Osteoarthritis

Question 1

What is another term for OA?

Answer 1

Nodal arthritis

Question 2

RFs for OA?

Answer 2

Prev. trauma to joint
Obesity
Hypermobility of joint
Occupation

Question 3

What reduces OA risk?

Answer 3

Osteoporosis

Question 4

Features of OA of the hand?

Answer 4

Usually bilateral (CMC + DIP more than PIP)
Episodic joint pain
Stiffness
Painless nodes (Heberden’s, Bouchard’s)
Thumb squaring
NO FUNCTIONAL IMPAIRMENT

Question 5

How are joints affected in OA of the hand?

Answer 5

Usually one at a time affected over several years

Question 6

How is joint pain relieved/exacerbated in OA of the hand?

Answer 6

Relieved - resting
Exacerbated - movement

Question 7

How does joint stifness in OA of the hand present?

Answer 7

Exacerbated by long periods of inactivity (morning)

Question 8

How can OA morning stiffness be differentiated from RA morning stiffness?

Answer 8

OA: < 30 mins
RA: > 30 mins

Question 9

Why does OA of the hand present with thumb squaring?

Answer 9

Bony outgrowth deform CMC of thumb -> fixed thumb adduction

Question 10

When may functional impairment present in OA of the hand?

Answer 10

Usually no functional impairment
Only if severe DIP involvement -> less grip strength -> disuse atrophy

Question 11

Ix of OA of the hand?

Answer 11

X-ray (osteophytes, joint space narrowing, etc)
X-ray signs develop before symptoms

Question 12

How may OA of the knee present?

Answer 12

Pt > 50, often overweight
Pain may be severe
Intermittent swelling, crepitus, movement limitation

Question 13

What is the most common presentation of OA?

Answer 13

Knee, then hip
lumbar spine

Question 14

What are RFs of OA specific to the hip?

Answer 14

Developmental dysplasia of the hip

Question 15

What are features of OA of the hip?

Answer 15

Chronic groin ache after exercise and relieved by rest

Question 16

What are red flag features suggestive of an alternative cause in suspected OA of the hip?

Answer 16

Rest pain
Night pain
Morning stiffness > 2 hours

Question 17

What can be used to assess severity of OA of the hip?

Answer 17

Oxford Hip Score

Question 18

Ix of OA of the hip?

Answer 18

Clinical diagnosis can be made if features typical, otherwise plain x-rays are first-line

Question 19

Mx of OA of the hip?

Answer 19

Oral analgesia (paracetamol - mild disease, NSAIDs are generally better though)
Intra-articular injections (short-term benefit)
weight loss and exercise
physiotherapy/occupational therapy

DEFINITIVE: THR

Question 20

Perioperative complications of THR?

Answer 20

VTE, fracture, nerve injury, surgical site infection

Question 21

Postoperative compliations of THR?

Answer 21

Leg length discrepancy
Posterior dislocation
Aseptic loosening (most common reason for revision)
Prosthetic joint infection

Question 22

How may posterior dislocation of a THR present?

Answer 22

May occur at extremes of hip flexion
Typically presents acutely with a ‘clunk’
Pain and inability to WB
Examination - internal rotation and shortening

Question 23

what is the most common joint disease worldwide?

Answer 23

osteoarthritis

Question 24

when are steroids usually used in OA mx?

Answer 24

usually just to cover during important life event or holiday
there’s a limit to how many injections a pt can have in a year

Question 25

other surgical procedures for oa aside from arthroplasty?

Answer 25

joint fusion or excision

Question 26

is thr useful in oa mx?

Answer 26

excellent pain relief but doesn’t improve function of joint much