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Osteoarthritis: Key Facts (Symptoms (Affects: knees, hips, DIPs, PIPs,…
Osteoarthritis: Key Facts
Mx
Surgical
Arthroscopic Washout
Mainly knees
Trim cartilage
Remove loose bodies.
Realignment Osteotomy
Small area of bone cut out
Useful in younger (<50yrs) pts. c¯ medial knee OA
High tibial valgus osteotomy redistributes wt. to lateral part of joint.
Arthroplasty: replacement (or excision)
Arthrodesis: last resort for pain management
Novel Techniques
Microfracture: stem cell release → fibro-cartilage
formation
Autologous chondrocyte implantation
MDT
GP, physio, OT, dietician, orthopod
Conservative
Lifestyle: ↓ wt., ↑ exercise
Physio: muscle strengthening
OT: walking aids, supportive footwear, home mods
Medical
Analgesia
Paracetamol
NSAIDs: e.g. arthrotec (diclofenac + misoprostol)
Tramol
Joint injection: local anaesthetic and steroids
OA vs. RA
OA
Pathology
Degenerative
Negative serology
Clinical
Asymmetric
Large joints
Early AM stiffness <30min
Worse PM
Hands: DIPJs and PIPJs
No extra-articular features
Radiology
Osteophytes
Subchondral sclerosis
Subchondral cysts
Mild deformity
RA
Clinical
Symmetric
Small joints
Early AM stiffness >1hr
Worse AM
Hands: PIPJs and MCPJs
Extra-articular features
Radiology
Soft tissue swelling
Periarticular osteopenia
Periarticular erosions
Severe deformity
Pathology
Inflammatory
Positive serology
Ix
Exclude Rheumatological Disease
FBC
ESR
RF, ANA
Check Renal Function
Important before prescribing NSAIDs: esp. in elderly
U+E
X-ray Changes
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Deformity
Pathophysiology
Softening of articular cartilage → fraying and fissuring
of smooth surface → underlying bone exposure.
Subchondral bone becomes sclerotic c¯ cysts.
Proliferation and ossification of cartilage in unstressed
areas → osteophytes.
Capsular fibrosis → stiff joints
Symptoms
Affects: knees, hips, DIPs, PIPs, thumb CMC
Pain
Worse c¯ movement
Background rest/night pain
Worse @ end of day
Stiffness
Especially after rest: joint “gelling”
Lasts ~30min (e.g. AM)
Deformity: e.g. genu varus
↓ ROM
Definition
Degenerative joint disorder in which there is
progressive loss of hyaline cartilage and new bone
formation at the joint surface and its margin.
Aetiology / Risk Factors
Age (80% >75yrs)
Obesity
Joint abnormality
Classification
Primary: no underlying cause
Secondary: obesity, joint abnormality