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L14| Cold Orthopaedics & Degenerative joint disorders (Common…
L14| Cold Orthopaedics & Degenerative joint disorders
Common conditions
Degenerative - OA
Progressive disorder of joints caused by gradual loss of cartilage, resulting in the development of osteophytes (bone spurs) and cysts are margins of joints
Disability in people >50y/o
30% between 45-64
63-85% in >65y/o
Pri
: Abnormal stresses on weightbearing joints or normal stress n weakened joints
Usually knees, fingers, hips, spine
Genetically related
Obesity increases stress
Aging, reduction in ability for cartilage to repair itself
Enzymatic disturbance, bone disease, liver dysfunction, inflammatory isse
Knee
Gender: Women
Postmenopausal: Estrogen deficiency
Thinner cartilage
Sec to
:
Trauma
Repetitive stress (Keyboard)
Inflammatory (gout / sepctic arthirits)
Poor posture or bone alignment
Metabolic disorders
Pathogenesis
:
Microfissures in hyaline cartilage
Eburnation (degeneration) of bone
Clinical presentation
Pain
Deformity
Stiffness
Loss of function
Radiological features:
Decreased joint space
Subchondral sclerosis
Suubchondral cyst
Osteophytes
Bow legged ness
Mx non-srugical
:
1. Weight reduction
2. Exercise
3. Pharmacology:
Analgesics/NSAIDS/Glucosamine( fake)
Walking aids
Intra-articular injections (Steroids/viscosupplement)
NOT ACCUPUNCTURE NOTGLUCOSAMINE, NNOT HYLAURONIC ACID,
DO TRUE FALSE FOR MX SLIDE 30/31 :red_cross:
Mx surgical
:
Joint preserving (eg. high tibial osteotomy, leg cut at shin or fermur to realign and reduce stress on knee / Tibial tubercle elevation / )Arthroscopic Debridement
Joint replacement (Unicompartmental knee replacement, total knee replacement)
OPorosis
Systemic skeletal disease, characterized by low bone mass, microarchitectural deterioration of bone tissue leading to enhanced bone fragility and increase fracture risk
BONE IS FULLY MINERALIZED but ABNORMALLY POROUS, lower than normal strength, lack in quantitiy
Diagnosed by bone marrow density below young adult mean (S.D 2.5) slide 35
Types
REFER TO SLIDE 36 :red_cross:
Sec
Chronic medical condition (Endocrine/GI/Liver/Renal)
Drugs (Anticonvulsants/ Antipsych/ANtiretroviral/CHemo, steroid)
Pri
Senile
(Type 2)
Hip
Cortical/Trabecular
Low turnover osteoporosis
Aetiology: Poor calcium absorption
70y/o
Post menopausal
(Type 1)
Distal radius, vertebra
Only trabecular
High turnover osteopororsis (Osteoclast resorb v quickly > osteoblast lying down)
Aetiology: Loss of estrogen
55-70y/o
Radiographic features
Loss of trabecular
Thinning of cortices
OSteopenia (Less mineralized)
Investigations:
Gold standard
Bone Density Scan (DEXA,DXA)? Bone density scanning, also called dual-energy x-ray absorptiometry (DXA) or bone densitometry, is an enhanced form of x-ray technology that is used to measure bone loss. :red_cross:
Compared to population averages
Vs using singh's index
Clinical s/Sx:
Back pain
Kyphosis
Height diminished
Fair skinned
Low body weight
Smoke cig
Glucocorticooid use
ALcohol
Low protein intake
ANti convulsant use
Vita D deficiency
Prolong immobilization
Hypogonadism (Men)
Cushing syndrome
condition increasing risk of falls
Risk factors on Pg 49
Common areas
: Spine (Wedge compression) Slide 61 example , :red_cross: distal end of radius, hip, humerus proximal end
FRAX (Fracture Risk assessment tool)
20% = treat
factors age, bmi, parental hx, smoking, alcohol, gluccorticcoid/steroid, RA, BMD
Mx-
Modify risk factors
Weight smoking alcohol exercise diet medications
Inc calcium and Vit D intake
(Decreases bne resrotpion but doesn't increase bone mass or density, more effective for type II) Calcium and Vit D (1000 1500 mg + 400 800 IU of vit D per day)
Anabolic Agent
(BUILD UP) teriparatide (Synthethic form of recombinant human PTH, activates osteoblast, risk of osteosarcoma in animals CI pagets (slide 57) or strontum
Anticatabolic (Bisphosphonates)
, SERM hormones, inhibit osteoclast, GI side effects, sit upright 30-60mins, acute phase reaction fever, transcient hypocalcemia
Calcitonin (inhibit osteoclastic resorption, hypersensitivty reaction, expensive oppose parathyroid hormone)
Denosumab
HRT (increase risk of breast cancer) within 6yrs of menopause, increase risk of DVT/PE
Hormonal: Selective estrogen receptor modulator increase menopause sysmptoms
Overall efficacy based on areas (Slide 59)
Surgical
Slide 67
Displaced ahtroplasty (cement or don't cement)
Undisplaced (conservative or pining)
Complete replacement
Internal fixation: SLiding hip screw (DHS)