Osteoarthritis Osteoarthritis is a non-inflammatory, degenerative condition of joints Characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.
Common in weight-bearing joints such as hip and knee. Also seen in spine and hands. Both male and females are affected. But more common in older women i.e. above 50 yrs,particularly in postmenopausal age.
Risk factors Obesity esp OA knee Abnormal mechanical loading eg.meniscectomy, instability Inherited type II collagen defects in premature polyarticular O Inheritance in nodal OA Occupation eg farmers Infection:Non-gonococcal septic arthritisHereditaryPoor postureInjured joints
Ageing process in joint cartilageDefective lubricating mechanismIncompletely treated congenitaldislocation of hip
X-Ray Classification of OA1- No Osteophytes / Minimal changes2- Single osteophytes / Subchondrial sclerosis / Widening3- Significant narrowing, Multiple osteophytes4- Narrowing osteophytes, Deformity, Ankylosis
According to Limitation of Activity1- Patient is able to do physical activity2- Moderate decrease of physical activity3- Significant decrease of physical activity4- Total Ankylosis and no activity
Clinical features of OA Pain Stiffness Muscle spasm Restricted movement Deformity Muscle weakness or wasting Joint enlargement and instability Crepitus• Joint Effusion
Pain syndrome•Morning stiffness <20 mins•Pain is worst at the end of the day•Present muscular spasms•Inflammatory sinovits
Movement abnormalities ‘Gelling’: stiffness after periods of inactivity, passes over within minutes (approx 15min.) of using joint again Coarse crepitus: palpate/hear (due to flaked cartilage & eburnated bone ends)
Osteoarthritis of the DIPjoints. This patient hasthe typical clinicalfindings of advancedOA of the DIP joints,including large firmswellings (Heberden’snodes), some of whichare tender and red dueto associatedinflammation of theperiarticular tissues aswell as the joint.
Special Investigations Blood tests: Normal Radiological features: Cartilage loss Subchondral sclerosis Cysts Osteophytes
COMPLAINS a. Patient complains of pain of insidious onset in the knee joints. The pain is aching and poorly localized. b. Pain first occurs after normal joint use and can be relieved by rest. As the disease progresses, pain during rest develops. Morning stiffness lasts less than a half hour. c. Systemic symptoms are absent.
PATHOGENETICAL THERAPYChondroprotection a) systemic - 1500mg atleast 1yr, glucosamine, chondroitin sulfate, (most slowly influencing drugs b) local- Intrarticular injections (Hyaluronic acid, ) ), Traumeel, Alflutop) (A joint should not be injected more than 3 times a year. Intraarticular corticosteroids have an adverse effect on local car-tilage metabolism. )
Surgery 1. Indications a. Relief of pain or severedisability after failure ofconservative measures to reverseor alleviate the pathologic process. b. Correction of mechanicalderangement that may lead to OA.
Contraindications a. Infection. b. Poor vascular supply. c. Emotional instability or occupational factors that make surgical rehabilitation unlikely to succeed. d. Obesity (relative contraindication). e. Serious medical illness (relative contraindication).Knee procedures a. Osteotomy. b. Arthrodesis. c. Total knee prosthesis. d. Arthroscopic debridement.
Hip a. Osteotomy. b. Excision arthroplasty. . c. Arthrodesis. d. Total hip replacement