OA

Question 1

what is OA

Answer 1

mechanical joint degradation with degeneration of articular cartilage, peri-articular bone remodelling + inflammation

Question 2

RFs for primary OA

Answer 2

age
obesity
FH
female

WB sports - knee
labouring - hip

Question 3

joint pain in OA

Answer 3

worse on exercise, relieved by rest

morning pain < 30min

Question 4

OA on examination

Answer 4

creptius
pain on movement
reduced range of movement
bony swelling (osteophytes)
joint instability
joint effusion

Question 5

hand deformities in OA

Answer 5

heberden’s + bouchard’s

squaring of carpometacarpal joint of thumb

Question 6

commonly affected joints in OA

Answer 6

knees
hips
DIP + PIP
carpometacarpal joint of thumb
lumbosacral + cervical spine

Question 7

OA - investigations

Answer 7

xray

FBC + CRP/ESR - rule out infection + inflamm causes

Question 8

management of OA

Answer 8

conservative
analgesia+ topical NSAIDs
intra-articular steroid injections
joint replacement - reduce pain + improve mobility

Question 9

conservative management of OA

Answer 9

exercise
physio
weight loss
walking aids
supportive footwear
local thermotherapy

Question 10

analgesia in OA

Answer 10

1 - paracetamol +- topical NSAIDs
2 - codeine
3 - oral NSAIDs for flare ups

Question 11

xray in OA

Answer 11

Loss of joint space - from cartilage thinning
Osteophytes - from endochondral ossification
Subchondral sclerosis - from stimulation of osteoblasts
Subchondral bone cysts - from bone marrow oedema/necrosis

Question 12

indications for THR vs hemiarthroplasty in OA

Answer 12

must be fit:
no dementia
no sig comorbidities
mobile with stick at least

as THR longer op than hemiarthroplasty

if not, hemiarthroplasty