Osteoarthritis Flashcards
What are 4 x-ray changes in osteoarthritis?
- Decrease of joint space
- Subchondral sclerosis
- Subchondral cysts
- Osteophytes forming at joint margins
What is another way of referring to osteoarthritis of the hand?
nodal arthritis
What causes osteoarthritis of the hand?
loss of cartilage at synovial joints, often accompanied by degeneration of underlying bone
not usually inflammation
What may be present in the history of someone with OA?
positive family history
What is the gender ratio of those affected by hand osteoarthritis?
M:F 1:3
What is the typical age at which patients are affected by hand OA?
usually after 55 years
What is more common, hand OA radiologic signs vs. symptoms?
radiologic signs more common than symptoms
What are 2 things that the presence of hand OA increases the risk of?
future hip and knee OA (higher for hip than for knee OA)
What are 5 risk factors for osteoarthritis of the hand?
- Genetics
- Previous trauma of a joint
- Obesity
- Hypermobility of a joint
- Occupation e.g. cotton workers and farmers
What genetics are thought to be involved in hand OA?
genes that encode for collagen type II, thought to be involved especially in interphalangeal involvement
What is a factor that reduces the risk of osteoarthritis?
osteoporosis
What are 4 features of the distribution of osteoarthritis in the hand?
- Usually bilateral
- Carpometacarpal joints (CMCs) distal interphalangeal joints (DIPs) affected more than PIPs
- Painless nodes: Heberdens at DIP joint, Bouchard’s at PIP joints
- Squaring of the thumbs: deformity of carpometacarpal joints of thumb, resulting in fixed adduction
What is the cause of Heberden’s and Bouchard’s nodes?
caused by osteophyte formation
Herbeden’s = DIPs
Bouchard’s = PIPs
What causes squaring of the thumb in osteoarthritis?
deformity of carpometacarpal joint of thumb, resulting in fixed adduction of the thumb
What are 4 symptoms of osteoarthritis in the hand?
- Episodic joint pain - intermittent ache provoked by movements, relieved by resting joint
- Stiffness - worse after long periods of inactivity e.g. waking up in morning. Lasts only a few minutes compared to morning stiffness in RA
- Functionally, usually no problems
- May be reduced grip strength if DIPs involved which can cause disuse atrophy
What is the key investigation in osteoarthritis of the hand?
x-ray: osteophytes and joint space narrowing
What is the most common presentation of osteoarthritis?
knee
What is the second most common presentation of osteoarthritis?
hip
What are 4 risk factors for osteoarthritis of the hip?
- Increasing age
- Female gender (2:1)
- Obesity
- Developmental dysplasia of the hip
What are the key sympoms of osteoarthritis of the hip?
chronic history of groin ache following exercise and relieved by rest
What are 3 features suggesting an alternative diagnosis to osteoarthritis of the hip?
- Rest pain
- Night pain
- Morning stiffness >2 hours
What score can be used to assess the severity of osteoarthritis of the hip?
Oxford Hip Score
What are 2 options for investigations of suspected osteoarthritis of the hip?
- If features are typical, clinical diagnosis can be made
- Otherwise plain X-rays are first line
What are 3 aspects of the management of osteoarthritis of the hip?
- Oral analgesia
- Intra-articular injections: provide short-term benefits
- Total hip replacement remains definitive treatment
What type of treatment do intra-articular steroid injections provide in osteoarthritis?
short-term benefit
What is the definitive treatment for osteoarthritis of the hip?
total hip replacement
What are 3 complications of total hip replacement surgery?
- Venous thromboembolism
- Intraoperative fracture
- Nerve injury
What are 4 reasons for revision of total hip replacement?
- Aseptic loosening (most common reason)
- Pain
- Dislocation
- Infection
What is the most common reason for revision of total hip replacement?
aseptic loosening
What are 3 lifestyle measures to help manage osteoarthritis?
- Weight loss
- Local muscle strengthening exercises
- General aerobic fitness
What are the first line medical treatments for OA? 2 drugs
paracetamol and topical NSAIDs
What are the only 2 situations when topical NSAIDs should be used for osteoarthritis?
- Knee
- Hand
What are 4 second-line treatment options for osteoarthritis?
- oral NSAIDs/COX-2 inhibitors + PPI
- Opioids
- Capsaicin cream
- Intra-articular corticosteriods
When should you avoid prescribing oral NSAIDs/COX-2 inhibitors?
if the patient takes aspirin
What are 3 non-pharmacological treatment options for osteoarthritis?
- Supports and braces
- TENS
- Shock-absorbing insoles or shoes
What is the next treatment option following conservative measures to manage osteoarthritis?
joint replacement
What is glucosamine?
normal constituent of glycosaminoglycans in the cartilage and synovial fluid
What is the role for glucosamine for treating osteoarthritis?
provides modest pain relief in knee OA but should not be prescribed on NHS due to limited evidence of cost effectiveness
What are 2 selection criteria for joint replacement for osteoarthritis?
- 25% of patients are now younger than 60 years
- obesity often thought to be barrier, but only slight increase in short-term complications and no difference in long term joint replacement survival
What is the most common surgical technique for hip replacement for OA?
cemented hip replacement
What does a cemented hip replacement involve?
metal femoral component is cemented into the femoral shaft. this is accompanied by cemented acetabular polyethlene cup
What are 3 options for surgical techniques for hip replacement?
- Cemented hip replacement
- Uncemented hip replacement
- Hip resurfacing
In which group are uncemented hip replacement becoming more popular?
younger, more active patients
What is a downside of uncemented hip replacements compared with cemented hip replacement?
more expensive
What does hip resurfacing involve?
metal cap attached over the femoral head
What patient group is hip resurfacing often used rather than replacement?
younger patients
What is the advantage of hip resurfacing over replacement?
femoral neck is preserved which may be useful if conventional arthroplasty is needed later in life
What are 2 things received by patients during post-operative recovery following hip replacement?
- Physiotherapy and course of home-exercises
- Walking sticks or crutches used for up to 6 weeks after hip or knee replacement surgery
How long are walking sticks or crutches used for following hip replacement?
6 weeks after
What are 4 important pieces of advice to give a patient who has had a hip replacement operation?
- Avoiding flexing the hip >90 degrees
- Avoid low chairs
- Do not cross your legs
- Sleep on your back for the first 6 weeks
What are 3 possible complications of joint replacement surgery?
- Wound and joint infection
- Thromboembolism
- Dislocation
What prophylaxis against thromboembolism is given following joint replacement surgery + for how long?
low-molecular weight heparin for 4 weeks following surgery
