chronic degenerative disorder of synoveal joints with progressive softening, disintegration of articular cartilage, osteophyte formation. Etiology: Age (50%>60 year). ♂=♀ (♀-polyarticular). Genetics (type II collagen). Inflammation (Arthritis). Asymmetric loading (Deformity, Instability, Fractures, Dysplasia).
  3. 3. Pathogeneses – Collagen failure. – Proteoglycan loss. – Cartilage deformation. – Chondrocyte damage, enzyme release. Collagen failureProteolytic enzyme Proteoglycan matrix loss Cartilage deformation release Chondrocyte damage
  4. 4. Pathology Progressive cartilage destruction (Fraying, Fibrillation). Ivory like bone (Eburination). Subchondral cyst. Subchondral Scleroses. Marginal Osteophytes. Capsular fibroses. Subchondral venous congestion.
  5. 5. Clinical featuresAbove middle age. ♀ usually polyarticular. Knee& hip,interphalangeal joints (♀). Previous joint problem(Fracture, Deformity, Infection, Dysplasia). Symptoms intermittent.
  6. 6. Clinical features Pain (Diffuse, Gradual, ↑Exertion, Night Pain) {cause}. Stiffness (After rest). Swelling (Intermittent, Constant). Deformity. Loss of function (Limping). Crepitus. Baker cyst. Muscle wasting.
  7. 7. ImagingPlain X-ray: Four Cardinal SignsNarrow joint space (Asymmetric).Subchondral scleroses.Marginal Osteophytes.Subchondral cysts.• Subluxation.• Features of the cause.
  8. 8. Imaging• MRI:Concomitent meniscal tear, bone cavities before surgery,assesing popliteal cyst.• CT scan: previous fracture, incongruity
  9. 9. ManagementEarly stage:• Physiotherapy (Movement, Muscle Power).• Load reduction (Wt. Reduction, stick, activities).• Analgesic medication {NSAID}, hyaluronic acid injections.
  10. 10. ManagementIntermediate stage:• Arthroscopic debridement (Mechanical, Chemical).• Osteotomy (Mechanical, Decompression).
  11. 11. ManagementLate stage:• Arthroplasty( standard treatment for late stages).• Arthrodeses(limited indications).

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