Osteoarthritis

Question 1

What changes can be seen in an X-ray in osteoarthritis?

Answer 1

LOSS:
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts

Question 2

How does osteoarthritis present in a patient?

Answer 2

Joint pain and stiffness
Worsened by activity
Weather can trigger pain
Either no morning stiffness or stiffness that only lasts <30mins
Severe osteoarthritis can cause pain at rest and night
Leads to deformity, instability and reduced function in the joint

Question 3

What is the management for osteoarthritis?

Answer 3

Education
Weight loss
Physiotherapy
OT
Orthotics

Stepwise use of analgesia to control symptoms:

1. Paracetamol and topical NSAIDs or capsaicin
2. Add oral NSAIDs and co-prescribe PPI
3. Consider opiates e.g. codeine, morphine

Intra-articular steroid injection

Joint replacement - in severe cases

Question 4

What surgical techniques can be used to replace hip joints if patient has osteoarthritis?

Answer 4

Cemented hip replacement (most common)

Uncemented hip replacement (more popular in younger, more active patients)

Hip resurfacing (often used in younger patients)

Question 5

What advice should be given post hip replacement to reduce the risk of dislocation?

Answer 5

Avoiding flexing the hip >90 degrees
Avoid low chairs
Do not cross your legs
Sleep on your back for the first 6 weeks

Question 6

What surgical techniques can be used to replace hip joints if patient has osteoarthritis?

Answer 6

Cemented hip replacement (most common)

Uncemented hip replacement (more popular in younger, more active patients)

Hip resurfacing (often used in younger patients)

Question 7

What advice should be given post hip replacement to reduce the risk of dislocation?

Answer 7

Avoiding flexing the hip >90 degrees
Avoid low chairs
Do not cross your legs
Sleep on your back for the first 6 weeks

Question 8

What movement is reduced in osteoarthritis of hip?

Answer 8

Internal rotation is reduced in hip in OA