T&O: Osteoarthritis Flashcards
Describe the four features of OA on XRAY
Subchondral sclerosis, narrowing of joint space, osteophytes, bony cysts (SNOB)
How may OA present?
Deep aching pain in the joint which is exacerbated by use.
Reduced range of motion.
Grinding sensation/sound.
Stiffness during rest - morning stiffness usually lasts less than an 30mins.
Name categories of secondary OA
post-traumatic, post-operative, inflammation/infection related, miscellaneous
What may you find on examination of someone with OA?
Swelling of joint,
joint deformity,
tenderness on palpation,
joint effusions,
restricted/reduced movements,
joint instability,
weakness or wasting
To be considered for a knee replacement, what three features need to be present during a knee examination?
Correctable varus,
full extension of the leg (at the knee),
flexion of at least 100 degrees
What management options are available for OA?
Analgesia (e.g. NSAIDS - ibuprofen 200mg, naproxen 500mg initially, then 250mg every 6-8 hours as required). Steriodal injection. Weight loss. Use of walking stick. Surgery - partial or total knee replacement.
What condition can predispose to a Baker’s cyst?
OA
Causes of OA?
Idiopathic,
infection,
inflammation,
trauma
Name two risk factors for OA?
Increasing age, genetic factors, female, obesity, low bone density, previous joint injury, occupational or recreational stress, joint laxity, malignancy, surgery.
How does OA present in the knee?
Pain around knee. Pain can radiate to hip/thigh. Made worse by walking/exercise. Better when resting. Stiff in knee joint, swollen, crepitus, reduced range movement, bilateral.
How does OA of hip present?
Chronic worsening sx, pain, stiffness, grinding sensation, relieved by rest, aggravated by activity. Pain in hip can radiate to groin, anterior thigh or can present as pain in the knee (referred).
What would you find on examination of pt with OA of hip?
Antalgic gait, tenderness round hip. Passive movements are often painful, crepitus. reduced range of movement. Fixed flexion deformity on Thomas test. Trendelenberg gait.
What investigations would you order for suspected OA of hip?
XR. May want MRI too.
What are risk factors for OA of hip?
Primary - female, obesity, manual handling occupation, increasing age. Secondary - connective tissue disorders - RA, Marfans, Trauma, Infiltrative diseases
What is involved in conservative management of OA of hip?
Lose weight. Minimise aggravating activity. Use walking aids. Meds - NSAIDs (remember to give PPI!), corticosteroid injection, Acetminophen.
What surgical options would you offer for OA of hip?
Total hip replacement, hip resurfacing
What are some complications of hip surgery?
Anaesthetic complications
Infection
Loosening of the joint
Hip dislocation
Leg length disparity
Thrombosis
Nerve damage
Name a differential for OA of hip presentation
Teach me surgery: trochanteric bursitis, radiculopathy, spinal stenosis, iliotibial band syndrome
Sciatica, trochanteric bursitis, femoral NOF, gluteus medias tendinopathy
What scoring system can be used to classify severity of knee OA?
The Kellgren and Lawrence system
What does the The Kellgren and Lawrence system for knee OA entail?
Grade 0 – no radiographic features of OA are present
Grade 1 – unclear joint space narrowing and possible osteophytic lipping
Grade 2 – definite osteophytes and possible joint space narrowing on AP weight-bearing views
Grade 3 – multiple osteophytes, definite joint space narrowing, evidence of sclerosis, and possible bony deformity
Grade 4 – large osteophytes, marked joint space narrowing, severe sclerosis, and definite bony deformity
Compare OA and RA based on Aetiology
OA :
Mechanical - wear & tear with localised loss of cartilage, remodelling of adjacent bone and
associated inflammation
RA :
Autoimmune
Compare OA and RA based on gender it affects
OA: similar incidence in men and women
RA: more common in wormn
Compare OA and RA based on Age of pt effected
OA: elderly
RA: adults of all ages
Compare OA and RA based on typical affected joints
OA : Large weight-bearing joints (hip, knee)
Carpometacarpal joint
DIP, PIP joints
RA: MCP / PIP joints
Compare OA and RA based on typical Hx
OA : Pain following use, improves with rest
Unilateral symptoms
No systemic upset
RA: Morning stiffness, improves with use
Bilateral symptoms
Systemic upset
Compare OA and RA based on X ray findings
OA: Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes forming at joint margins
RA: Loss of joint space
Juxta-articular osteoporosis
Periarticular erosions
Subluxation
