Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

The loss of cartilage and changes to underlying bone

Question 2

What are symptoms of OA?

Answer 2

Progressive pain

• initially worse during physical activity/weight bearing and relieved by rest
• rest and night pain occur in advanced disease

Stiffness
-after periods of rest esp if ?30mins

Decreased function

Joint instability

Question 3

What are signs of OA?

Answer 3

Joint and joint line tenderness
Crepitus on movement
Decreased range of movement and deformity- varus/valgus
Bony swelling 
Muscle wasting
Potential effusion

Hands

• Herbedens nodes in DIP and Bouchards in PIP
• squaring at base of thumb
• palpable osteophytes

Question 4

What are common sites of OA?

Answer 4

Knee= most common
Hip
Hands- DIP, PIP, CMJ and thumb
Hallux and MTP joints
Cervical spine

Question 5

What are risk factors for OA?

Answer 5

Increasing age >40
Obesity
Female- nodal generalised OA
FH
Previous trauma
Occupation- miners/farmers
Osteoporosis=protective

Question 6

What is nodal generalised OA?

Answer 6

Commonly seen in post-menopausal women
Joints in hand affected one by one over many years with painful swelling and functional impairment
Inflammatory phase settles over months/yrs

Question 7

What investigations are needed for OA?

Answer 7

Bloods

• CRP/ESR to rule out infection
• rheumatoid factor and ANA
• LFT- if starting NSAID

XR

• Findings do not correlate to pain level- can have severe changes with no pain
• loss of joint space
• osteophytes
• subchondral sclerosis
• subchondral cysts

Question 8

How is OA diagnosed?

Answer 8

Clinical diagnosis if patient meets criteria

• > 45
• activity related joint pain
• no morning stiffness or stiffness lasting <30mins

Question 9

What is conservative management of OA?

Answer 9

Treat based on symptoms
Weight loss
Hot/cold pads
Capsaicin pads
OT and Physio input- cushioned footwear and strengthening exercises

Question 10

What is the medical management of OA?

Answer 10

1) paracetamol and topical NSAID/capsaicin prn
2) Oral NSAID- with PPI if needed
3) Short term opioids- only work for short period of time and high risk of dependency
4) Intra-articular steroid injections
- temporary improvement of symptoms <6wks
- should avoid frequent injection into same joint

Question 11

What is the surgical management of OA?

Answer 11

Indicated if pain or stiffness leads to poor function and impacts on quality of life
Replacement arthroplasty for knees/hips/ankles

One compartment arthroplasty- just one aspect replaces
Excision arthroplasty of 1st MCP or base of thumb
Realignment osteotomy of knee/ip

Question 12

What are complications of replacement arthroplasty?

Answer 12

Leg length discrepancy
Dislocation
Infection- rare but devastating
Persistent pain