Osteoarthritis Flashcards
What is osteoarthritis?
Osteoarthritis is a chronic disease involving the imbalance between wear and repair of articular cartilage, leading to progressive cartilage loss and accompanying periarticular change
It is often referred to as “wear and tear”
How many people in the UK are thought to have osteoarthritis?
8.5 million people
What are the most commonly affected joints in osteoarthritis?
Knees (Thumb bases and IPJs)
Hands
Hips
Neck
Lower back
What types of factors increase risk of osteoarthritis?
Genetic factors
Constitutional factors
Bio-mechanical factors
What are some constitutional factors that increase risk of osteoarthritis?
Female
Ageing
Obesity
What are some bio-mechanical factors that increase risk of osteoarthritis?
- Joint injury
- Occupational or recreational usage
- Joint laxity
- Prior joint trauma or malalignment
What are some forms of joint trauma that increase risk of knee osteoarthritis?
PCL rupture
ACL rupture
Describe the pathophysiology of osteoarthritis
Osteoarthritis is a metabolically active, dynamic process that involves all joint tissues (joint tissues, cartilage, bone, synovium, ligaments and muscles)
A mixture of biomechanical and genetic features leads to localised loss of hyaline cartilage and remodelling of adjacent bone with new osteophyte formation at the joint margins
This is a combination of both tissue loss and tissue synthesis
What are the distribution patterns of osteoarthritis?
Locaslised:
Affecting hips, knees, fingers and the facet joints of lower cervical and lower lumbar vertebrae
Generalised:
Affecting either the spinal or hand joints and at least 2 other joint regions
What are some symptoms of osteoarthritis?
- Pain, worse with joint use
- Morning stiffness lasting less than 1 hour
- Inactivity gelling
- Instability
What will examination show in osteoarthritis?
- Joint line tenderness
- Crepitus
- Joint effusion
- Bony swelling
- Deformity
- Limitation of motion
- Poor grip in thumb OA
What are the 2 main bony swellings in osteoarthritis?
Heberden’s nodes
Bouchard’s nodes
What are Heberden’s nodes?
Bony swellings of the DIP joints
What are Bouchard’s nodes?
Bony swellings of the PIP joints
How can osteoarthritis affect thumb position?
Osteoarthritis in the base of the thumb will also cause squaring of the thumb, as it becomes pressed into the hand
What are some other clinical signs of osteoarthritis in the knee?
Genu varus (Knock kneeing)
Valgus deformities
Baker’s cysts, which are small, fluid-filled lumps found on the back of the knee, at the popliteal fossa
What are some other clinical signs osteoarthritis of the hip?
The pain may radiate to the groin or knee
What are some other clinical signs osteoarthritis of the cervical spine?
It can restrict movement of the head, cause pain and may cause occipital headaches
What are some other clinical signs osteoarthritis of the facet joints?
Osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica
What tests are required in the diagnosis of osteoarthritis?
History and examination, with no specific laboratory tests available
Radiological imaging such as x-rays, MRI scans and US scans can be used
What are the 4 main radiographic features of osteoarthritis?
LOSS:
- L - Loss of joint space
- O - Osteophytes
- S - Subchondral sclerosis (Increased density)
- S - Subchondral cysts (Fluid-filled holes)
What is shown on this X-ray?
Subchondral sclerosis (Black arrows)
Loss of joint space (Orange arrow) in the hip
What is shown on this X-ray?
Subchondral cysts (Black arrows)
Osteophytes (White arrows)
What is shown on this X-ray?
Asymmetry in osteoarthritis
What are some non-pharmacological management strategies in osteoarthritis?
- Education
- Lifestyle management
- Physiotherapy
- Occupational therapy
What are some pharmacological management options in osteoarthritis?
Analgesia
Intra-articular steroid injections
Describe the pain ladder used in osteoarthritis?
Mild pain is treated using NSAIDs (+PPI in elderly) or paracetamol
Moderate pain requires addition of a weak opioid
Severe pain requires addition of a strong opioid
What surgical management can be used in severe osteoarthritis?
Joint replacement
Arthroscopic surgery
Removal of loose bodies
What management in required in nerve root entrapment by osteophytes?
surgical decompression, with trimming of the impinging osteophytes
When would total knee replacement be considered in patients with knee osteoarthritis?
In an appropriate patient, with at least moderately severe OA on x-ray and which significant pain that is uncontrolled by conservative management
What are some limitations of total knee replacement?
These replacements don’t act like a normal knee and don’t last forever
They often don’t improve stiffness
Replacements are based on male knees and so don’t always act normally
What is the problem with revising a replacement?
The problems with revising a knee replacement is that because it is a much bigger surgery with more blood loss and higher risk of complications
Revision knees also don’t work as well as the first knee replacement
What surgical option is used in cases of unicompartmental (Only medial or lateral) knee osteoarthritis?
Unicompartmental knee replacement in which only a small region of the knee is replaced
What is involved in a total knee replacement?
They involve replacement of the femoral condyles with a metal alloy and replacement of the tibial head with a polyethylene mould
How will patients with glenohumeral arthritis present?
Patients will usually present with gradual onset of pain and stiffness at rest or at night, with intermittent exacerbations
What are some signs of glenohumeral arthritis?
Muscle wastage
Asymmetry
Global restriction of ROM
What are some non-operative treatments for glenohumeral osteoarthritis?
Analgesia
Physiotherapy
GH steroid injection
What are some operative treatment options for glenohumeral osteoarthritis?
- Shoulder replacement (Arthroplasty)
- Resurfacing
- Total shoulder arthroplasty
- Reverse polarity shoulder arthroplasty
