OSTEOARTHRITIS OSTEOARTHROSİS DEJENERATIVE JOINT …
Transcript of OSTEOARTHRITIS OSTEOARTHROSİS DEJENERATIVE JOINT …
OSTEOARTHRITIS
Dr Igin Ginting Sp.OT Mkes
DEFINITION
Osteoarthritis OA is a Chronic ,
Progressive degenerative disease of
diarthrodial (synovial) joints,
characterized by Breakdown of
articular cartilage and proliferative
changes of surrounding bones
Gangguan pada satu sendi atau lebih
Lokal
Progresif
degeneratif
Perubahan patologis pada struktur sendidegenerasi kartilago hialin
EPIDEMIOLOGY
Osteoarthritis(OA) is the most common
joint disease
OA of the knee joint is found in 70% of
the population over 60 years of age
Radiological evidence of OA can be found
in over 90 % of the population
LIMITED FUNCTION
OA may cause functional loss
Activites of daily living
Most important cause of
disability in old age
Major indication for joint
replacement surgery
CLASSIFICATION OF OA
Primary OA Secondary OA
Etiology is unknown Etiology is known
Osteoarthitis primer
Penyebabnya tidak diketahui
Sering menyerang sendi penahan beban tubuh
Osteoarthitis sekunder
Akibat trauma, kongenital,
penyakit sistemik
Terjadi pada umur lebih awal
daripada OA primer
AGE
Primary OA > 40 years
Direct correlation
Aging process
RISK FACTORS PRIMARY OA
Age
Sex
Obesity
Genetics
Trauma (daily)
SECONDARY OSTOARTHRITIS
Trauma
Previous joint disorders;
Congenital hip dislocation
Infection: Septic arthritis, Brucella, Tb
Inflammatory: RA, AS
Metabolic: Gout
Hematologic: Hemophilia
Endocrine: DM
ETIOLOGY OF OA
Cartilage properties
Biomechanical problem
CLINICAL SIGNS AND SYMPTOMS
Joint pain - degenerative
Stiffness following inactivity – 30 min
Limitation of ROM – later stages
Deformity – restricition of ADL
ETIOPATHOGENESIS OF OA
Dysfunction of joint cartilage
Condrocyte function: 1- Degredative enzymes
(metalloproteases)
2- Inhibitors
Degeneration and regeneration functions are
balanced
IL-1 , degredative enzymes + synovial
inflammation results: Breakdown of cartilage
PATHOLOGY OF OA
Fibrillation
Eburnation
Osteophytes
Subcondral cysts
LABORATORY FINDINGS
There are no pathognomonic
laboratory findings for OA
Laboratory analysis is performed for
differential diagnosis
RADIOLOGIC FINDINGS
Narrowing of joint space
(due to loss of cartilage)
Osteophytes
Subchondral (paraarticular) sclerosis
Bone cysts
RADIOLOGIC GRADE OF OA
G1 Normal
G2 Mild
G3 Moderate
G4 Severe
Kellgren Lawrence Classification
DIAGNOSIS OF OA
CLINICAL FINDINGS
Joint pain
+
RADIOLOGIC FINDINGS
Osteophytes
RADIOLOGIC FINDINGS?
GRADE 1 - 4?
TREATMENT OF OA
Symptomatic treatment
Structure modifying treatment
Surgical treatment
STRUCTURE MODIFYING TREATMENT
Hyaluronic acid injection (HA)
Glycose amino glycans (GAG)
PRIMARY PREVENTION OF OA ??
Regular exercises
Weight control
Prevention of trauma
Non-Pharmacologic Treatment
Patient education
Weight loss (if overweight)
Aerobic exercise programs
Physical therapy
Range-of-motion exercises Muscle-strengthening exercises
Assistive devices for ambulation Patellar taping Appropriate footwear Lateral-wedged insoles (for genu varum)
Bracing
Occupational therapy
Joint protection and energy conservation
PHARMACOLOGIC TREATMENT
Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
Topical agents
SYMPTOMATIC TREATMENT OF OA
Decrease of joint loading
- Weight control
- Splinting
- Walking sticks
Exercises
- Swimming
- Walking
- Strengthening
Patient education
INDICATIONS OF SURGICAL
INTERVENTION
Severe joint pain,
resistant to conservative treatment methods
Limitation of daily living activities
Deformity, angular deviations, instability
INVASIVE METHODS
Joint lavage
Arthroscopy
Cartilage grafting- genetic engineering
Surgery
Osteotomy
Joint replacement