Osteoarthritis

Question 1

Osteoarthritis Epidemiology

Answer 1

Most common arthritis
Increases over 30y
80% of >65y but only 1/4 symptomatic

Question 2

Osteoarthritis Joints most commonly effected

Answer 2

Spine
Hips
Knees
DIPJS
Base of thumb

Question 3

Osteoarthritis Risk factors

Answer 3

Age
Female
Joint shape and alignment 
Obesity 
Genetic deformity 
Previous injury
Repetitive trauma
Sport
Occupation
Caucasian

Question 4

Osteoarthritis Pathology

Answer 4

Repeated micro trauma/abnormal biomechanics
-> damage to cartilage-> wears away
Exposed subchondral bone

Chondrocytes attempt repair via enzyme release

• > inflam response
• > micro fractures-> cysts
• > bone proliferation-> sclerosis and osteophytes
• > synovial inflammation-> effusion

Question 5

Osteoarthritis X Ray changes

Answer 5

Joint space narrowing
Sclerosis
Cysts
Osteophytes

Question 6

Osteoarthritis Clinical features

Answer 6

Joint pain

• insidious onset
• aching/burning
• worse after use
• relieved by rest

Transient stiffness after rest
Swelling
Deformity
Muscle weakness

Question 7

Osteoarthritis Hip Signs

Answer 7

Groin pain
Antalgic gait
Unilateral
Restricted internal ROM
Limb shortening
Quads/gluteal wasting

Question 8

Osteoarthritis Knee signs

Answer 8

Increased on uneven ground and stairs
Antalgic gait
Difficulty getting up
Bilateral
Varus
Fixed flexion
Quads wasting
Medial and patella femoral

Question 9

Osteoarthritis Hand signs

Answer 9

Decreased rom
Often settles with preserved function 
FH
Bilateral
Herbedens and Bouchard nodes
CMCJ subluxation 
Thumb base squaring
DIPJ
Peri menopausal
Mucoid cyts-> clear gel discharge

Question 10

Osteoarthritis Investigations

Answer 10

X Ray
-changes frequently a symptomatic
Serum Ca2+ and ALP-> hyperthyroid and hypophosphatosis
Ferritin-> haemachromatosis

Question 11

Osteoarthritis Management-medical

Answer 11

Lifestyle

• exercise
• wt reduction
• footwear
• loading avoidance

Physiotherapy
Patellar taping
Knee brace
Walking AIDS
Heat/ice
TENS 

Paracetamol
NSAIDS
Corticosteroid injections

Question 12

Osteoarthritis Management-surgical

Answer 12

Joint replacement 
-hip 90% success
-knee 60-70%
Osteotomy/joint preserving 
Joint fusion

Question 13

Osteoarthritis Complications of joint replacement

Answer 13

Early

• infection
• bleeding
• fracture
• thrombosis
• fat embolus

Late

• loosening
• dislocation
• continuing symptoms

Question 14

Osteoarthritis Prognosis

Answer 14

Knee

• evolves slowly 1/3 deteriorates
• pain and X Ray changes predict prognosis

Hip
-1/2 progress over 10y

Hand

• 50% progress
• DIPJ fastest
• high risk of knee OA