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<ul><li>Chronic disorder </li></ul><ul><li>Degenerative joint disease </li></ul><ul><li>result in progressive erosion of a...
Epidemiology <ul><li>Starts at 50 years of age </li></ul><ul><li>Female > male (2: 1) </li></ul><ul><li>10% of general pop...
Classification <ul><li>Primary  OA – idiopathic and appear insidiously </li></ul><ul><ul><li>arises without obvious predis...
<ul><li>Secondary  OA – presence of other predisposing factor </li></ul><ul><ul><li>Previous trauma  and  mechanical  prob...
Pathology   <ul><li>The cardinal features are: </li></ul><ul><ul><li>Progressive loss of cartilage thickness </li></ul></u...
Pathogenesis   <ul><li>the normal homeostasis in the joint is disturbed </li></ul><ul><li>OA is a disease of  wear-&-tear ...
<ul><li>Characterized by significant changes of: </li></ul><ul><ul><li>Composition </li></ul></ul><ul><ul><li>Mechanical p...
Morphology <ul><li>Early stage: </li></ul><ul><ul><li>Increased in chondrocytes </li></ul></ul><ul><ul><li>Subsequently  ...
Clinical features <ul><li>Pain  </li></ul><ul><li>Stiffness </li></ul><ul><li>Swelling  </li></ul><ul><li>Deformities </li...
History <ul><li>Age – 50++, obese? </li></ul><ul><li>Occupation – what type?  </li></ul><ul><li>Any history of trauma that...
Physical examination <ul><li>General examination </li></ul><ul><li>Elderly, obese lady </li></ul><ul><li>Inspection </li><...
<ul><li>Movement  </li></ul><ul><li>Limited (reduced ROM) </li></ul><ul><li>Crepitus on movement </li></ul><ul><li>Special...
Clinical course <ul><li>Insidious onset </li></ul><ul><li>Deep, achy pain that worsen with use </li></ul><ul><li>Morning s...
<ul><li>Heberden nodes : </li></ul><ul><ul><li>In women, not in men </li></ul></ul><ul><ul><li>Prominent osteophytes at th...
Investigation  <ul><li>X – ray features: </li></ul><ul><ul><li>Narrowing or loss of joint space (1 st  sign of OA) </li></...
 
<ul><li>Treatment of osteoarthritis can be divided into 2: </li></ul><ul><ul><li>Conservative management  </li></ul></ul><...
TREATMENT Try to treat patient conservatively, if failed-surgical 1. CONSERVATIVE <ul><li>Relieve pain </li></ul><ul><li>–...
2.OPERATIVE MANAGEMENT Arthroscopic debridement and cleaning of the joint cavity and infusion of synthetic synovial fluid ...
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Osteoarthritis

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Osteoarthritis

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  1. 2. <ul><li>Chronic disorder </li></ul><ul><li>Degenerative joint disease </li></ul><ul><li>result in progressive erosion of articular cartilage </li></ul>
  2. 3. Epidemiology <ul><li>Starts at 50 years of age </li></ul><ul><li>Female > male (2: 1) </li></ul><ul><li>10% of general population </li></ul><ul><li>*OA increases in frequency with age. Not because of ageing but OA takes many years to develop. </li></ul>
  3. 4. Classification <ul><li>Primary OA – idiopathic and appear insidiously </li></ul><ul><ul><li>arises without obvious predisposing influences </li></ul></ul><ul><ul><li>( majority of cases) </li></ul></ul><ul><ul><li>Oligo-articular </li></ul></ul><ul><li>Age </li></ul><ul><li>Genetic – familial tendency </li></ul><ul><li>Obesity – OA knee </li></ul>
