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LOCO > 10 - Treatment options for osteoarthritis > Flashcards

10 - Treatment options for osteoarthritis Flashcards

1
Q

What joints are most commonly affected in osteoarthritis

A

Knees
Hips
Small hand joints

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2
Q

Symptoms of osteoarthritis

A
  • Joint pain
  • Morning stiffness <30 mins
  • Joint instability
  • Loss of function
  • Crepitus on motion
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3
Q

Signs of osteoarthritis

A
  • Bony enlargement at joint
  • Limited range of movement
  • Muscle atrophy/weakness
  • Joint deformity
  • Crepitus on motion
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4
Q

Treatment for mild osteoarthritis

A

Information + lifestyle advice

Self help - simple analgesics, topical agents

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5
Q

Treatment for moderate osteoarthritis

A

Simple non-surgical interventions - NSAIDs, aids, therapy

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6
Q

Treatment for more severe osteoarthritis

A

Injections

Surgery - partial or total joint replacement

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7
Q

Exercise options

A

Local muscle strengthening
General aerobic fitness
Weight loss

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8
Q

Non-pharmacological options

A 
TENS
Acupuncture
Aids 
Diet
Nutraceuticals
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9
Q

What nutraceuticals can be given in osteoporosis

A

Increase omega-3 rich foods

Chondroitin sulphate and glucosamine supplements

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10
Q

Pharmacological management

A

Oral analgesics
Oral NSAID/COX-2 inhibitor
Intra-articular injection

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11
Q

Example of analgesics

A

Topical NSAID
paracetamol
topical capsaicin

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12
Q

What does an intra-articular injection contain

A

Corticosteroid injection

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13
Q

When do you refer someone with osteoarthritis for surgery

A

When pain stiffness and reduced function have a substantial impact on QofL
e.g waking up in the night because of pain

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14
Q

What is arthroscopic lavage

A

washing out the contents of the joint
tidying up the articular cartilage
often not done alone

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15
Q

What is arthroscopic lavage plus debridement

A

washing out and removing the debris from the joint

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16
Q

What is a microfracture procedure

A

Drill into the subchondral bone and bone marrow pluripotent stem cells
Causes repair of articular cartilage - usually recovers in 4-6months

17
Q

Disadvantage of microfracture

A

Produces fibrocartilage

less durable and resilient than hyaline

18
Q

What are the positives and negatives of the autologous chondrocyte implantation technique

A

Adv - more hyaline-like cartilage forms

Disadv - can hypertrophy and unreliable biological potential of implanted cells

19
Q

What is mosaicplasty

A

An osteochondral transplant

Take the undamaged cartilage from less weight bearing regions (plus the underlying bone) and move to the OA region

20
Q

What are chondrocyte grafts

A

Grafting of autologous chondrocytes to repair large defects
Use periosteum as a cap on the articular cartilage
Inject the chondrocytes below the periosteum

21
Q

What is the source of chondrocytes in OA

A

Rib costochondral process
Non-damaged part of joint
Cartilage implants from young individuals

22
Q

What is an osteotomy and why would you do it

A

Taking away a part of the bone to realign the joint surfaces

23
Q

In an osteotomy where would you do it in genus valgus

A

To femur

24
Q

In an osteotomy where would you do it in genus varus

A

To tibia

25
Q

What is a conventional hip replacement incision?

A

Large (20-30cm)

Cuts muscles, ligaments and tendons to access the joint

26
Q

What is the newer minimal invasive hip replacement technique

A

Incision small - 10cm or less

Less damage to surrounding structure

27
Q

Lifetime of a hip replacement

A

15-20 years

28
Q

What causes the hip replacement to be needed to be revised

A

Loosening and movement of the prosthesis

29
Q

What is viscosuplementation

A

removing the synovial fluid and replacing it

30
Q

Mechanism of action of viscosuplementation

A

Returns higher molecular weight hyaluronans and increases viscosity
Provides direct analgesic effect

31
Q

What is the hyaluronic acid in synovial fluid responsible for

A

viscoelastic properties of synovial fluid

32
Q

What are the biologicals that can be given in OA

A

IL1 blockage

TNF inhibition

LOCO (25 decks)

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