OsteoArthritis Flashcards
what is osteoarthritis?
degenerative joint disease
what body parts is OA most common in?
hips, knees, spine, hands
patho of OA
- wearing down of cartilage in joints resulting in bone on bone
- –> friction of bones as cartilage wears down
- –> formation of bony spurs (osteophites?) as a result of increased osteoblastic activity
primary causes of OA
- Aging
- Genetics
secondary causes of OA
- Joint Injury (Occupational and Repetitive exercise)
- Obesity
- Trauma
- Overuse
- Diseases
characteristics of OA
- chronic joint pain and stiffness that worsens after activity and diminishes with rest
- limited ROM with pain or crepitus
- enlarged/hardened joints
Heberden’s Nodes vs Bouchard’s Nodes:
Heberden’s Nodes: boney nodules at distal interphalangeal joint
Bouchard’s Nodes: boney nodules at proximal interphalangeal joint
diagnostics for OA
Based on History and Physical Examination
X-rays may show degenerative changes
MRI and CT for vertebral and knees
Erythrocyte sedimentation rate and hs-C reactive protein (synovitis)(generalized inflammatory markers)
pain management interventions for OA….what is last resort?
- Tylenol
- Lidoderm patches
- Other topical medications
- NSAIDS
- Topical NSAIDS
- Muscle Relaxants
- Opioids - last resort, use if waiting for long term fix like surgery, not itself a long term solution
is there a cure for OA?
no!
other interventions for OA pain management??
- Exercise and Rest balance
- Hot or cold therapy (focus on heat)
- Weight control
- Supplements
- Glucosamine
- Chondroitin
- Position
- Shoes
- Surgery
- PT/OT
- Swimming, Walking, Cycling, Aerobics
- Home Adjustments
- Beware of curative remedies
- -> nothing cures it
surgery for OA
total joint arthroplasty/replacement
total joint arthroplasty/replacement- when do we do it and what is it?
= surgical creation of joint
- Indicated:only when QOL can no longer be maintained
- Majority of patients are >60
most common joint for arthroplasty/replacement?
knee
contraindications for arthroplasty?
Infection, Advanced osteoporosis, Severe inflammation, Severe diabetes/dialysis
preoperative considerations for arthroplasty
- Acquire equipment - walker, place to sleep downstairs, skilled nursing facility?
- Clean entire body with an antibiotic soap: a few days before surgery consecutively
- Blood transfusions
- Pre-operative Antibiotic
- NPO after midnight
education about dental procedures w/ arthroplasty
take prophylactic antibiotic before dental procedure with hardware
2 parts affected in hip arthroplasty
acetabulum and femoral
2 parts affected in knee arthroplasty
femur/tibia
cement vs fit press
Cement = immediately held together = weight bearing immediately –> more likely to happen in older person
Press Fit= osteoblastic activity has to occur for security, takes time! = NWB after surgery
post op hip athroplasty complications
-dislocation
-WB vs NWB
–DVT/ PE
-Infection
-Bleeding
-Neurovascular Compromise
-Assess? –> CMS (circulation, motion, sensation)
circulation = pulses, perfusion
motion = movement
sensation = feel it
Hip Arthroplasty: Precautions
-knees @ 90 angle
-do not bend/cross legs
-Abduction pillow = for posterior approach only
- use for elderly with confusion
CMS assessment
CMS (circulation, motion, sensation)
circulation = pulses, perfusion
motion = movement
sensation = feel it
Hip Arthroplasty: Precautions
- knees @ 90 angle
- do not bend/cross legs
- Abduction pillow = for posterior approach only
- use for elderly with confusion
only use abduction pillow with
posterior hip approach / elderly w/ confusion
post op knee considerations
-Continuous Passive Motion machine: settings based on provider order- continuous motion of joint, store on chair- not on floor
-Ice
-Pressure dressing
-Prevention of adduction is not necessary
-Keep in neutral position (avoid hyperextension and rotation)
-DVT/PE, Bleeding, Infection, NV Compromise
AMBULATE!
-Continuous Passive Motion machine, settings are based on
provider order!
signs of dislocation
severe pain, shortening of the leg, leg rotation
