Osteoathritis Flashcards
Name some risk factors for osteoathritis
Genetics Age Mechanical injury Gender Joint immobilisation Obesity Overuse High intensity sport
Briefly state what happens to bone and cartilage as a result of osteoathritis
Loss of cartilage
Remodelling of adjacent bone
5 symptoms of OA
Joint pain with use Morning stiffness lasting <30 minutes Joint instability or buckling Loss of function Crepitus on motion
5 signs of OA
Bony enlargements at joints Limited range of motion Muscle atrophy Malalignment Crepitus
Give some examples of non pharmacological care
Exercises TENS Acupuncture Aids and devices Diet
What are the aims of exercising with OA
Local muscle strengthening
General aerobic fitness
Weight loss
What aids and devices may somebody with OA use
Orthopaedic insoles
Walking stick
What netriceuticals may be prescribed
Increase intake of omega-3 rich foods
Chondroitin sulphate and glucosamine supplements
What drugs are first line for osteoathritis
Paracetemol/ topical NSAID
Topical capsaicin
What drugs may be offered where paracetamol/ topical NSAIDs are ineffective
Oral NSAID/ COX-2 inhibitor
Intra-articular corticosteroid injections
What COX-2 inhibitor is commonly used to treat osteoathritis
Celecobix
When is surgical management suggested for osteoathritis
Pain stiffness and reduced function have significant impact on quality of life
Waking up at night due to the pain
What is an arthroscopic lavage plus debridement
Washout of the knee under general anaesthetic
Debridement involves using instruments to remove damaged cartilage or bone
What is a microfracture
Drilling into subcondral bone and bone marrow stem cells to stimulate repair of articular cartilage
How much of a difference does debridement make?
80-90% of patients who had debridement and washout were pain free at a year
14% of those with just wash out were pain free
How long does it take for cartilage to recover
4-6 months
What molecule is responsible for the viscoelastic properties of synovial fluid
Hyaluronic acid
What is viscosuplementation
Addition of hyaluronic acid via injection
Advantages of Viscosuplementation
- Works well at all stages
- Improves pain
- Well tolerated
- Long term effectiveness
Disadvantages of viscosuplementation
- Severe OA may not respond well
- Some local adverse effects
Describe the mechanism by which Viscosuplementation works
- Returns high molecular weight hyaluronans and increases viscocity
- Provides direct analgesic effect
What is chondrocyte grafting
Grafting of autologous chondrocytes to repair larger defects
Where can chondrocytes be found for the graft
Rib costochondral process
Non damaged part of the joint
What is created in microfracture
Fibrocartilage
Disadvantages of microfracture
Less durable and resilient
What is formed in autologous chondrocyte implantation
Hyaline like cartilage
What are the disadvantages of autologous chondrocyte implantation
Hypertrophy
Unreliable biological potential of implanted cells
What is mosaicplasty
Undamaged cartilage taken from less weight bearing regions plus underlying bone and move to OA region
How can osteotomy be used to treat osteoathritis
Medial compartment usually affectedd
By taking a wedge from the side of the tibia you can realign the joint surfaces
What osteotomy should be done if genu valgus
Osteotomy to femur
What osteotomy should be done if genu varus
Osteotomy to tibia
Name some potential biologicals for OA treatment
IL1 blockage
TNF inhibition
Give an example of a drug that inhibits TNH
Adalimumab
