Osteoarthritis and Joint Replacement Flashcards
What is osteoarthritis?
A disease of the synovial joints resulting in degeneration of the joint and progressive loss of cartilage
What are the clinical features of osteoarthritis?
- pain
- stiffness
- loss of range of motion
- deformity
- loss of function
- reduced quality of life
What are the risk factors of osteoarthritis?
- modifiable: trauma, muscle weakness, high impact activities
- non-modifiable: gender (female>), age, genetics, congenital
- acquired: infection, dysplasia, SCFE, perthes
Describe the pathogenesis of osteoarthritis
The failure of chondrocytes to maintain homeostasis between the synthesis and degradation of extracellular matrix. Molecules from the breakdown can cause the release of pro-inflammatory cytokines (eg. TNF, IL-6) which can bind to chondrocyte receptors leading to further release of degradative enzymes and inhibition of collagen production
What are the radiographical features of osteoarthritis?
- joint space narrowing
- sclerosis
- subchondral cysts
- marginal osteophytes
Describe the non-operative management of osteoarthritis
- analgesia (paracetamol, weak opioid, NSAID, topical)
- lifestyle modification (weight loss, exercise program/physio)
- corticosteroid injection
- viscoelastic injection
- glucosamine/chondroitin supplements
Describe the operative management of osteoarthritis
- arthroscopic debridement
- joint preserving osteotomy
- focal resurfacing
- full joint resurfacing (hip)
- partial joint arthroplasty (knee)
- total joint arthroplasty
When is a joint replacement indicated in osteoarthritis?
- end stage osteoarthritis on x-ray
- attempted most non-surgical options
- significant deterioration in QoL
What are the possible complications of joint replacement surgery?
- infection
- nerve injury
- blood loss
- DVT/PE
- wound healing problems
- dislocation
- leg length discrepancy
- aseptic loosening and wear
- fracture
