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18 ORR > Degenerative and Inflammatory Joint Disease > Flashcards

Degenerative and Inflammatory Joint Disease Flashcards

1
Q

components of articular cartilage

A
  • thin superficial (tangential) zone
  • middle (transitional) zone
  • deep (radial) zone
  • calcified zone
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2
Q

resistance to compressive forces

A

middle -> deep

proteoglycans (CHONDROITIN, keratan sulfate)

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3
Q

type of collagen in the ecm of cartilage

A

type 2

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4
Q

hip pain radiates towards __

A

groin, lateral aspect of thigh, anterior thigh

mostly due to extremes of motion

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5
Q

hallmark sign of weakness of hip abductors

A

trendelenburg sign

  • stance phase of gait cycle
  • weakness of abductors = dip on contralateral side
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6
Q

range of motion of hip

A

flexion: 0-135 deg
extension: 0-30 deg
abduction: 45-50 deg
adduction: 20-30 deg
ext rot: 0-45 deg
int rot: 0-35 deg

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7
Q

range of motion of knee

A

flexion 0-130 deg
full extension 0 deg
full flexion 100 deg

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8
Q

pathophysio of osteoarthritis

A
  • increase in inflammatory markers (il-6 il-1)
  • final common pathway = injury to articular cartilage
  • most common form of arthritis
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9
Q

clinical manifestations of osteoarthritis

A
  • women: hands and knees (distal interphalangeal joints)
  • men: hips
  • altered balance -> falls
  • stiffness (>30 min in morning), swelling and pain, crepitus
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10
Q

pathologic findings in osteoarthritis

A
  • fibrillation of cartilage
  • increase in water content
  • altered proteoglycan content (inc)
  • decreased collagen
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11
Q

diagnosis of osteoarthritis

A
  • no gold standard

- xray: joint space narrowing, subchondral sclerosis, osteophytes

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12
Q

pathophysio of rheumatoid arthritis

A
  • autoimmune, chornic

- unknown cause (genetic, bacterial, mycoplasmal, viral)

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13
Q

clinical manifestations of rheumatoid arthritis

A

polyarthritis

  • wrist, metacarpophalangeal, proximal interphalangeal
  • elbow
  • shoulder
  • cervical spine
  • hip, knee, ankle
  • usually symmetrical/bilateral and migratory

extra-articular involvement

  • vasculitis, pericarditis, skin nodules
  • pulmonary fibrosis
  • penumonitis and scleritis
  • felty’s syndrome (arthritis, lymphadenopathy, and splenomegaly)
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14
Q

pathologic findings in rheumatoid arthritis

A
  • synovitis

- pannus formation: thickened synovium with activated t and b lymphocytes

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15
Q

labs in rheumatoisd arthritis

A
  • high titer of rheumatoid factor
  • uniform loss of joint space
  • articular erosions
  • periaarticular osteoporosis/ osteopenia
  • deformities and subluxations
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16
Q

joint aspiration of ra vs oa

A

read

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17
Q

general differences between ra and oa

A

ra: systemic, symmetris, small joints, young
oa: localized, asymmetric, large joints, older

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18
Q

pathogenesis of osteonecrosis of the hip

A
  • traumatic or idiopathic
  • risk factors: alcohol abuse, gout, caisson disease, renal osteodystrophy, sickle cell anemia, steroids, trauma
  • direct cell toxicity, coagulopathic states, fat emboli, vascular interruptions, elevated bone marrow pressure
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19
Q

ficat classification of avascular necrosis

A
  • higher stage = more symptomatic
  • stage of collapse (stage 3) – crescent sign!

read!!