  4. 5. <ul><li>Secondary OA – presence of other predisposing factor </li></ul><ul><ul><li>Previous trauma and mechanical problem – intrarticular # (stepping >1cm),recurrent dislocation </li></ul></ul><ul><ul><li>Infection – septic arthritis </li></ul></ul><ul><ul><li>Congenital deformity of a joint- Perthe’s ds, SUFE </li></ul></ul><ul><ul><li>Inflammatory – RA </li></ul></ul><ul><ul><li>Underlying systemic diseases </li></ul></ul><ul><ul><ul><li>DM, Haemochromatosis, Obesity </li></ul></ul></ul><ul><ul><li>Knees & hands in women, Hips in men </li></ul></ul>
  5. 6. Pathology <ul><li>The cardinal features are: </li></ul><ul><ul><li>Progressive loss of cartilage thickness </li></ul></ul><ul><ul><li>Subarticular cyst formation and sclerosis </li></ul></ul><ul><ul><li>Remodelling of the bone ends and osteophyte formation </li></ul></ul><ul><ul><li>Synovial irritation </li></ul></ul><ul><ul><li>Capsular fibrosis </li></ul></ul>
  6. 7. Pathogenesis <ul><li>the normal homeostasis in the joint is disturbed </li></ul><ul><li>OA is a disease of wear-&-tear based on: </li></ul><ul><ul><li>Occur in old age </li></ul></ul><ul><ul><li>Weight bearing joints </li></ul></ul><ul><ul><li>Increase frequency in the joints predisposed to abnormal mechanical stress  obese & previous joint deformity </li></ul></ul><ul><li>Genetic factors </li></ul><ul><li>Risk increased with: </li></ul><ul><ul><li>Reduced Bone density </li></ul></ul><ul><ul><li>High levels of oestrogen </li></ul></ul>
  7. 8. <ul><li>Characterized by significant changes of: </li></ul><ul><ul><li>Composition </li></ul></ul><ul><ul><li>Mechanical properties of cartilage </li></ul></ul><ul><li>Early  the degenerating cartilage </li></ul><ul><ul><li>Increased in water </li></ul></ul><ul><ul><li>Decreased concentration of proteoglycans </li></ul></ul><ul><ul><li>Weakening of collagen network (reduce type II collagen) </li></ul></ul><ul><ul><li>IL-1, TNF and NO are increased in the joint </li></ul></ul><ul><ul><li>Increased apoptosis of chondrocytes </li></ul></ul><ul><li>These resulted in: </li></ul><ul><ul><li>Reduce tensile strength </li></ul></ul><ul><ul><li>Reduce resilience </li></ul></ul><ul><ul><li> DEGENERATION </li></ul></ul>
  8. 9. Morphology <ul><li>Early stage: </li></ul><ul><ul><li>Increased in chondrocytes </li></ul></ul><ul><ul><li>Subsequently  cracking of the matrix </li></ul></ul><ul><li>Gross </li></ul><ul><ul><li>Granular surface </li></ul></ul><ul><ul><li>Small fractures & dislodge , producing ‘joint mice’ </li></ul></ul><ul><ul><li>Osteophytes formation </li></ul></ul>
  9. 10. Clinical features <ul><li>Pain </li></ul><ul><li>Stiffness </li></ul><ul><li>Swelling </li></ul><ul><li>Deformities </li></ul><ul><li>Joint instability </li></ul><ul><li>Loss of function </li></ul>
  10. 11. History <ul><li>Age – 50++, obese? </li></ul><ul><li>Occupation – what type? </li></ul><ul><li>Any history of trauma that involve joint? </li></ul><ul><li>Rule out secondary causes – cong, RA </li></ul><ul><li>Any joint pain? – become worst by activity, relieve by rest </li></ul><ul><li>(usually patient complaint cannot walk long distance, stand for long) </li></ul><ul><li>Joint stiffness – early morning, long rest </li></ul><ul><li>Noticed swelling? </li></ul><ul><li>Ask daily activity affected or not?? </li></ul><ul><li>Climbing stairs </li></ul><ul><li>How do they pray? </li></ul><ul><li>- House works – cooking, laundry </li></ul>
