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Osteoarthritis Flashcards

1
Q

What are 4 x-ray changes in osteoarthritis?

A
  1. Decrease of joint space
  2. Subchondral sclerosis
  3. Subchondral cysts
  4. Osteophytes forming at joint margins
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2
Q

What is another way of referring to osteoarthritis of the hand?

A

nodal arthritis

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3
Q

What causes osteoarthritis of the hand?

A

loss of cartilage at synovial joints, often accompanied by degeneration of underlying bone

not usually inflammation

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4
Q

What may be present in the history of someone with OA?

A

positive family history

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5
Q

What is the gender ratio of those affected by hand osteoarthritis?

A

M:F 1:3

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6
Q

What is the typical age at which patients are affected by hand OA?

A

usually after 55 years

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7
Q

What is more common, hand OA radiologic signs vs. symptoms?

A

radiologic signs more common than symptoms

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8
Q

What are 2 things that the presence of hand OA increases the risk of?

A

future hip and knee OA (higher for hip than for knee OA)

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9
Q

What are 5 risk factors for osteoarthritis of the hand?

A
  1. Genetics
  2. Previous trauma of a joint
  3. Obesity
  4. Hypermobility of a joint
  5. Occupation e.g. cotton workers and farmers
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10
Q

What genetics are thought to be involved in hand OA?

A

genes that encode for collagen type II, thought to be involved especially in interphalangeal involvement

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11
Q

What is a factor that reduces the risk of osteoarthritis?

A

osteoporosis

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12
Q

What are 4 features of the distribution of osteoarthritis in the hand?

A
  1. Usually bilateral
  2. Carpometacarpal joints (CMCs) distal interphalangeal joints (DIPs) affected more than PIPs
  3. Painless nodes: Heberdens at DIP joint, Bouchard’s at PIP joints
  4. Squaring of the thumbs: deformity of carpometacarpal joints of thumb, resulting in fixed adduction
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13
Q

What is the cause of Heberden’s and Bouchard’s nodes?

A

caused by osteophyte formation

Herbeden’s = DIPs

Bouchard’s = PIPs

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14
Q

What causes squaring of the thumb in osteoarthritis?

A

deformity of carpometacarpal joint of thumb, resulting in fixed adduction of the thumb

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15
Q

What are 4 symptoms of osteoarthritis in the hand?

A
  1. Episodic joint pain - intermittent ache provoked by movements, relieved by resting joint
  2. Stiffness - worse after long periods of inactivity e.g. waking up in morning. Lasts only a few minutes compared to morning stiffness in RA
  3. Functionally, usually no problems
  4. May be reduced grip strength if DIPs involved which can cause disuse atrophy
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16
Q

What is the key investigation in osteoarthritis of the hand?

A

x-ray: osteophytes and joint space narrowing

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17
Q

What is the most common presentation of osteoarthritis?

A

knee

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18
Q

What is the second most common presentation of osteoarthritis?

A

hip

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19
Q

What are 4 risk factors for osteoarthritis of the hip?

A
  1. Increasing age
  2. Female gender (2:1)
  3. Obesity
  4. Developmental dysplasia of the hip
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20
Q

What are the key sympoms of osteoarthritis of the hip?

A

chronic history of groin ache following exercise and relieved by rest

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21
Q

What are 3 features suggesting an alternative diagnosis to osteoarthritis of the hip?

A
  1. Rest pain
  2. Night pain
  3. Morning stiffness >2 hours
22
Q

What score can be used to assess the severity of osteoarthritis of the hip?

A

Oxford Hip Score

23
Q

What are 2 options for investigations of suspected osteoarthritis of the hip?

A
  1. If features are typical, clinical diagnosis can be made
  2. Otherwise plain X-rays are first line
24
Q

What are 3 aspects of the management of osteoarthritis of the hip?

A
  1. Oral analgesia
  2. Intra-articular injections: provide short-term benefits
  3. Total hip replacement remains definitive treatment
25
Q

What type of treatment do intra-articular steroid injections provide in osteoarthritis?

