Osteoarthritis 2 Flashcards
What are the causes of hip OA?
primary hip OA
secondary to hip disease - DDH, Perthes’ disease, previous trauma and other arthritic processes leading to hip joint destruction
How do patients with hip OA present?
peak incidence is in 6th decade
often bilateral
pain is felt in anterior thigh or groin and is made worse by walking
What is seen on examination in hip OA?
limp due to antalgic or trendelenburg gait
flexion and adduction deformity are commonly seen, leading to shortening of the limb
What are the predisposing conditions in the lower limb to developing knee OA?
valgus/varus deformity (weight distribution changes) fractures infective conditions meniscus and ligamentous injuries rheumatoid arthritis osteochrondritis dissecans
Describe how the symptoms in osteoarthritis correlate to disease progression?
early OA - rarely symptomatic unless accompanied by an effusion
advanced OA isn’t always symptomatic
Where is the correlation between presence of structural OA and pain/disability strongest?
in hip and knee
however poor quads strength and depression are better predictors of pain
Describe the pathology of osteoarthritis
Weight bearing cartilage surface degenerates and eventually wears away completely, exposing the subchondral bone, which becomes eburnated.
Cysts occur because because of microfracture of the articular surface and new bone laid down (sclerosis) in the surrounding bone. Disorganized new bone is produced at the margins of the joints (osteophytes) as the disease progresses.
Synovial lining becomes thickened and inflamed often producing excess synovial fluid (an effusion)
What are the four cardinal features seen on x-ray in OA?
LOSS
Loss of joint space
Osteophyte formation around the edges of the joint
Subarticular sclerosis
Subchondral cysts
What lifestyle advice is given to patients with OA?
patient education regular exercise physiotherapy - strength exercises weight loss appropriate footwear for LL OA
How is OA managed medically?
analgesics are the mainstay of treatment
oral analgesics - paracetamol and NSAIDS
intra-articular corticosteroid injections
What factors are considered when deciding which surgical treatment is best for each patient?
age occupation general mobility psychological make up severity of symptoms condition of other joints
What is an osteotomy?
realignment of the joint by removing a wedge of bone above or below the joint. This corrects varus deformity with medial compartment OA. Most commonly performed at the knee.
What is arthrodesis?
Joint fusion when bones either side of the joint are joined together permanently. It is used in small joints most commonly around the foot and ankle. Good pain relief, poor movement.
What is an arthroplasty?
Joint replacement most commonly used in hip and knee. It gives pain relief and good functional outcomes.
What is an arthroscopic lavage?
clearing out debris and washing out joint. This is done for osteoarthritis of the knee and gives temporary relief in some patients and can also be used as a palliative procedure.
