Osteoarthritis

Question 1

pathophysiology of OA

Answer 1

degeneration of knee joint
articular cartilage damage, break down and degeneration
joint space narrowing

Question 2

risk factors for OA

Answer 2

• Age
• Gender - female>men
• BMI - main modifiable risk factor
• Previous sports injury
• Intense sport activities
• Occupation (hand, hip)
• Quadriceps strength (knee)
• Alignment (knee)
• ‘pistol grip deformity’ (hip)
• Genetic
• Secondary OA - consider if patient presents at a young age <40, atypical distribution of joints, high index of suspicion and detailed PMH and FH needed e.g. metabolic, traumatic, anatomical, inflammatory, neuropathy - DM

Question 3

presentation of OA

Answer 3

insidious onset
pattern of pain getting worse
makes exercise difficult as pain increases when exercising
dull ache, mild early morning stiffness <30 mins
gelling and reduced ROM

Question 4

Common site for OA

Answer 4

knees, feet, hips, lumbar and cervical spine
hands - base of thumb/carpometacarpal joint
proximal interphalengeal joints, distal interphalangeal joints
occurs commonly in synovial joints

Question 5

signs of OA on hand examination

Answer 5

nodal osteoarthritis: hebderns nodes (DIP) bouchards (PIP)

Question 6

OA on xray

Answer 6

LOSS
loss of joint space
osteophytes on the joint margins
subchondral bone sclerosis
subchonral cysts - small pseudocystic areas with sclerotic walls situated in the subchondral bone

Question 7

management of OA

Answer 7

conservative: weight loss, patient education, exercise/physiotherapy

pharmacological: analgesia
topical anti-inflammatories
paracetamol, NSAIDs, opioids

surgical - if symptoms have had a substantial impact on QoL and aren’t responding to non-surgical replacements
total hip replacement or knee replacement

Question 8

signs of OA on knee examination

Answer 8

Antalgic gait, weakness +/- muscle wasting, joint line tenderness, deformity, bony swelling, instability