Osteoarthritis

Question 1

What is Osteoarthritis?

Answer 1

‘Wear and Tear’ in the synovial joints as a result of genetic factors, overuse and injury; not an inflammatory condition.

Question 2

Risk Factors of Osteoarthritis (6).

Answer 2

1. Obesity.
2. Age.
3. Occupation.
4. Trauma.
5. Female.
6. Family History.

Question 3

Aetiology of Osteoarthritis.

Answer 3

Imbalance between cartilage being worn down and chondrocytes repairing it, leading to structural issues in the joint.

Question 4

What is Glucosamine?

Answer 4

A normal constituent of Glycosaminoglycans in Cartilage and Synovial Fluid.

Question 5

Clinical Presentation of Osteoarthritis (3).

Answer 5

1. Joint Pain and Stiffness (less than 20 minutes).
2. Worsened by Activity and End of Day (unlike Inflammatory Arthritis).
3. Leads to Deformity, Instability and Reduced Functioning of Joint.

Question 6

Commonly Affected Joints (7).

Answer 6

1. Hips (2nd commonest).
2. Knees (commonest).
3. Sacra-iliac joints.
4. DIPs in Hands.
5. CMC at Base of Thumb.
6. Wrist.
7. Cervical Spine.

Question 7

Signs in Hands (Nodal Arthritis) (6).

Answer 7

1. Heberden’s Nodes - DIPs.
2. Bouchard’s Nodes in PIPs (less than DIPs and CMCs) - HD:BP.
3. Squaring at Base of Thumb at CMC Joint (fixed adduction of thumb).
4. Reduced Range of Motion.
5. Weak Grip.
6. Bilateral.

Question 8

What is the Carpo-Metacarpal Joint?

Answer 8

Saddle joint with Metacarpal Bone of Thumb sat on Trapezius.

Question 9

Epidemiology of Nodal Arthritis (OA of Hand) (3).

Answer 9

1. Positive Family History.
2. Females 3x commoner.
3. Increased Risk of Future Hip OA (+ then Knee OA).

Question 10

Aetiology of Nodes in Hand Joints.

Answer 10

Osteophyte Formation.

Question 11

Special Risk Factor of OA of Hip.

Answer 11

DDH.

Question 12

Investigations of Osteoarthritis (2).

Answer 12

1. Diagnosis - No Investigations needed if patient is over 45, typical activity-related pain and no morning stiffness or stiffness lasting more than 30 minutes.
2. Imaging - X-ray (no correlation with severity).

Question 13

X-Ray of Osteoarthritis (4).

Answer 13

LOSS :-
L - Loss of Joint Space.
O - Osteophytes.
S - Subchondral Sclerosis (Increased Density of Bone along Joint Line).
S - Subchondral Cysts/Geodes (Fluid-filled Holes in Bones)

Question 14

Management of Osteoarthritis (7).

Answer 14

1. Patient Education + Lifestyle e.g. Weight Loss & Local Muscle Strengthening Exercises + General Aerobic Fitness (not weight-bearing).
2. Physiotherapy.
3. Occupational Therapy and Orthotics.
4. Stepwise Control of Analgesia.
5. Intra-Articular steroid Injections : Temporary Reduction in Inflammation and Improve Symptoms.
6. Non-Pharmacological : Supports, Braces, TENS, Shock-Absorbing Insoles or Shoes.
7. Joint Replacement (most effective) - Severe (mainly Hip, Knee).

Question 15

Stepwise Control of Analgesia in Osteoarthritis (3).

Answer 15

1. Oral Paracetamol + Topical NSAIDs or Topical Capsaicin (Chilli Pepper Extract).
2. Oral NSAIDs (for Knee or Hand Only) with PPIs (use intermittently; not continuously) - avoid if on Aspirin.
3. Opiates e.g. Codeine, Morphine (not for chronic pain).

Question 16

Basic Advice for Hip Replacement Patients to Minimise Risk of Dislocation (4).

Answer 16

1. Avoid Flexing Hip > 90 Degrees.
2. Avoid Low Chairs.
3. Do Not Cross Legs.
4. Sleep on Back for 1st 6 weeks

Question 17

Complications of Hip Replacement Surgery (5).

Answer 17

1. Wound and Joint Infection.
2. VTE - LMWH for 4 weeks after.
3. Dislocation (Posterior - Extreme Hip Flexion causes it presenting with a clunk, pain and inability to bear weight : internal rotation and shortening of affected leg).
4. Leg Length Discrepancy.
5. Aseptic Loosening (Prosthetic Joint Infection).

Question 18

What is the commonest cause for revision?

Answer 18

Aseptic Loosening.