Osteoarthritis is a degenerative joint disease that involves the breakdown of articular cartilage and underlying bone. It most commonly affects weight-bearing joints like the knees and hips. Risk factors include age over 45, female sex, joint injuries, obesity, and hereditary factors. Symptoms include pain, stiffness, swelling, and loss of function. Diagnosis is made based on symptoms and confirmed with x-rays showing cartilage loss, bone spurs, and bone changes. Treatment focuses on pain management, physical therapy, braces, and surgery like joint replacement for severe cases.

1. Osteoarthritis

2. Osteoarthritis (OA)
• OA is the most common form of arthritis and
the most common joint disease
• Over 10 million Americans suffer from OA
of the knee alone
• Most of the people who have OA are older
than age 45, and women are more commonly
affected than men.
• OA most often occurs at the ends of the
fingers, thumbs, neck, lower back, knees, and
hips.
Definition : is a degenerative joint disease
in which there is progressive loss of
articular cartilage and accompained by
new bone formation and capsular fibrosis
.

3. Pathology of OA
• Any joint can be affected
• Articular cartilage is slowly worn away
• Bone is exposed ( subchondral bone)
• Bone at the margines of joint hypertrophies
to form ( osteophytes )
• Osteophytes eroded the synovial membrane

4. OA
OA is a disease of
joints that affects all
of the weight-bearing
components of the
joint:
•Articular
cartilage
•Menisci
•Bone
No extra articular features & no systemic illness

5. OA Nodal osteoarthritis Note bony
enlargement of distal and
proximal interphalangeal joints
(Heberden's nodes and Bouchard's
nodes, respectively).
OA is mainly a noninflammatory disease of
synovial joints
No joint ankylosis is observed in the course of
the disease
Non nodal
o less prominent & affect distal interphalengeal joints

6. CLASSIFICATION OF OA
• Primary OA Secondary OA
Etiology is unknown Etiology is known

7. Age
• Ageisthestrongestrisk factorforOA.AlthoughOAcanstartinyoungadulthood,ifpateintisover45yearsold,He
isathigherrisk.
Femalegender
• Ingeneral,arthritisoccursmorefrequentlyinwomenthaninmen.Beforeage45,OAoccursmorefrequently inmen;
afterage45,OAismorecommonin women.OAofthehandisparticularlycommonamongwomen.
Jointmal-alignment
• Peoplewithjointsthatmoveorfittogetherincorrectly,suchasbowlegs,adislocatedhip,ordouble-jointedness,are
OA – Causes & risk factors

8. Hereditarygenedefect
• Adefectinoneofthe genesresponsibleforthecartilagecomponentcollagen cancausedeterioration ofcartilage.
Jointinjury orpreviousdisease overusecausedby orsports
• Traumaticinjury(ex.Ligamentormeniscaltears)tothekneeorhipincreasestherisk fordevelopingOAin these
joints.Jointsthatareusedrepeatedlyincertainjobsmay bemore likelytodevelopOAbecauseofinjuryoroveruse.
Obesity
• BeingoverweightduringmidlifeorthelateryearsisamongthestrongestriskfactorsforOAoftheknee.
OA – Risk Factors

9. OA – Symptoms
• OA usually occurs slowly -
It may be many years before
the damage to the joint
becomes noticeable
• Only a third of people
whose X-rays show OA
report pain or other
symptoms:
– Pain intermittent at first but later chronic in a
joint
Worst in the evening , relieved by rest
– Morning Stiffness or that tends to follow
periods of inactivity, such as sleep or sitting .
– Disability

10. signs
1-Swelling o r2- tenderness in one or more joints [not
necessarily occurring on both sides of the body at the
same time]
-3-Crunching feeling or sound of bone rubbing on bone
(called- crepitus) when the joint is use
4-Muscle wasting
5-Joint deformities

11. Osteoarthritis (OA)
Osteoarthritis may result from wear and tear
on the joint
•The normal
cartilage lining
is gradually
worn away and
the underlying
bone is
exposed.

13. Osteoarthritis (OA)
•The repair mechanisms of tissue absorption and
synthesis get out of balance and result in
osteophyte formation (bone spurs) and bone cysts
A case of the, “Which
came first? The
chicken or the egg?”

