Monoarticular pain Flashcards
Why do we replace joints?
Because of pain, stiffness or correction of deformity
What 2 most common types of joint replacement?
- Hip
2. Knee
What are the 4 options of joint arthroplasty?
- Fixation
- Bearing surface
- Bone preserving/sacrificing
- Hemiarthroplasty/total arthroplasty
What are the major complications of joint replacement?
- Dislocations
- Infections
- Thromboembolic disease
- Leg length discrepancy
- Nerve palsy
- Fracture
- On going pain
How long do most replacements last for?
10 - 15 years
Joint arthroplasty is a minor surgery. TRUE or FALSE
FALSE - it is a MAJOR surgery
What properties should the material of the joint replacement have?
- Strength
- Elastic modulus
- Biocompatible
- Bearing surface
- Attachment to bone
What measures can be taken to prevent post-operative infections of the joint replacement?
- clean, filtered air
- prophylactic antibiotics
What are some metal on metal complications that can occur with JA?
- wear debris (cobalt and chrome ions can form)
- debris can cause response in local tissues
- ions are usually filtered by kidneys
What is osteoarthritis?
A disease of the entire joint that breaks down the tissues and causes pain and stiffness
- also known as wear and tear disease
What places are usually affected in osteoarthritis?
- Knees, Hips, Hands (first metacarpal joint)
What is primary osteoarthritis caused by?
EXACT CAUSE IS UNKNOWN
- Biological factors (genetics)
- Mechanical factors (excessive use of the joint)
What is the onset of osteoarthritis?
> 40 years old
Name 4 treatments for OA?
- Patient education
- Exercise
- Weight loss
- Use of analgesia
- Surgery
In OA the articular cartilage around the joint is damaged. TRUE or FALSE
TRUE
Name some secondary causes of OA
- Trauma
- Infection
- Inflammatory diseases
- Perthes disease
Which types of surgery are carried out for OA?
- Arthrodesis (fusion)
- Excision arthroplasty (removal of joint)
- Hemi arthroplasty
- Total joint arthroplasty
What is a trapezectomy?
Removal of the small bone called trapezium
What are the risks and benefits of a trapezectomy?
Benefits: - non - weight bearing bone - preserves range of movement Risks: - It can cause instability - long rehabilitation time
Name 3 risk factors of osteoarthritis?
- Obesity
- Age
- Females
- Muscle weakness
- Occupation
- Calcium crystal deposition
Osteophytes can be formed due to osteoarthritis. TRUE OR FALSE
TRUE
What is the rotator cuff arthritis?
Type of shoulder arthritis that can develop after a massive and prolonged rotator cuff tear
What is the function of the rotator cuff?
stabilize the glenohumeral joint by compressing the humeral head against the glenoid.
What are the radiographical features of osteoarthritis?
- Loss of joint space
- Cyst forming on bone
- Sclerosis
- Formation of osteophytes
LOSS
What are the clinical features of osteoarthritis
- Asymmetrical joint pain
- Pain worse after exercise but gets better with rest
- Night pain occasionally
- usually systemically well
- Morning stiffness for < 30mins
- older than 45 yrs
Name 3 reasons why we need bones?
- Production of blood cells
- Protection of vital organs
- Transmission of forces generated by muscle
- Mechanical support
- Mineral homeostasis
What is the diaphysis (shaft)
- the middle part of the bone
Where does the metaphysis extend from?
Extends from the growth plate to the point where the bone becomes narrow.
Where is the metaphysis in immature or growing bone?
It is separated from the epiphysis by a growth plate or physis
What kind of forces are long bones exposed to?
Twisting forces
What is the difference between woven bone and lamellar bone
- Lamellar bone can withstand stress equally well in all directions and is more stable than woven bone.
When is bone made rapidly and what type of bone is produced
- unborn child
- when bone is produced rapidly
- woven bone is produced
How is woven bone formed
Type 1 collagen fibres are laid down in a criss cross pattern
Does woven bone or lamellar bone take longer to form
Lamellar bone
How long intramembranous ossification last for?
From in vitro to adolescent
What kind of bones undergo intramembranous ossification?
Flat bones e.g
- skull
- clavicle
Name 3 types of fractures
- Simple
- Compound
- Comminuted
- Displaced (if ends of bones are not aligned properly)
- Stress (repeated physical stress e.g load on bone)
- Greenstick fracture (only happens in children - only part of bone is broken)
- Pathological (bone is weakened by a disease)
What is a displaced fracture
when the ends of the bones are not aligned properly
What is a stress fracture
-physical stress causes by repeated load on bone
What is a greenstick fracture
- occurs in infants and children where the bone is soft
- fracture does not extent through the bone
In a clinical settings how do most fractures occur?
