Osteoarthritis Flashcards
What is osteoarthritis?
Degenerative disease of the joints resulting from wear of the articular cartilage, which may lead to secondary changes in the underlying bone
Can be primary, or secondary to abnormal load to the joint or damage to the cartilage from inflammation or trauma
What percentage of individuals over the age of 60 years old have some form of osteoarthritis?
10-15%
Why does osteoarthritis occur?
What anatomical problems can cause the development of osteoarthritis?
- Dysplasia
- SUFE
- Perthes
- Osteodysplasia
-
Impingement lesions
- Mechanical mismatch
What are the traumatic causes of osteoarthritis?
- Direct joint trauma
- Malalignment
What diseases can cause osteoarthritis?
- Haemophilia
- Haemochromatosis
- Hypermobility syndrome
What risk factors can predispose to the development of osteoarthritis?
- Obesity
- Diet
- Bone density
- Age
- Exercise
- Occupation
- Gender
- Ethnicity
What are the symptoms of osteoarthritis?
-
Pain/stiffness
- Stiffness for a few minutes in the morning
- RELIEVED BY REST
- Progressive from weight bearing to at rest/at night if very severe
- Swelling
- Decreased ROM
What are the general clinical signs of osteoarthritis?
- Muscle Wasting
- Palpable/Audible Crepitus
- Joint effusion
- Joint instability
- Warmth over affected joint
- Visible Deformity
- Abnormal gait
- Decreased active/passive movment ROM
What is a Bouchard’s node?
Osteoarthritic enlargement of the PIP
What are Heberden’s nodes?
Osteoarthritic enlargements of the DIP
What does arthritis mean?
Inflammation of a/multiple joints
What does arthropathy mean?
Joint pathology; any disease of the joint
What does arthrosis mean?
A term for a degenerative disease of the joint where the cartilage lining the joint erodes over time. Usually used for osteoarthritis.
What are symptoms of osteoarthritis in the knee?
-
Pain - on walking on uneven ground/ascending/descending stairs
- Anterior/medial pain most common
- Stiffness - after inactivity, resolves in <30 mins
- Decreased ROM
- Swelling
What are symptoms of OA in the hip?
-
Pain - groin on exercise
- Referred pain - buttock, anterior thigh, knee
- Decreased ROM
- Stiffness
What is the pathophysiology of Osteoarthritis?
What are the clinical features of OA in the hand?
- Pain
- Swelling/stiffness
- Restricted ROM
On examination, what is one of the early signs of the development of osteoarthritis of the hip?
Internal rotation
What would you see on examination in someone with knee OA?
- Antalgic gait
- Varus/Valgus deformity - more often varus
- Joint effusion
- Joint-line tenderness
- Crepitus
- Quad muscle wasting
- Bony deformity
- Reduced ROM
On examination of the hand, what would you see in osteoarthritis of the hand?
Bilateral
- Herberden’s/bouchards nodes
- Squaring of the hand
- Subluxation of 1st CMCJ
On examination, what signs would you see in someone with hip osteoarthritis?
Unilateral - more often than bilateral
- Antalgic Gait
- Global deficit in ROM - internal rotation early on, external rotation/abduction/adduction later
- Fixed flexion deformity
- Limb shortening
- Quad/gluteal muscle weakness +/- wasting
What is the following?
Bouchard’s Node
What are the following?
Heberden’s Nodes
What is the following deformity?
Genu Valgum - Valgus deformity
Distal point deviates away from the midline of the proximal point
What is the following deformity?
Genu Varum - Varus deformity
Distal point deviates towards the midline of the proximal point
What is the following deformity?
Squaring of the hand - 1st CMCJ
How would you investigate someone that you suspect has osteoarthritis of a joint?
Imaging
- X-ray
- MRI (early)
- Bone Scan
- CT
What findings on an X-ray would indicate osteoarthritis?
- Loss of joint space - loss of articular cartilage
- Osteophytes - extra bone formed to take extra load
- Subchondral Cyst formation - change of bone to cartilaginous tissue due to load change
- Sub-chondral sclerosis - increased whitening of the bone on x-ray due to hardening of bone
The following radiograph was taken of someone with suscpected osteoarthritis in the knee. What findings are circled in the image?
Osteophytes
The following radiograph was taken from someone with suspected osteoarthritis of the knee. What radiological finding is circled?
Loss of joint space
The following radiograph was taken from someone with suspected osteoarthritis of the hip. What radiographic finding is circled?
Subchondral cyst
The following radiograph was taken from someone with suspected osteoarthritis. What radiographic finding is circled?
Subchondral sclerosis
What is the differential diagnosis of someone with joint pain, stiffness and decreased ROM?
- Bursitis
- Gout
- Pseudogout
- Rhematoid Arthritis
- Psoriatic arthritis
- Avascular necrosis
- Internal derangements (e.g. meniscal tears)
What general measures would you take in the management of someone with joint osteoarthritis?
- Patient education - diagnosis, expectations
- Physiotherapy
- Activity modification
- Offloading support - crutches, stick, zimmer
- Lifestyle - weight loss
How would you manage pain in osteoarthritis?
Therapeutic ladder
- Paracetamol/topical NSAIDs
- Oral NSAIDs
- Opiates
What other medical therapies (besides pain management) could be used to manage someone with osteoarthritis?
Injection Therapies
What types of inection therapies can be used in osteoarthritis?
- Steroid- reduces inflammation, 6 week effects
- Hyaluronic acid - Restoration of elastovicous properties, Anti-inflammatory, Analgesic
- Platelet rich plasma - Stimulates hyaluronic acid production
What is the definition of arthroplasty?
Surgical refashioning of a diseased joint to relieve pain and to maintain/regain movement
What are the different types of arthroplasty surgery?
- Excision arthroplasty - excision of enough bone to create a gap at which movement can occur
- Hemiarthroplasty - One sided joint replacement with erosion opposing surface. (e.g. only femoral head, not acetabulum as well)
- Uni-compartmental Arthroplasty - Mainly knee (medial knee)
- Resurfacing - Hip capsule and femoral head. 9 year follow up
- Total Joint arthroplasty - Both sides joint replacement
What is an osteotomy?
Surgical procedure to cut a bone into two parts, followed by realigment of the ends of the bone to allow healing - changes biomechanics of the joint
Example - osteotomy of the humerus
What is surgical debridement?
Process of cleaning an open wound by removal of foreign material and dead tissue, so that healing can occur without hindrance
What does microfracture surgery involve?
Articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone. This causes new cartilage to develop from a so-called super-clot
What is arthrodesis?
“Artificial Ankylosis”
The fusion of bones across a joint space by surgical means, which eliminates movement
Performed when a joint is very painful, highly unstable, grossly deformed or chronically infected
Can use cement, or can be fixated uncemented (e.g titanium implant)
What are the two classes of surgical interventions in the management of osteoarthritis?
- Joint sparing
- Joint replacing
What is a baker’s cyst?
- Baker’s cysts (also known as a popliteal cyst) are not true cysts but rather a distension of the gastrocnemius-semimembranosus bursa.
- They may be primary or secondary:
- Primary: no underlying pathology, typically seen in children
- Secondary: underlying condition such as osteoarthritis, typically seen in adults
How would a ruptured baker’s cyst present?
Rupture may occur resulting in similar symptoms to a deep vein thrombosis, i.e. pain, redness and swelling in the calf. However, the majority of ruptures are asymptomatic.
