OSTEOARTHRITIS
DEFINITION
Osteoarthritis is a degenerative joint disease .
Primary affects articular cartilage.
TYPES
1. Idiopathic/ primary osteoarthritis
Occurs in old age
Mainly in the weight bearing joints like hip and knee.
2. Secondary osteoarthritis
It may occurs at any age after adolescence and commonly at hip joint
Predisposing factors:
Congenital maldevelopment of a joint
Irregularity of joint surfaces from previous trauma
Previous disease producing a damaged articular surface
Internal derangement of the knee, such as loose body
Mal-alignment (bow leg)
Obesity and excessive weight
PATHOLOGY
● It primarily affects the articular cartilage.
● First change observed is an increase in water content and depletion of the
proteoglycans from the cartilage matrix.
● The cartilage gets abraded by the grinding mechanism at work at the points of
contact between the apposing articular surface,until eventually the underlying
bone is exposed .
● With the further rubbing,the subchondral bones become hard and glossy.
● The bones at the margins of the joint hypertrophies to form a rim of projecting
spurs known as osteophytes
● A similar mechanism results in the formation of subchondral cysts and
sclerosis.
● The loose flakes of cartilage incite synovial inflammation and thickening
of the capsule, leading to deformity and stiffness of the joint.
● Often one compartment of a joint is affected more than the other.
For example,in the knee joint,the medial comparison affected more than the
lateral, leading to a varus deformity.
CLINICAL FEATURES
1. Pain - earliest symptom
Initially it is dull pain and comes on starting an activity after a period of rest
but later it becomes worse and cramp like,and comes after activity.
Intermittently in the beginning, becomes constant over months or years.
2. Coarse crepitus
3. Swelling of the joint
Due to effusion caused by inflammation of the synovial tissues
4.Stiffness Initially due to pain and muscle spasm, but later capsular contracture
and incongruity of joint surface contribute to it.
5. Feeling of instability of joint and locking resulting from loose bodies and
frayed menisci.
EXAMINATION
• Tenderness on the joint line
• Crepitus on moving the joint
• Irregular and enlarged-looking joint due to formation of peripheral
osteophytes
• Deformity- varus of the knee, flexion-adduction- external rotation of the hip
• Effusion- rare and transient
• Terminal limitation of joint movement
• Subluxation detected on ligament testing
• Wasting of quadriceps femoris muscle
INVESTIGATIONS
Radiological examination
• narrowing of joint space
• Subchondral cysts
• Osteophyte formation
• Loose bodies
• Deformity of joint
Other investigations
Serological tests and ESR to rule out rheumatoid arthritis.
Serum uric acid to rule out gout.
Arthroscopy,if a loose body or frayed menisci is suspected.
TREATMENT
Principles of treatment:
a) To delay the occurrence of the disease, if the disease has not begun
yet
b) To stall progress of the disease and relieve symptoms, if the disease
is in early stages
c) To rehabilitate the patient, with or without surgery, if his disabilities
can be partially or completely alleviated.
Methods of treatment:
a) Drug
Analgesics to suppress the pain
Long acting formulations preferred
b) Chondroprotective agents
Glucosamine and Chondroitin sulphate- result in repair of damaged cartilage
c) Viscosuplementation
Sodium hylarunon- injected in joint 3-5 times at weekly interval
Improve cartilage function, chondroprotective
d) Supportive therapy
Weight reduction
Avoidance of stress and strain
Local heat- provides relief of pain and stiffness
Exercises- for building up of muscles controlling the joint, help provide stability to the joint
Local application of counter-irritants and liniments
e) Surgical treatment
Osteotomy: A high tibial osteotomy for OA of knee with genu varum
Joint replacement:commonly performed for hip and knee.
Joint debridement : Affected joint is opened, degenerated cartilage
smoothened ,and osteophytes and the hypertrophied synovium excised.
Arthroscopic procedures: In arthroscopic chondroplasty,the degenerated,
fibrillated cartilage is excised using power driven shaver under arthroscopic
vision.
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