OSTEOARTHRITIS Flashcards
PRIMARY OA: def, prevalence, age, prognosis, causes
D = Degenerative joint disease (articular disease) - Slowly evolving
P: most common type of arthritis, resulting in disability
- 60% in men
- 70% in women (higher number of females > age of 45)
A: > 40 - 65 y
P: No cure, but pain & dysfunction decrease following guideline recommendations as regards lifestyle, pain management…
C: unknown for primary OA & trauma, infection, osteonecrosis… for secondary OA
HYALINE CARTILAGE: role & components
ROLE
- Smooth surface between bones surfaces - Friction free
- Reduces load transmitted through joint - Provides flexibility
Loss of cartilage
➠ inflammation, bone growth (osteophytes), edema ➠ progressive muscle weakness and atrophy
➠ pain & ROM limitation
COMPONENTS
- Chondrocytes: mediate extracellular matrix ratio Dual function: Repair & degradation of cartilage
- Extracellular matrix: water , collagen, proteoglycans & small component of calcium salt
OA: etiology & risk factors
Multifactorial etiology, poorly understood
- Genetics
- Ageing (stronger risk factor)
- Nutrition
- Weight control
- Female gender
- Bone density
- Immune system response
- Biomechanical factors
- Smoking
- High intensity sports
- Occupational activities
- Labral tear / femora acetabular & impingement
- Generalized ligament laxity / hypermobility
- Some link between patella alignments & PFJ osteoarthritis
OA: articular cartilage changes
Cartilage = matrix + chondrocytes
Schema
OA: pathogenesis + subchondral changes + synovial mb changes
Active disease process & disorder of whole synovial joint (bone, ligaments, tendon, synovium and meniscus)
☹ Articular cartilage changes ☹ Subchondral bone changes
☹ Synovial membrane changes
Mechanism understanding still poor:
- Chondropathy (Articular cartilage changes): Cartilage softening, thinning
Loss of cartilage and attempts for regeneration
- Failure of chondrocytes to control degradation & repair of cartilage
SUB: Bone structure changes - disorganized bone remodelling Increased abnormal type I collagen
SYN: Hyperplasia of synovial membrane
OA: progression, signs & symptoms, involved joints, management
EARLY STAGE: normal joint structure - no symptoms
- normal muscle functioning
END STAGE: joint failure - total loss of cartilage
- structural changes
- instability
- loss of muscle function
- severe pain at night & during activity
- impaired physical function
- reduced quality of life
Subjective findings:
- Onset of symptoms: Sudden or insidious
- Complain of deep ache, difficulty with walking/ standing, Stairs,
- Stiffness: Short duration(less than 30m) , either in morning or after prolonged inactivity.
Aggs: activity (post exercise pain), prolonged sitting,
Eases: rest, meds
Most common signs of OA:
- bony enlargement
- limited ROM
- crepitus
- Tenderness On Palpation (TOP) - Joint effusion
- malalignment & joint deformity
Hip, knee, cervical spine (and other part of spine), 1st MTP joint, 1st CMJ joint
Based on severity of disease
- Non medical intervention – oral or topical NSAIDS, intra-articular corticosteroid injections
- Physiotherapy – EXERCISE!
- Weight loss
- Arthroplasty
OA: classification, clinical diagnostic cluster & physical examination
C: 1: Possible osteophytes, no joint space narrowing
2: Definite osteophytes, possible narrowing of joint space
3: Moderate multiple osteophytes, definite joint space narrowing, some sclerosis & possible deformity of bone ends
4: Severe sclerosis & definite deformity of bone ends
CDC: tableau
PE: Knee joint:
- decrease ROM
- Pain
- Muscle atrophy
- Stiffness
- Joint effusion
- Crepitus
- Difficulty with weight bearing
Hip joint:
- Pain in lower back, buttocks & groin
- ROM limited in abduction & IR
- Limping gait
- Stiffness
- ‘’Locking’’ of hip
Glenohumeral joint:
- ROM reduced (ER /IR elevation)
- Pain with activities
- Difficulties with ADLs (eating, dressing)
≠ OA & RHEUMATOID ARTHRITIS: characteristics + onset, patient history, physical examination
Image + tableau
EXERCISE PRESCRIPTION for OA, ankylosing spondylitis & rheumatoid arthritis
OA: moderate exercise, improve function & muscle strength
Ankylosing Spondylitis (AS): GOAL: control inflammation & stiffness in joints, avoid high impact & flexion exercises, emphasis on low impact, rotational mvts, trunk strengthening
RA: remission & relapse periods
GOAL: state of remission, modification of exercise prescription during inflammatory period, balance between rest & activity during flare ups
Over exercising exaggerate inflammatory process in RA & AS
OA: ≠ surgical interventions + def
- Surgical reconstruction & stabilization: reduce laxity
- Muscle/tendon transfer: improve stability of unstable joint
- Release / lengthening / decompression: ROM improvement, pain relief, prevent or minimize deformation
- Arthrodesis: Late stage of arthritis, severe muscles weakness (mobility not concern)
Rehabilitation & post op management varies according to surgeon technique, age, patient’s responses, PMH…
OA: joint replacements
- Successful surgical intervention & for older population with advanced arthritis
- Most effective healthcare measure in improving patients quality of life
- Usually involves Hip/ knee & Shoulder joint Duration: a decade to 20 years
= Treatment option if failure of nonsurgical treatment - Total or Partial replacements to relieve pain & improve function of patient
FEATURES
Prothesis or implants: - Rigid (metal)
- Semirigid (plastic- polyethylene)
Fixation methods: - Cemented - Non cemented
- Hybrid
TISSUE GRAFTS: ≠ types & def of each
Autografts: Patients own’s tissue
Allografts: Source other than patient, usually cadaveric donor
Synthetic grafts: Alternative to human tissue, usually for ligament reconstruction
Common MSK orthopedic surgeries + some examples of each
Tableau
TOTAL KNEE REPLACEMENT: type of patients & common surgical approach
Indicated for patients with:
- Severe knee OA, pain with weight bearing - Gross instability or ROM limitation
- Failure of conservative management
Common surgical approach:
- Long anterior incision
- Minimally invasion incision
Total hip replacement: type of patient, common surgical approaches & common precautions after surgery
Indicated for patients with:
- Severe OA & hip pain
- Significant ROM decrease
- Failure of conservative management
Common surgical approaches:
- Posterior or posterolateral incision (most common) splitting gluteus maximus in line with fibers or splitting gluteus maximus & medius. Capsule incised & External rotator (ER) also transected
- Anterolateral incision: IT band is split. ER rotators remain intact
Common precautions after surgery:
- Avoid hip flexion >90 degrees
- Avoid adduction & Internal Rotation beyond neutral - Do not cross legs
- Avoid bending trunk over legs
- Avoid lying in side lying position
Minimally invasive THR gets more popular & less cutting / tissue damage surrounding hip → quicker recovery, less damage to tissue
