OSTEOARTHRITIS

OSTEOARTHRITISDr Sami AbdallahAnatomy of synovial joints:

MECHANISMS FOR MAINTAININGJOINT STABILITYAlignment of joint componentsShape and fit of articular surfacesAdhesive property of synovial fluidIntegrity of capsule and ligamentsMuscle tone and powerNeurological control of balanceTHREATS TO CARTILAGE INTEGRITYLoss of joint stabilityLocalized increase in loading stressIncreased stiffness of the cartilageInflammatory (enzymatic) degradationRestriction of free joint movementSclerosis in the subchondral bone

Osteoarthritis (OA) is a slowly progressive chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilageThe commonest of all joints diseasesAsymmetrical affectionNo systemic manifestationsDegenerative disease with some inflammatory processNew growth of cartilage and bone at the joint margins(osteophytes) Cyst formation and sclerosis in the subchondral bone Mild synovitis and capsular fibrosisPrevalenceUniversal disorderMales = femalesAll people > 65 years 40 % of people reaching 40 yearsRacial distributionHips, knees and spine are commonly affectedPrevalence Risk factorsJoint dysplasiaObesity Bone densityTraumaFamily historyOccupation Pathology The cardinal features are: Progressive cartilage destruction Subarticular cyst formation Sclerosis of the surrounding bone Osteophyte formation Capsular fibrosisClinical featuresSymptoms PainSwellingDeformity Stifness Loss of function SignsSwelling Muscle wastingTendernessInstability Crepitus Clinical types:Monoarticular The classic form of OAClinical types:MonoarticularPauciarticular

Clinical types:MonoarticularPauciarticularGeneralized The commenest type of OAAffects middle aged womenSmall joints

ComplicationsCapsular herniationLoose bodiesRotator cuff dysfunctionSpinal canal stenosisImaging X rays

Radioisotope scanning

CT and MRI

Arthroscopy

EARLY TREATMENTPRINCIPLES

To maintain movement and muscle strengthTo protect the joint from overloadTo modify the daily activitiesPhyseotherapy

PhyseotherapyLoad reduction

PhyseotherapyLoad reductionAnalgesia

INTERMEDIATE TREATMENTJoint debridementCorrective osteotomy

LATE TREATMENTRe-alignment osteotomyJoint replacementArthrodesis

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