Osteoarthritis Flashcards
How common is OA
Affects 8 million people
1/2 of all people over 70
The higher the age the more common it becomes - typically in over 45s
What is OA
Thinning or loss of the articular cartilage within a joint - degenerative disease of cartilage
Main sign is loss of joint space
Which sex is OA most common in
Female
Describe the progress of OA
Cartilage starts breaking down - thins and cracks form in surface
Gaps in cartilage expand until they reach bone
Synovial fluid leaks in and causes more damage and may cause cysts
What are the types of OA
Idiopathic (primary)
Secondary - occurs due to previous injury, RA, crystal deposition etc
In which joints does OA present in
Weight bearing - hips, knees, spine
Joints that are used often - hand, neck
Sometimes affect joints with previous injury
What are the clinical presentations of OA
Pain - worse on activity
Stiffness - in morning lasting under 30 mins
Reduced range of movement
What signs of OA may you find on examination
Crepitus
Joint swelling - bony enlargements
Joint tenderness
Joint effusion
How does OA present in the hands
Thumb base is often one of the first sites
Affects DIP, PIP, CMC
May see bony enlargements at DIPs
Squaring of the hand at thumb
How does OA present in the knees
osteophytes effusions crepitus restricted movement deformity Bakers cyst
What are Genu varus and valgus deformities
Valgus- knees come together (curve inward)
Varus- knees bend out the way
What is Baker’s cyst
Cause by any fluid accumulation in the joint
Can be OA but also many other conditions
How does OA present in the hip
Pain - may be felt in groin or radiate to/from back and knee
Restricted movement in hip
Start up pain
How does OA present in the cervical spine
Pain
Restriction of movement in the neck
How does OA present in the lumbar spine
Pain when standing or walking
Osteophytes can cause spinal stenosis
If nerve roots are pinched you can get neuralgic pain in the limbs
What signs of OA can be seen on imaging
Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes
How is OA graded
From 0-4
0 - no radiological finding
1- minute osteophytes
2- definite osteophytes with normal joint space
3- definite osteophytes with some space narrowing
4- definite osteophytes with severe narrowing and subchondral sclerosis
How does OA usually progress in knees
in 1/3 the symptoms improve
1/3 symptoms stay the same
1/3 deteriorate
How does OA usually progress in hands
In small joints, pain often improves over 2 years but swelling gets worse
How does OA usually progress in hips
symptoms improve in 10% of patients
allows them to come of surgical list so don’t rush a replacement
What are some non-pharmacological treatments for OA
Weight loss
Exercise - need to stay mobile and strong
Walking stick
Insoles - correct imbalance to take pressure off worn part
Physio - muscle strengthening
What are some pharmacologic treatments for OA
Analgesia - e.g. paracetamol
NSAIDs - topical or systemic for symptom relief
Pain modulators - amitriptyline, gabapentin (anticonvulsants)
Intra-articular steroids
What are some surgical treatments for OA
Arthroscopic wash out - removes any debris etc
Joint replacement - most definitive
Arthrodesis - joint fusion
Osteotomy
OA is usually symmetrical - true or false
False
Joint involvement is often asymmetrical
What are the radiographic features of OA
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Joint deformity can occur in late stages due to weakened bone
What causes subchondral sclerosis
Increase in bone cellularity and vascularity causes excess bone turnover
What causes subchondral cysts
Synovial fluid leaks into damaged bones and forms a cyst
What causes osteophyte formation
Periosteal stimulation at joint margins
What pathologies can lead to OA
DDH SUFE Septic arthritis AVN FAI Trauma - fractures, meniscal tears or cartilage Crystal arthropathy etc.
How is OA diagnosed
Radiographs
How does weight loss and walking aids help in treatment of OA
Reduce the body mass putting pressure on the joint
What is the indication for joint replacement
Severe pain
Impacting quality of life
When would you use an uncemented prothesis in the hip
Younger patients
When would you use a cemented prothesis in the hip
Older patients
