Osteoarthritis

• Osteoarthritis

  • Degenerative arthritis
  • Arthrosis
  • Osteoarthrosis
  • Hypertrophic arthritis
  • Post-traumatic arthritis
• Osteoarthritis


  • Chronic condition of the synovial joint causing pain & stiffness & sometimes inflammation & swelling
  • Most common variety of arthritis
  • Degenerative wear-and-tear process occurring in joints that exceeds the capacity of the articular cartilage (hyaline cartilage) to renew and repair itself
• Risk factors for Osteoarthritis

  • Congenital failures of normal development, such as hip dysplasia
  • Irregularity of joint surfaces from previous fracture
  • Internal derangements, such as a loose body, a torn meniscus or cruciate ligament injury
  • Previous disease, leaving a damaged articular cartilage (Ex: rheumatoid arthritis or hemophilia)
  • Mal-alignment of a joint from any cause (Varus or valgus deformity)
  • Obesity (5 X risk of Developing OA by BMI above 30 in the same age group)
• Pathophysiology of Osteoarthritis


  • Any joint may be affected, lower limb joints more often than upper
  • Articular cartilage is slowly worn away until underlying bone is exposed
  • Subchondral bone becomes hard and glossy ('eburnation')
  • Bone at margins of the joint hypertrophies to form osteophytes
  • No primary change in the capsule or synovial membrane, but recurrent strains lead to slight thickening and fibrosis
• Pathophysiology of Osteoarthritis

  Joint affected -> Articular cartilage worn away -> Bone exposed -> Subchondral bone hard and glossy ('eburnation') -> Bone hypertrophies at margins to form osteophytes -> Recurrent strains lead to slight thickening and fibrosis
• Osteoarthritic knee

  • Most common in the medial tibiofemoral joint
  • Pain usually felt in the groin
  • Instability (feeling that the knee is going to give way)
  • Referred pain felt only in the knee not uncommon
  • Varus deformity
  • Pain worse on exercise, reduced walking distance
  • Fixed flexion deformity
  • Globally reduced range of movement with restricted internal rotation early in disease progression
  • Swelling and stiffness common features
  • Antalgic gait
  • Wasting of quadriceps muscles
• Clinical features of Osteoarthritis

  • Most patients past middle age, uncommon in young age
  • Gradual onset with pain increasing over months and years
  • Movements become more restricted
  • Deformity common in later stages, joint cannot be placed in neutral position
• Clinical features of Osteoarthritis

  Pain increases gradually over months and years -> Movements become more restricted -> Deformity common in later stages
• Examination for Osteoarthritis

  1. Slight thickening often found on palpation caused by marginal osteophytes

  2. Movements impaired according to degree of arthritis, crepitation may be present

  3. Fixed deformity found in hip, sometimes at knee and other joints
• Diagnosis of Osteoarthritis

  • Usually made clear by history, clinical findings, and radiographic features
• Management of Osteoarthritis

  • Non-pharmacological management
• The neutral anatomical position is often found in the hip, and sometimes at the knee and in other joints
• Varus deformity
• Swelling
• Diagnosis: This is usually made clear by the history, clinical findings, and radiographic features
• Management

  1. Non-pharmacological management: Education, Exercise, Weight loss, Appropriate footwear

  2. Further Non-pharmacological management: Physiotherapy to restore quadriceps muscle, Braces

  3. Pharmacological management: NSAID, Opioids, Intra-articular glucocorticoid

  4. Surgery: Indication: Debilitating pain and major limitation of functions such as walking and daily activities, Impaired ability to sleep or work (Failure of Conservative treatment). Osteotomy to realign a joint, Arthrodesis for the elimination of the joint by fusion, Total joint arthroplasty: The operation for construction of a new movable joint. Surgeon removes all the damaged bone and cartilage. Surgeons may replace affected joints with artificial joints called prostheses. Made from metal alloys, high-density plastic, and ceramic material. Joined to bone surfaces by special cements
• Osteoarthritis
• Rheumatoid arthritis
• PATHOGENESIS: Mechanical—wear and tear destroys articular cartilage (degenerative joint disorder) → inflammation with inadequate repair (mediated by chondrocytes). Autoimmune—inflammation induces formation of pannus (proliferative granulation tissue), which erodes articular cartilage and bone
• PREDISPOSING FACTORS

  • Age, female, obesity, joint trauma, Female, HLA-DR4, HLA-DRB1, Tobacco smoking, Rheumatoid factor, Anti-cyclic citrullinated peptide antibody (more specific)
• PRESENTATION: Pain in weight-bearing joints after use (eg, at the end of the day), improving with rest. Asymmetric joint involvement. Knee cartilage loss begins medially (“bowlegged”). No systemic symptoms. Pain, swelling, and morning stiffness lasting > 1 hour, improving with use. Symmetric joint involvement. Systemic symptoms (fever, fatigue, weight loss). Extraarticular manifestations common
• JOINT FINDINGS

  • Osteophytes (bone spurs), Joint space narrowing (asymmetric), Subchondral sclerosis, Cysts, Synovial fluid noninflammatory (WBC < 2000/mm3), Development of Heberden nodes (at DIP) and Bouchard nodes (at PIP), Erosions, Juxta-articular osteopenia, Soft tissue swelling, Subchondral cysts, Joint space narrowing (symmetric), Deformities: cervical subluxation, ulnar finger deviation, swan neck, boutonniere. Involves MCP, PIP, wrist; not DIP or 1st CMC
• TREATMENT: Activity modification, acetaminophen, NSAIDs, intra-articular glucocorticoids. NSAIDs, glucocorticoids, disease-modifying agents (eg, methotrexate, sulfasalazine), biologic agents (eg, TNF-α inhibitors)