20
Q

treatment for osteonecrosis depends on __

A
  • symptoms
  • collapse of femoral head
  • size of the lesion
  • degree of involvement of weight bearing surface
  • acetabular involvement
21
Q

pharmacologic agents for osteonecrosis

A
  • in early stages
  • statins
  • anticoagulants and prostacyclin analogs
  • inhibiting aggregation of platelets promotes blood flow
  • bisphosphonates
22
Q

surgical treatment for osteonecrosis

A
  • in later stages
  • head-preserving treatment
  • arthroplasty/replacement techniques
23
Q

type of head preserving treatment that is used in patients with >30% involvement of the head

A

vascularized fibular graft

  • preferred for young patients (<50)
  • not indicated for early disease
24
Q

what is arthroplasty

A
  • final option
  • larger lesions, > 3% of femoral head surface

types:

  • resurfacing hemiarthroplasty
  • hemiarthroplasty (poorer results)
  • resurfacing arthroplasty
  • total hip arthroplasty (most popular, modern)
25
Q

conservative methods to treat osteoarthritis

A
  • weight loss
  • walking aids
  • limit activities
  • pain medications (acetaminophen, nsaids)
  • exercise: strength, rom, agility
26
Q

injections for osteoarthritis

A
  • lidocaine test: diagnostic
  • corticosteroids: therapeutic
  • hyaluronic acid: for viscoelasticity
27
Q

surgical options for osteoarthritis

A
  • joint preserving* (younger)
  • joint salvage procedures: arthrodesis
  • total joint replacement (hip and knee)
28
Q

what is joint debridement and synovectomy

A
  • to relieve pain by synovium

- to prolong life of hyaline joint surface

29
Q

indications for joint debridement and synovectomy

A
  • chronic synovitis
  • synovitis limited to membrane
  • recurrent hemarthroses
  • imminent destruction of joint by lysosomal enzymes from wbcs in infections
  • failure of conservative treatment
30
Q

contraindications for joint debridement and synovectomy

A
  • reduced joint range of motion

- significant arthritis/cartilage involvement

31
Q

types of synovectomy

A
  • open synovectomy (infectious)
  • arthroscopic synovectomy (degenerative arthritis)
  • radiation synovectomy (rheumatoid arthritis)
32
Q

cartilage transplant techniques

A
  • for athletes with focal cartilage defects

- autologous chrondrocyte transplantation

33
Q

what is osteotomy

A
  • break the bone incompletely so you have a hinge on one side
  • allows swinging of the bone in a direction to correct defects
34
Q

indications for high tibial osteotomy

A
  • varus knees (for valgus = femoral osteotomy)
  • unicompartmental arthritis
  • relatively younger (<50)
  • pts with good range of motion
  • no knee instability
  • normal bmi

goal: preserve native knee for as long as possible

35
Q

most common mode of failure of high tibial osteotomy

A

contralateral compartment disease

36
Q

reasons to consider osteotomy of the hip

A
  • there is normal viable cartilage that may be moved to weight-bearing area where there was thinned cartilage
  • biomechanical load on the joints that cause pain are reduced
37
Q

what are femoral osteotomies

A
  • performed in the intertrochanteric region

- “derorotation” procedures

38
Q

what is joint salvage

A
  • creation of a bony fusion across a joint

- for younger or cannot get replacements

39
Q

what is the girdlestone procedure

A
  • resection of the femoral head without replacement

- last option after failed replacement

40
Q

indications for girdlestone procedure

A
  • severe infection
  • limited function
  • unreconstructable bone defects
  • poor medical condition
  • failed arthroplasty
41
Q

what is joint replacement

A
  • last option
  • to relieve pain
  • uses prosthetic devices
42
Q

indications for total hip replacement

A
  • debilitating pain
  • failure of conservative treatment
  • medically fit
  • no infection
43
Q

the force generated within a joint in response to the forces acting on it

A

joint reaction force

44
Q

indications for total knee replacement

A
  • pain affecting activities of daily life
  • failure of conservative management
  • no infection
  • medically fit for surgery
45
Q

goals of total knee replacement

A
  • neutral mechanical alignment
  • restore the joint line
  • normal q-angle
  • well balanced knee
46
Q

complications of arthroplasties

A
  • infection
  • neurovascular injuries
  • revision (loosening and wear, osteolysis)
  • medical (dvt, pe, stroke)
  • dislocations
  • peri-prosthetic fractures

18 ORR (21 decks)

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