- in the elderly who have loss of bone density (osteoporosis)
Name some impaired healing of fractures
- Open fractures could cause secondary infection
- Non- union could cause (pseudo-arthrosis)
- Displaced- comminuted fractures could cause deformity
What is osteonecrosis?
Ischaemic necrosis of bone and bone marrow
-
How does osteonecrosis usually occur?
- Fractures and trauma
- Sickle cell anemia (abnormal shape of rbc)
- Corticosteroid therapy
What is osteomyelitis?
Inflammation of the bone and bone marrow usually due to infection with bacteria
- usually hematogenous bacteria spread
What kind of bacteria is usually involved in osteomyelitis?
- Stapyhloccucus aureus
What are some features of osteomyelitis?
- bone pain
- signs of infection e.g fever
How is osteomyelitis is diagnosed?
By blood culture
Septic arthritis is common. TRUE OR FALSE
FALSE - it is not common
What is the most common area for septic arthritis?
- hip and knee but can be present in any synovial joint
What are some risk factors of septic arthritis?
- Skin infection
- Prosthetic joint
- Immune suppression
- IV drug use
- Liver cirrhosis
- Comorbid conditions e.g diabetes
- Children and Elderly >80 yrs
How does septic arthritis clinically present?
- Fever
- Joint pain - any movement causes intense pain
- Loss of weight bearing in that joint
- Limited movement
- Swelling
- Joint effusion
What is septic arthritis?
Infection within a synovial joint caused by a microorganism
What bacteria most commonly causes septic arthritis?
- Staphylococcus aureus
- Streptococci A or B
- Haemophilus influenza
- Gonorrhoea bacteria
How does septic arthritis occur?
- Haematogenous pathway
- Dissemination from osteomyelitis
- Penetrating trauma
- Puncture or injections
Describe the pathophysiology of septic arthritis
Bacterium settles in synovium and proliferates > causes inflammation and leucocytes migrate into joint
- variety of enzymes breakdown products damage articular surface
What are the two main types of crystal arthritis?
- Gout
2. Calcium pyrophosphate dihydrate (CPPD)
What drugs cause hyperuricemia?
- Cyclosporine
- Alcohol
- Thiazide
- Aspirin
- Lasix
- Nicotinic acid
Name 3 risk factors of gout
- High purine diet and protein diet
- Obesity
- Males
- Cancer
- Psoriasis
- Hypertension and renal disease
- Diuretic use
What are the clinical presentations of gout?
- Severe pain
- Rapid onset (patients often wake up with pain)
- Extreme tenderness
- Marked swelling with overlying red , shiny skin
How many people does gout affect in the UK?
2.5%
Gout affects males more than woman. TRUE OR FALSE
TRUE
What causes gout?
Gout is caused by hyperuricemia where the uric acid levels in the blood is soo high that it gets deposited in joints and tissues and forms crystal
What kind of crystals are formed in gout?
Monosodium urate monohydrate
What kind of crystals are formed in pseudogout?
Calcium pyrophosphate dihydrate crystals
Why does uric acid build up?
Builds up when the kidneys cannot filter them enough uric acid out.
What can be used to treat gout?
- NSAIDs e.g colchicine
- Urate lowering therapy e.g allopurinol
- Advice on healthy life style
- Analgesia
How is gout diagnosed?
- joint aspiration (urate crystals might be present)
- blood tests (serum uric acid levels)
- X-rays and ultrasound to detect inflammation and tophus
Describe the urate crystals in gout
Yellow and needle shaped
- negatively birefringent
Describe the urate crystals in pseudogout
crystals appear rhomboid shaped and blue
- weakly positively birefringent
What is the most common site for gout
Big toe
What is the most common site for pseudogout
Knees
Pseudogout is rare for people under the age of 55. TRUE OR FALSE
TRUE
What are some risk factors for pseudogout
- Age
- Osteoarthritis
- Hyperparathyroidism
- Hypophosphatasia
- Hemochromatosis (build up of iron)
What is the clinical presentation of pseudogout?
Similar to gout - can be differentiated by joint aspiration
What does allopurinol do?
It inhibits the enzyme xanthine oxidase (converts xanthine into uric acid)