  11. 12. Physical examination <ul><li>General examination </li></ul><ul><li>Elderly, obese lady </li></ul><ul><li>Inspection </li></ul><ul><li>Antalgic gait </li></ul><ul><li>Varus deformity </li></ul><ul><li>Muscle wasting over the quadriceps </li></ul><ul><li>Joint is swollen </li></ul><ul><li>No redness or discoloured </li></ul><ul><li>Palpation </li></ul><ul><li>Min/no joint effusion (patella tap) </li></ul><ul><li>Check for tenderness </li></ul><ul><li>Synovial membrane not thickened </li></ul><ul><li>Protuberant (osteophyte) at the edge of articular cartilage </li></ul>
  12. 13. <ul><li>Movement </li></ul><ul><li>Limited (reduced ROM) </li></ul><ul><li>Crepitus on movement </li></ul><ul><li>Special test </li></ul><ul><li>Valgus and varus stress test </li></ul>
  13. 14. Clinical course <ul><li>Insidious onset </li></ul><ul><li>Deep, achy pain that worsen with use </li></ul><ul><li>Morning stiffness </li></ul><ul><li>Crepitus </li></ul><ul><li>Limited ROM </li></ul><ul><li>Impingement on spinal foramina by osteophytes  radicular pain, muscle spasm & atrophy </li></ul><ul><li>Typically, only one or a few joints </li></ul><ul><li>Joint involved: </li></ul><ul><ul><li>Hips </li></ul></ul><ul><ul><li>Knees </li></ul></ul><ul><ul><li>Lower lumbar & cervical </li></ul></ul><ul><ul><li>Proximal & distal IP joints </li></ul></ul><ul><ul><li>First carpometacarpal </li></ul></ul><ul><ul><li>First metatarsal </li></ul></ul>
  14. 15. <ul><li>Heberden nodes : </li></ul><ul><ul><li>In women, not in men </li></ul></ul><ul><ul><li>Prominent osteophytes at the distal IP joints </li></ul></ul><ul><li>No satisfactory means of preventing primary OA </li></ul><ul><li>Permanent disability </li></ul>
  15. 16. Investigation <ul><li>X – ray features: </li></ul><ul><ul><li>Narrowing or loss of joint space (1 st sign of OA) </li></ul></ul><ul><li> reflects loss of articular cartilage; main pathology </li></ul><ul><ul><li>Osteophyte formation-around the periphery of the joint </li></ul></ul><ul><ul><li>Subchondral sclerosis-looks very white on the radiograph </li></ul></ul><ul><ul><li>Subchondral cyst </li></ul></ul>
  16. 18. <ul><li>Treatment of osteoarthritis can be divided into 2: </li></ul><ul><ul><li>Conservative management </li></ul></ul><ul><ul><li>Operative management </li></ul></ul><ul><ul><ul><li>indicated for patients with persistent symptoms </li></ul></ul></ul>
  17. 19. TREATMENT Try to treat patient conservatively, if failed-surgical 1. CONSERVATIVE <ul><li>Relieve pain </li></ul><ul><li>– Analgesic and NSAIDS </li></ul><ul><li>Intra articular corticosteroid </li></ul><ul><li>Rest period and modification of activity </li></ul>To increase movement to prevent ms wasting and deformity/contracture - physiotherapy/exercise programme,non -weight bearing exercise to strengthen ms strength (cycling.swimming) <ul><li>To reduce load on the joint </li></ul><ul><li>Weight loss if patient is obese </li></ul><ul><li>Use of walking stick to distribute the load </li></ul><ul><li>avoid unnecessary stress,eg jogging,climbing stairs </li></ul>
  18. 20. 2.OPERATIVE MANAGEMENT Arthroscopic debridement and cleaning of the joint cavity and infusion of synthetic synovial fluid Realignment osteotomy- for unicompartmental OA, to redistribute the loading forcetowards less damaged parts of the jt <ul><li>Arthrodesis </li></ul><ul><li>If stiffness is acceptable and neighbouring joints are not likely to be prejudiced </li></ul><ul><li>Usually done in young patient </li></ul><ul><li>Arthroplasty </li></ul><ul><li>Joint replacement </li></ul><ul><li>Usually done in old patient </li></ul>
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