Osteoarthritis Flashcards
Modifiable local risk factors of OA
- Muscle strength (esp. quad. femoris)
- Physical activity/occupation
- Joint injury (esp. ACL tear)
- Joint alignment
- Leg length inequality
Many patients will show OA changes within ____ years after an ACL tear
10
Risk factors that increase chance of developing OA after ACL tear
Damage to:
- Articular cartilage
- Subchondral bone
- Collateral ligaments
- Menisci
________ is one of the strongest predictors of knee OA
Knee malalignment
Varus vs. valgus knee alignment in progression of knee OA
Varus → medial knee OA
Valgus → lateral knee OA
Modifiable systemic risk factors for OA
- Obesity (esp. for knee/hip joints)
- Diet
- Bone metabolism
Non-modifiable risk factors of OA
- Age
- Female, esp. post-menopausal
- Genetics
- Ethnicity
Treatment for arthritis
- Pain control
- Viscosupplementation
- PT, bracing, assistive devices
- Surgery → arthroplasty or osteotomy
- Risk factor modification → muscle strengthening, weight management
Definitive treatment for arthritis
Surgery - arthroplasty or osteotomy
1kg weight loss = ______ reduction in load during ADLs
4x
True or false: Opioids have little to no use in arthritis
True
First line analgesic for OA
Acetaminophen (Tylenol)
Maximum dosage of Tylenol
4g/day
2g/day if chronic alcohol intake or underlying liver disease
What options do you have if Tylenol isn’t treating OA pain?
- NSAIDs
- Viscosupplementation
- Topical analgesics → diclofenac gel, capsaicin
- Corticosteroid injections
True or false: NSAIDs work immediately
False
Analgesic effects begin within 1-2 hours, but anti-inflammatory effects may take 2-3 weeks
What counseling should you provide with NSAIDs?
GI complaints are common - take with food
Maximum of ___ corticosteroid injections in a joint. Why?
3 injections/joint/year due to increased cartilage degeneration
How do valgus braces help mediate pain relief?
Stabilize joint
Reduce muscle contractions and joint compressions
What is hyaluronic acid used for in OA?
Synthesized by synovial membrane, functions as lubricant and shock absorber → viscosupplementation for OA
Synvisc-One vs. Euflexxa
- Synvisc has higher risk of pseudo-septic reaction (knee effusion, inflammation, leukocytosis)
- Euflexxa better option b/c no pseudo-septic reaction
When would you use narcotics in DJD?
Post-op, NOT pre-op
? Short-term use in exacerbations
