10 - Treatment options for osteoarthritis Flashcards
What joints are most commonly affected in osteoarthritis
Knees
Hips
Small hand joints
Symptoms of osteoarthritis
- Joint pain
- Morning stiffness <30 mins
- Joint instability
- Loss of function
- Crepitus on motion
Signs of osteoarthritis
- Bony enlargement at joint
- Limited range of movement
- Muscle atrophy/weakness
- Joint deformity
- Crepitus on motion
Treatment for mild osteoarthritis
Information + lifestyle advice
Self help - simple analgesics, topical agents
Treatment for moderate osteoarthritis
Simple non-surgical interventions - NSAIDs, aids, therapy
Treatment for more severe osteoarthritis
Injections
Surgery - partial or total joint replacement
Exercise options
Local muscle strengthening
General aerobic fitness
Weight loss
Non-pharmacological options
TENS Acupuncture Aids Diet Nutraceuticals
What nutraceuticals can be given in osteoporosis
Increase omega-3 rich foods
Chondroitin sulphate and glucosamine supplements
Pharmacological management
Oral analgesics
Oral NSAID/COX-2 inhibitor
Intra-articular injection
Example of analgesics
Topical NSAID
paracetamol
topical capsaicin
What does an intra-articular injection contain
Corticosteroid injection
When do you refer someone with osteoarthritis for surgery
When pain stiffness and reduced function have a substantial impact on QofL
e.g waking up in the night because of pain
What is arthroscopic lavage
washing out the contents of the joint
tidying up the articular cartilage
often not done alone
What is arthroscopic lavage plus debridement
washing out and removing the debris from the joint
What is a microfracture procedure
Drill into the subchondral bone and bone marrow pluripotent stem cells
Causes repair of articular cartilage - usually recovers in 4-6months
Disadvantage of microfracture
Produces fibrocartilage
less durable and resilient than hyaline
What are the positives and negatives of the autologous chondrocyte implantation technique
Adv - more hyaline-like cartilage forms
Disadv - can hypertrophy and unreliable biological potential of implanted cells
What is mosaicplasty
An osteochondral transplant
Take the undamaged cartilage from less weight bearing regions (plus the underlying bone) and move to the OA region
What are chondrocyte grafts
Grafting of autologous chondrocytes to repair large defects
Use periosteum as a cap on the articular cartilage
Inject the chondrocytes below the periosteum
What is the source of chondrocytes in OA
Rib costochondral process
Non-damaged part of joint
Cartilage implants from young individuals
What is an osteotomy and why would you do it
Taking away a part of the bone to realign the joint surfaces
In an osteotomy where would you do it in genus valgus
To femur
In an osteotomy where would you do it in genus varus
To tibia
What is a conventional hip replacement incision?
Large (20-30cm)
Cuts muscles, ligaments and tendons to access the joint
What is the newer minimal invasive hip replacement technique
Incision small - 10cm or less
Less damage to surrounding structure
Lifetime of a hip replacement
15-20 years
What causes the hip replacement to be needed to be revised
Loosening and movement of the prosthesis
What is viscosuplementation
removing the synovial fluid and replacing it
Mechanism of action of viscosuplementation
Returns higher molecular weight hyaluronans and increases viscosity
Provides direct analgesic effect
What is the hyaluronic acid in synovial fluid responsible for
viscoelastic properties of synovial fluid
What are the biologicals that can be given in OA
IL1 blockage
TNF inhibition
