MSK Degenerative Joint Disease Teaching Flashcards
which joints are most commonly affected by OA
knee
then hip
and then small joints of the hand
risk factors of OA
age
F>M
obesity
previous joint injury
repeated stress on the joint
metabolic disease - diabetes, haemochromatosis
genetic disorders - bone deformities, connective tissue disease which affects the cartilage
what are common symptoms of OA
joint pain, worse on movement
pain can refer to other joints
may struggle to bear weight
stiffness, worse with activity
limitation of ALDs
what can you find on examination with OA
antalgic gait
reduced ROM both active and passive
crepitus on passive
tenderness on palpation
swelling?
what investigations can you do for OA
bedside: body habitus and BMI, ECG
lab: baseline bloods, CRP/ESR, clotting
Imaging: XR
what are the signs you look for on XR for OA
L- Loss of joint space
O - osteophytes
S - subchondral cysts
S - subchondral sclerosis
what does ABCDE stand for when intrepreting a MSK XR
A - alignment and anatomy
B - bone, any interruptions
C - cartilage, is there joint space, erosions
D- deformity/ density, cysts, tumours, lysis, oestoporosis
E - everything else, soft tissue/ sounding structures
what can you find on XR with any arthritis
marginal erosions, especialy in the radial side of the MCPJ
soft tissue swelling
oestoeporosis, initially is juxta-articular then generalised later
joint space narrows, symmetrically or concentric but always uniform
what is the first line treatment for OA
education, exercise, weight loss
topical analgesia and capsaicin
then oral paracetamol/ NSAIDS
or opiate analgesia if severe
steriod joint injection
when would you refer an OA patient for surgical management
joint symptoms - pain, stiffness, reduced function
substantial impact on QOL
refractory to non-surgical treatment
no improvement with conservative management
what is the recovery from arthroplasty like
usually stay inpatient for 3-5 days
most people stop using walking aids around 6weeks
start driving 6-8 weeks
tends to last 15 years
what is the appropriate VTE prophylaxis for arthroplasty of the hip
LMHW for 10 days followed by asprin (75 or 100) for 28
LMWH for 28 days with anti-embolism stocking
Rivaroxaban is the recommended choice for adults
what is the appropriate VTE prophylaxis for arthroplasty of the knee
asprin (75 or 100) for 14 days
LMWH 14 days with anti-embolism stockings
Rivaroxaban is the recommended choice for adults
what is the recommened antibiotic prophylaxis for arthroplasty
post-operative ABX prophylaxis is not recommended for elective arthroplasty
single pre-operative dose is as effective