14. OA – Articular Cartilage
Articular cartilage is the main tissue affected
OA results in:
•Increased tissue swelling
•Change in color
•Cartilage fibrillation
•Cartilage erosion down to subchondral bone

15. OA – Articular Cartilage

16. OA – Articular Cartilage
The cartilage damage causes chondrocyte cloning in an
attempt to restore articular surface (Normal adult
chondrocytes are fully differentiated and do not proliferate)
(A) Normal articular cartilage (B) Osteoarthritic cartilage

17. Osteoarthritis with lateral osteophyte, loss of articular cartilage and
some subchondral bony sclerosis- X-ray shows loss of joint space
OA – Overall Changes

18. Asymmetrical joint space narrowing from loss of
articular cartilage
The medial (inside) part of the knee is most commonly affected by osteoarthritis.
OA – Radiographic Diagnosis

19. OA – Radiographic Diagnosis
•Asymmetrical
joint space
narrowing
•Periarticular
sclerosis
•Osteophytes
•Sub-chrondral
bone cysts

22. OA – Arthroscopic Diagnosis
Normal Articular Cartilage
Ostearthritic degenerated cartilage
with exposed subchondral bone
Arthroscopy allows earlier
diagnosis by demonstrating the
more subtle cartilage changes
that are not visible on x-ray

23. Defferential diagnosis
1-Avascular necrosis
2-Inflammatory arthropathies
(a) Osteoarthritis with marked subarticular
bone collapse is sometimes mistaken for osteonecrosis. The
clue to the diagnosis is that in OA the articular ‘space’
(cartilage) is progressively reduced before bone collapse
occurs, whereas in primary osteonecrosis (b) articular
cartilage is preserved even while the underlying bone
crumbles

24. Defferential diagnosis
3-Polyarthritis of the
fingers
4-Diffuse idiopathic
skeletal hyperostosis
(DISH)

25. Treatement
• GENERAL ( rest , weight loss , suitable
walking stick , change occupation )
• Drug treatment ( symptomatic relief by
NASIDS ,For inflammatory ecxerbations by
intraarticular corticosteroid )
• Physical therapy
• Surgical (Arthrodesis , Arthroplasty )

26. Non-Pharmacologic
Treatment of OA
Patient education
Weight loss (if overweight)
Physical therapy
Range-of-motion exercises
Muscle-strengthening exercises
Assistive devices for ambulation
Patellar taping
Appropriate footwear
Lateral-wedged insoles (for genu varum)
Bracing
Occupational therapy
Joint protection and energy conservation

27. OA – Arthroscopic Treatment
•In addition to being the most accurate way of determining how
advanced the osteoarthritis is:
•Arthroscopy also allows the surgeon to debride the knee joint
•Debridement essentially consists of cleaning out the joint of all debris
and loose fragments. During the debridment any loose fragments of
cartilage are removed and the knee is washed with a saline solution.
•The areas of the knee joint which are badly worn may be roughened with
a burr to promote the growth of new cartilage - a fibrocartilage material
that is similar scar tissue.
•Debridement of the knee using the arthroscope is not 100% successful. If
successful, it usually affords temporary relief of symptoms for somewhere
between 6 months - 2 years.
•Arthroscopy also allows access for surgical treatment of articular
cartilage: graft-transplantation, micro-fracture techniques, sub-
chondral drilling

28. OA – Non-operative Treatments
•Pain medications
•Physical therapy
•Walking aids
•Shock absorption
•Re-alignment through
orthotics
•Limit strain to affected
areas

29. The ultimate solution for osteoarthritis of the knee is to
replace the joint surfaces with an artificial knee joint:
•Usually only considered in people over the age of 60
•Artificial knee joints last about 12 years in an elderly population
•Not recommended in younger patients because:
•The younger the patient, the more likely the artificial joint will fail
•Replacing the knee the second and third time is much harder and much
less likely to succeed.
•Younger patients are more active and place more stress on the artificial
joint, that can lead to loosening and failure earlier
•Younger patients are also more likely to outlive their artificial joint, and
will almost surely require a revision at some point down the road.
•Younger patients sometimes require the surgery (simply because
no other acceptable solution is available to treat their condition)
Total Knee Replacement

30. •The ends of the femur, tibia, and patella are shaped to accept
the artificial surfaces.
•The end result is that all moving surfaces of the knee are
metal against plastic
Total Knee Replacement

31. Total Knee Replacement

32. Total Knee Replacement
Photographs of total knee
components on model
bone

33. Total Knee Replacement

34. Questions