Monoarticular Joint Pain: Joint replacement

Question 1

What are the types of joints?

Answer 1

• Fibrous - joined by fibrous tissue → sutures within the brain
• Primary cartilaginous - joined by hyaline cartilage
• Secondary cartilaginous - joined by hyaline cartilage and fibrous tissue
• Synovial - filled with synovium fluid

Question 2

What is the synovial joint?

Answer 2

• Examples - shoulder, hip knee
• Bones joined by capsule and strong ligament
• Bone ends covered in hyaline cartilage (no blood vessels here)
• Synovial membrane produces synovial fluid, rich in nutrition
  
  • Provides nutrition to hyaline cartilage
• Inflammation = synovitis, RA

can look on notion to see diagram :)

Question 3

Describe the hyaline cartilage

Answer 3

• No blood supply
• Derives nutrition from synovial fluid
• Produced by synovial membrane
• If damaged, repaired with fibrous tissue

Question 4

What causes oa?

Answer 4

• Deformed knees - valgus, varus
• Degenerative disease
• Post inflammation
• Severe injury

Question 5

What are common symptoms for OA of the hip?

Answer 5

• Painful antalgic gait causing back pain
• Shortening of leg
• PAIN, stiffness, swelling

Question 6

What are common symptoms for OA of the knee?

Answer 6

• Swelling, muscle wastage
• ‘Knobbly’ knee
• PAIN when walking up the stairs

Question 7

what are 4 cardinal signs on X-rays for OA?

Answer 7

• Loss of joint space
• Osteophyte formation
• Cyst formation
• Sclerosis

Question 8

What are the main Management schemes for OA?

Answer 8

• Exercise, lose weight
• Paracetamol, topical NSAIDs
• Intra-articular injections
• Joint replacement

Question 9

What are Intra-articular Injections and when are they given?

Answer 9

• Inject with local anaesthetic under x-ray guidance
• Steroid injection….
  
  • Hip OA
  • Helpful with mild OA
  • Shoulder OA (if unfit) every month

Question 10

When are joint replacements recommended?

Answer 10

• Fractures, tumors
• Prolonged functional limitation & pain
• Regular reviews to see how they are
• Annual reviews if…
  
  • Other illnesses or conditions
  • Troublesome joint pain

Question 11

What happens when joint is infected?

Answer 11

• Increasing number of people getting infections
• Reduce infection by…
  
  • Clear, filtered air in theatres
  • Prophylactic antibiotics
  • ‘Space suits’ in theatres
• DONT’s
  
  • aspirate outside operating theatre
  • Start antibiotics unless pt. under danger
• DO’s
  
  • Contact orthopaedic department
  • Refer early

Question 12

What are the complications with OA replacements?

Answer 12

• Dislocations
• Squeaks
• Venous thromboembolism (deep vein thrombosis