OSTEOARTHRITIS Dr Sami Abdallah. Anatomy of synovial joints:
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Transcript of OSTEOARTHRITIS Dr Sami Abdallah. Anatomy of synovial joints:
OSTEOARTHRITIS
Dr Sami Abdallah
• Anatomy of synovial joints:
MECHANISMS FOR MAINTAININGJOINT STABILITY• Alignment of joint components• Shape and fit of articular surfaces• Adhesive property of synovial fluid• Integrity of capsule and ligaments• Muscle tone and power• Neurological control of balance
THREATS TO CARTILAGE INTEGRITY• Loss of joint stability• Localized increase in loading stress• Increased stiffness of the cartilage• Inflammatory (enzymatic) degradation• Restriction of free joint movement• Sclerosis 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 cartilage
• The commonest of all joints diseases
• Asymmetrical affection• No systemic manifestations• Degenerative disease with some inflammatory
process
• New growth of cartilage and bone at the joint margins(osteophytes)
• Cyst formation and sclerosis in the subchondral bone
• Mild synovitis and capsular fibrosis
Prevalence
• Universal disorder• Males = females• All people > 65 years • 40 % of people reaching 40 years• Racial distribution• Hips, knees and spine are commonly affected
Prevalence
Risk factors• Joint dysplasia• Obesity • Bone density• Trauma• Family history• Occupation
Pathology
• The cardinal features are: Progressive cartilage destruction Subarticular cyst formation Sclerosis of the surrounding bone Osteophyte formation Capsular fibrosis
Clinical features
Symptoms • Pain• Swelling• Deformity • Stifness • Loss of function
Signs• Swelling • Muscle wasting• Tenderness• Instability • Crepitus
Clinical types:• Monoarticular The classic form of OA
Clinical types:• Monoarticular• Pauciarticular
Clinical types:• Monoarticular• Pauciarticular• Generalized The commenest type of OAAffects middle aged womenSmall joints
Complications• Capsular herniation• Loose bodies• Rotator cuff dysfunction• Spinal canal stenosis
Imaging
• X rays
• Radioisotope scanning
• CT and MRI
• Arthroscopy
EARLY TREATMENT
PRINCIPLES
• To maintain movement and muscle strength• To protect the joint from overload• To modify the daily activities
• Physeotherapy
• Physeotherapy• Load reduction
• Physeotherapy• Load reduction• Analgesia
INTERMEDIATE TREATMENT
• Joint debridement• Corrective osteotomy
LATE TREATMENT
• Re-alignment osteotomy• Joint replacement• Arthrodesis
THANK YOU