Osteoarthritis Flashcards
What is the strongest predictor in osteoarthritis?
Age
therefore extended life expectancy will result in a greater occurence of the disease
What percentage of adukts over 60 in england and wales have some degree of OA?
10-15%
What are the radiological features of osteoarthritis?
4 marks
Loss of joint space
Sub-chondral sclerosis
Cyst formation
Osteophytes
What is the critical change to articular cartilage in osteoarthritis?
Loss of proteoglycans
Describe the 4 main features of arthritis of the hip on x-ray
Narrowed joint space
-loss articular cartilage
Osteophytes
-Extra bone formed by body to take extra load
Sclerosis
-Seen as increased whitening of bone, caused by hardening of bone around joint caused by increasing loads
Cyst
-Change of bone to cartilaginous tissue due to load change
Describe the features that make osteoarthritis different to “normal” age change?
Normal aged cartilage
- Yellowing, fibrillated
- Less resistant to biomechanical insults
- Reduced cellular activity related to lack of use
Osteoarthritic cartilage
- Metabolically active
- Inflammatory component
- Seen in areas of high cyclical loading
- Age accelerated disorder
What are the primary and secondary aetiologies of osteoarthritis?
Primary
- Genetic
- Multifocal
Secondary
- Trauma
- Anatomic
- Disease
- Other
What two types of trauma can lead to osteoarthritis?
Think outside the box
Direct joint trauma
Malignant
Give 5 causes of osteoarthritis that come under developmental/ anatomy
Dysplasia SUFE Perthes OsteoDysplasias Impingement lesions
Give 3 causes of osteoarthritis that come under disease
Inflammatory
Haemophilia
Haemachromatosis
Femoroacetabular impingement is another cause of osteoarthritis of the hip.
What are the two types?
CAM
Pincer impingement
What is the strongest modifiable risk factor of osteoarthritis?
Obesity
overweight at 36-37 is a risk factor for knee OA
How can bone density effect OA?
Increased density -> increased risk
How does exercise and occupation effect OA?
Exercise:
-High impact sports present an increase for OA
Occupation:
-More common in those performing heavy physical work
How does gender effect OA?
Men 50 = higher prevalence and incidence
What are the 3 main presenting symptoms in OA?
Pain
Swelling
Stiffness
Describe the pain in OA
Exacerbated by activity
Night time
Gradual deterioration over time
May get episodes of increased intensity
Describe the stiffness in OA
Start up
Reduced movement
Difficult daily activities
What are the signs of OA?
6 marks
Visible deformity Swelling Warmth Crepitus Reduced movement Pain
What investigations can be carried out in OA?
X-ray
MRI (early)
Bone scan
CT
How can you manage patients pain in OA?
Analgesia ladder:
- Paracetamol/ topical NSAID
- Oral NSAID
- Opiates
How can muscle strengthening be used for OA?
how is it being delivered, effective
Proven in knee
Specific exercises
Proven amount required
Delivered by:
- Physiotherapy
- Groups
- Online
Reduction in pain
Delays surgery
How can activity modification be used in OA?
Reduce high impact activities
Reduce distance
Alter work
Reduce load carrying
How can weight loss help with OA?
Reduce load on joint
Reduce pro-inflammatory state
Reduce surgical problems
Help other co-morbidities
Give some offloading supports that can take increasing weight through upper body and offload lower limb
Splints
Stick
Crutch
Zimmer
How does the effectiveness of intra-articular steroid change over time?
Reducing effectiveness with repeats and disease progression
What is the mode of action for hyaluronic acid?
Restoration of elastoviscous properties
“Normalisation” of HA synthesis by synoviocytes
Anti-inflammatory effect
Analgesic effect
Describe the process of platelet rich plasma (PRP) injection
Collect blood
-30-60ml from patients arm
Separate the platelets
-Blood placed in centrifuge
Extract platelet rich plasma
-3-6ml
Inject injured area with PRP
What is the benefits of PRP injection?
Increase the growth factors up to eight times, which promotes temporary relief and stops inflammation
Limited evidence but this is increasing in knees
Stimulates hyaluronic acid production
Lasts severeal months
Describe the efficacy of DMARDs in OA
Currently no effective DMARD for OA
Trials in variety of drugs
Name 3 DMARDs that are being trialed for OA
Strontium Ranalate
Methotrexate
Biologics (antibodies to interleukin etc)
Name the two broad types of joint surgery in OA?
Joint sparing -> conservative
Joint replacing
Osteoarthritis of the toe is named what?
Hallux rigidus
What is Cheilectomy?
A cheilectomy is a surgical procedure that removes bone spurs from the base of the big toe.
What are the principles of osteotomy in OA?
Mechanical realignment
Offload arthritic cartilage
Load normal cartilage
Recovery arthritic cartilage
What is Keller’s procedure?
A first metatarsophalangeal (MTP) joint resection arthroplasty treats arthritis of the big toe.
What is arthrodesis?
Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery.
Pain on movement so remove joint to remove movement
Inevitable limitation activity
Name the common and less common joints to replace in the upper and lower limb
Common:
- Shoulder
- Elbow
- Hip
- Knee
Less common:
- Wrist
- MCP
- PIP
- Ankle
- MTP
List the 4 types of joint replacement
Hemi-arthroplasty
Uni-compartmental Arthroplasty
Resurfacing
Total Joint Arthroplasty
What is a hemiarthroplasty?
One side joint replacement
e.g. hip, shoulder, toe
What is unicompartmental knee replacement?
In unicompartmental knee replacement (also called “partial” knee replacement) only a portion of the knee is resurfaced. This procedure is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee.
The majority of unicompartmental knee replacements are on which area of the knee?
Medial
What is a total joint replacement?
Both sides of the joint are replaced
Variety of bearing surfaces
Varying bearing size
What is the chemical name of the cement used in surgery?
Polymethylmethacrylate
Uncemented fixation in joint replacement was developed due to cement disease.
What is cement disease?
the osteolysis that frequently occurs in association with loosening of cemented total hip replacements; the microscopic particles of polymethylmethacrylate cement induce a biologic reaction by osteoclasts leading to bone resorption and progressive bone loss.
Give 3 ways joint replacement may fail
Aseptic loosening (wear)
Dislocation (hip)
Infection
Describe the factors that lead to aseptic loosening
Particulate debris -> macrophages \+ Hydrostatic pressure \+ Immune response
Leads to
-Cytokines, inflammatory mediators
AND SO:
Osteolysis
