Osteoarthritis (OA) Flashcards
Describe the pathophysiology?
Thinning of the hyaline cartilage
The underlying bone is exposed and becomes damaged due to direct stress
What does primary OA mean?
What does secondary OA mean?
Generalised
Due to joint disease
Haemochromatosis
Obesity
Occupational
Primary nodal OA:
What symptoms do they get? - 3
What joint in the hand does it usually affect? - 1
What larger joints does it affect? - 2
It also affects the CMC joint. What does this stand for?
Why could they get loss of muscle bulk?
Pain (can be background ache)
Tenderness and swelling
Stiffness
DIP
Hips and knees
Carpometacarpals - wrist
Due to reduced activity - they also have instability due to the pain and perceived lack of power.
Primary nodal OA:
What joint is typically affected in post-menopausal women?
Why do they get squaring of the hand? - 2
What joint in their hand do they get Heberden’s nodes?
What joint in their hand do they get Bouchard’s nodes?
Knees
Due to thumb adduction and bony swelling at the 1st CMC joint
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41584-018-0095-4&psig=AOvVaw24kLHcIQ4l3vZ0K8nnL2bG&ust=1595863661026000&source=images&cd=vfe&ved=0CA0QjhxqFwoTCPjqt8id6-oCFQAAAAAdAAAAABAP
DIP = H - remember HD
PIP = B
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.rheumtutor.com%2Fclinical-images%2Fosteoarthritis%2F&psig=AOvVaw24kLHcIQ4l3vZ0K8nnL2bG&ust=1595863661026000&source=images&cd=vfe&ved=0CA0QjhxqFwoTCPjqt8id6-oCFQAAAAAdAAAAABA9
Secondary OA:
What joints does it typically affect? - 3
When does the pain tend to be worse?
What makes the pain worse?
Knee
Hip
Spine
Evening time
Movement
Secondary OA:
Hip OA:
- Where does the pain radiate to?
Spine OA:
- Why may they get pain in their legs?
Groin and buttocks
Due to compression of the nerves
Risk factors:
What electrolyte or chemical, if raised could cause OA?
Iron - haemochromatosis
Investigations:
XR:
LOSS - what does it stand for?
What blood test can be done to partially rule out RA?
L – loss of joint space
O – osteophytes
S – subchondral sclerosis
S – subchondral cysts - fluid filled micro fractures
CRP/ESR
Management:
Lifestyle changes - 5
Pharmacological:
A pain ladder is used.
- What is first? - 2
- What is next?
- What is done next which doesn’t last very long?
- Capsaicin cream can also be used. What is it derived from?
What is the final option if there is significant impact on someones life?
Exercise to improve strength and joint stability Reduce weight Walking aids Physio Hot and cold packs
(1) Paracetamol +/- topical NSAIDs
(2) NSAIDs + PPI
(3) Intra-articular steroid injections
Chillies
Joint replacement
Joint replacement:
What 2 joints are routinely replaced?
Indications?
Hip - Total Hip Replacement
Knee - Total Knee Replacement
Severe functional impairment
Severe sleep impairment
Severe radiological changes
Resistent to medical Rx
Joint replacement:
What materials are used for a THR? - 3
What materials are used for a TKR?
Complications:
- What general surgical complications are there? - 4
- What may happen which will need special shoes made for THR?
- What will damage of the sciatic nerve cause?
- What will damage of the superior gluteal nerve cause?
- What nerve can be damaged in a knee replacement?
Metal
Polyethene
Ceramic coating
2 metal parts, with polyethene articular surface
Infection - prophylactic ABs
Pain and stiffness
DVT
Leg length discrepancy
Nerve injury
Foot drop
Weak abductors and Trendelenburg gait
Peroneal nerve
