15. Osteoarthritis

Question 1

Definition

Answer 1

Result of wear and tear. Condition of worn tissue. Erosion of the cartilage and bones then rub against each other.
Chronic, degenerative condition.

Question 2

Pathological changes/trajectory

Answer 2

Articular cartilage looses glossy surface, becomes yellow/brown, up to 10-20 years before symptoms.
Surface starts to break down, articular cartilage flakes off, deeper layers develop longitudinal fissure into the deeper areas of the bone –> synovial fluid fills the fissures and may progress into bone –> cysts –> cartilage continues to thin –> completely worn away –> unprotected bone –> sclerosis (thickening) and free floating joint mice which break off into joint cavity causing pain –» osteophytes and new abnormal bone growth –> joint looses integrity and stability –> trauma to synovial membrane –> causes synovitis.

Question 3

Aetiology/risk factors

Answer 3

No single cause, multifactorial.
Age, sports injuries, repetitive small injuries, lots of kneeling and standing (weight on knees), obesity, genetics, lack of minerals in diet.
Also chronic inflammation, bleeding into joints, gout.

Question 4

Epidemiology risk factors:

Answer 4

Female, lower education level, Indigenous, poor muscle strength.

Question 5

Signs and symptoms

Answer 5

Joint pain: Aching, throbbing, deep pain, tenderness of the joint.
Decreased ROM, bony lumps or nodules, riding or grating feeling when moving, numbness and tingling, interfered with sleep, morning stiffness.
Referred pain: Lumbosacral spine

Question 6

Diagnosis

Answer 6

No one test. Family history, bone scans for osteoporosis, blood tests to exclude other arthritic conditions. Physical examination (ROM, pain, swelling, warmth, tenderness around joint), X-ray (only shows when lots of damage)

Question 7

Co-occurring conditions:

Answer 7

Obesity and depression

Question 8

Treatment and medications:

Answer 8

Prevention, control risk factors, medications (aspirin, NSAID’s, pain killers, corticosteroids.
If fluid build up: Arthroscopic remove or fluid or injection of steroids arthroscopically
Surgery: Replacements, osteotomy (change alignment) arthrodesis (surgically fuse bones) arthroscopic shaving of bone.

Question 9

If fluid build up:

Answer 9

Arthroscopic remove or fluid or injection of steroids arthroscopically