A

short-term benefit

26
Q

What is the definitive treatment for osteoarthritis of the hip?

A

total hip replacement

27
Q

What are 3 complications of total hip replacement surgery?

A
  1. Venous thromboembolism
  2. Intraoperative fracture
  3. Nerve injury
28
Q

What are 4 reasons for revision of total hip replacement?

A
  1. Aseptic loosening (most common reason)
  2. Pain
  3. Dislocation
  4. Infection
29
Q

What is the most common reason for revision of total hip replacement?

A

aseptic loosening

30
Q

What are 3 lifestyle measures to help manage osteoarthritis?

A
  1. Weight loss
  2. Local muscle strengthening exercises
  3. General aerobic fitness
31
Q

What are the first line medical treatments for OA? 2 drugs

A

paracetamol and topical NSAIDs

32
Q

What are the only 2 situations when topical NSAIDs should be used for osteoarthritis?

A
  1. Knee
  2. Hand
33
Q

What are 4 second-line treatment options for osteoarthritis?

A
  1. oral NSAIDs/COX-2 inhibitors + PPI
  2. Opioids
  3. Capsaicin cream
  4. Intra-articular corticosteriods
34
Q

When should you avoid prescribing oral NSAIDs/COX-2 inhibitors?

A

if the patient takes aspirin

35
Q

What are 3 non-pharmacological treatment options for osteoarthritis?

A
  1. Supports and braces
  2. TENS
  3. Shock-absorbing insoles or shoes
36
Q

What is the next treatment option following conservative measures to manage osteoarthritis?

A

joint replacement

37
Q

What is glucosamine?

A

normal constituent of glycosaminoglycans in the cartilage and synovial fluid

38
Q

What is the role for glucosamine for treating osteoarthritis?

A

provides modest pain relief in knee OA but should not be prescribed on NHS due to limited evidence of cost effectiveness

39
Q

What are 2 selection criteria for joint replacement for osteoarthritis?

A
  1. 25% of patients are now younger than 60 years
  2. obesity often thought to be barrier, but only slight increase in short-term complications and no difference in long term joint replacement survival
40
Q

What is the most common surgical technique for hip replacement for OA?

A

cemented hip replacement

41
Q

What does a cemented hip replacement involve?

A

metal femoral component is cemented into the femoral shaft. this is accompanied by cemented acetabular polyethlene cup

42
Q

What are 3 options for surgical techniques for hip replacement?

A
  1. Cemented hip replacement
  2. Uncemented hip replacement
  3. Hip resurfacing
43
Q

In which group are uncemented hip replacement becoming more popular?

A

younger, more active patients

44
Q

What is a downside of uncemented hip replacements compared with cemented hip replacement?

A

more expensive

45
Q

What does hip resurfacing involve?

A

metal cap attached over the femoral head

46
Q

What patient group is hip resurfacing often used rather than replacement?

A

younger patients

47
Q

What is the advantage of hip resurfacing over replacement?

A

femoral neck is preserved which may be useful if conventional arthroplasty is needed later in life

48
Q

What are 2 things received by patients during post-operative recovery following hip replacement?

A
  1. Physiotherapy and course of home-exercises
  2. Walking sticks or crutches used for up to 6 weeks after hip or knee replacement surgery
49
Q

How long are walking sticks or crutches used for following hip replacement?

A

6 weeks after

50
Q

What are 4 important pieces of advice to give a patient who has had a hip replacement operation?

A
  1. Avoiding flexing the hip >90 degrees
  2. Avoid low chairs
  3. Do not cross your legs
  4. Sleep on your back for the first 6 weeks
51
Q

What are 3 possible complications of joint replacement surgery?

A
  1. Wound and joint infection
  2. Thromboembolism
  3. Dislocation
52
Q

What prophylaxis against thromboembolism is given following joint replacement surgery + for how long?

A

low-molecular weight heparin for 4 weeks following surgery

GP (43 decks)

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