Osteoarthritis and Joint Replacement

Question 1

Explain the pathogenesis and presentation of osteoarthritis

Answer 1

• It is a degenerative disease with progressive loss of cartilage.
• It presents with pain, stiffness, loss of range of movement, deformity, loss of function and reduced quality of life.

Question 2

What are the modifiable and non-modifiable risk factors?

Answer 2

Modifiable - Trauma, muscle weakness and high impact activities.
Non-modifiable - Gender, age, gender, congenital and acquired (infections, dysplasia)

Question 3

What are the important examination steps for osteoarthritis?

Answer 3

Inspection - BMI, gait, leg lengths, scars
ROM - active and passive
Special tests

Question 4

What are the X ray findings of osteoarthritis?

Answer 4

• Joint space narrowing,
• Sclerosis,
• Subchondral cysts,
• Marginal osteophytes (bone spurs)

Question 5

Explain the non-operative management of osteoarthritis

Answer 5

• Analgesia: Paracetamol, 1st line opiate, NSAIDs or topical.
• Lifestyle modifications: Weight loss and exercise programmes.
• Corticosteroid injections,

Question 6

What is the operative management of osteoarthritis?

Answer 6

• Arthroscopic debridement,
• Joint preserving osteotomy,
• Focal resurfacing,
• Full joint resurfacing,
• Partial joint arthroplasty,
• Total joint arthroplasty

Question 7

Explain when joint replacement is indicated for osteoarthritis?

Answer 7

It is used for end stage osteoarthritis when patient has attempted most non-operative options and the patient has poor QoL. They need to be fit enough for surgery
Informed, voluntary consent is very important

Question 8

What are some complications of joint replacements?

Answer 8

• Infections,
• Blood loss,
• Nerve injury,
• Dislocation,
• DVT/PE,
• Leg length discrepancy,
• Fracture,
• Aseptic loosening,
• May not completely relieve pain