OA hip Flashcards
Clinical features on exam
- Crepitus
- Reduced ROM
- Pain on ROM
- Bouchards/Herbedens nodes if hands affected
- Fixed flexion deformity if knees affected
X-ray RA vs OA
OA:
* LOSS - loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis
RA:
* LESS - loss of joint space, periarticular erosions, soft tissue swelling, subluxation
Pathophys of OA
Degradation of cartilage due to active response from chondrocytes –> bone remodelling
* They release enzymes = collagen and proteoglycan breakdown
* = destruction of articular cartilage
* = sclerosis of subchondral bone as it is now exposed
* = reactive remodelling –> osteophytes and bone cysts
* Lose joint space over time
Treatment options for OA
Conservative:
* Strengthening exercises
* Heat/cool packs
* Physio
* Weight loss if overweight
Medical:
* Topical NSAIDs, simple analgesia, intra-articular steroid injections
Surgery:
* Arthroplasty
* Osteotomy
* Arthrodesis (fusion)
Complications of total joint replacement
- VTE
- Leg length discrepancy
- Infection
- Dislocation
- Implant loosening
- Blood vessel/nerve damage - sciatic, femoral
- Heterotopic ossification - bone formation in places it shouldn’t in soft tissue
How long for replacement to last?
15-20 years
Chemical VTE prophylaxis and MOA
- LMWH eg Enoxaparin
- Binds to antithrombin III and enhances it’s effects
- = inhibition of factor Xa
- = inhibits IIa (thrombin)
- = decreased thrombus formation
Mechanical VTE prophylaxis and MOA
Compression stockings or Intermittent pneumatic compression
* Increase pressure on outside of leg
* Act as if they are calf muscle pump
* Increase pressure = pressure gradient for blood in venous system to move up leg towards heart
* = reduced venous stasis
NICE reccomendations for VTE prophylaxis post joint replacement
- Start LMWH 6-12 hrs after surgery
- Continue for 28-35 days for THR
- Continue for 10-15 days for TKR
