OSTEOARTHRITIS
Ms.R.Sakthi Abirami M.sc
Faculty allied health sciences
SYNOPSIS
Osteoarthritis is common form of arthritis
Strong association with ageing
Major cause of pain and disability in elderly
DEFINITION
RISK FACTORS
PATHOGENESIS
CLINICAL FEATURES
TYPES OF OA
INVESTIGATION
MEDICAL AND SURGICAL MANAGEMENT
OSTEOARTHRITIS
A condition of synovial joints characterized by focal
loss of articular hyaline cartilage with proliferation of
new bone and remodelling of joint contour.
Inflammation is not a prominent feature
OA preferentially targets only certain small and large
joints
PATHOGENESIS
Mechanical ,metabolic, genitic or constitutional insult
Damage synovial joint
All the joint tissues
(cartilage ,bone,synovium,ligament,capsule,muscle
Depend on each other for health and function
Insult to any one tissue impacts on the others
Resulting in OA phenotype affecting whole joint
OA process invoves
Dynamic new tissue production Remodelling of joint shape
OA process compensate for insults (compensated OA) results
in
Anatomically altered Pain free functioning joint
In Chronic insult or poor repair response(compensatory
process fails)
Progressive tissue
damage ,associated with Joint failure
symptoms
CLINICAL FEATURES
PAIN CHARACTERISTICS
Patient over age of 45 (often over 60)
Insidious onset over months to years
Variable or intermittent over time (good days,bad
days)
Mainly related to movement and weight bearing ,
relieved by rest
Only brief (<15mins)morning stiffness and brief
(<1min )gelling after rest
Usually one or few joints painful (not multiple
regional pain
CLINICAL SIGNS
Restricted movements (capsular thickening ,blocking
by osteophytes)
Palpable ,sometimes audible coarse crepitus
Bone swelling around joint margin
Deformity ,usually without instability
Joint line or periarticular tenderness
Muscle weakness,wasting
No or mild synovitis (effusion,increased warmth)
NODAL GENERALISED OA
Pain ,stiffeness,swelling of one or few interphalangeal
joints
Peak onset in middle age
Predisposition to OA at other
joints
Strong genetic predisposition
OA kNEE
Targets patello femoral,and medial tibio femoral
compartments of knee
It may be isolated or occur as part of nodal generalised
OA
Trauma is more risk factor for men occurs
unilateralOA
The most OA ,particularly in the women is bilateral
Pain usually localised to anterior or medial aspect of
knee or upper tibia
LOCALEXAMINATION AND FINDINGS
A jerky ,asymmetric ,antalgic gait –less time weight
bearing on painful side
A varus ,deformity
Less commonly valgus deformity
Periarticular tenderness
Weakness or wasting of quadriceps muscle
Restricted flextion /extension with coarse crepitus
Bony swelling around the joint
Varus valgus
OA HIP
Targets the superior aspect of joint
Often unilateral in presentation
Lateral hip pain worse on lying on that side with
tenderness over greater thochanter
Antalgic gait
Pain and restriction of internal rotation of the hip
YOUNG ONSET OA
Patients present with typical symptoms of OA before
age og 45
OA of single joint such as knee has clear history of
trauma
Endemic OA – unknown environmental cartilage
toxins who grew up in specific area of the world
(eastern russia ,northan china)
INVESTIGATIONS
A Plain X ray is useful investigation
MANAGEMENT
Surgical management
Surgery should be considered if conservative measures
fails
INDICATIONS
Uncontrolled pain
Progressive immobility
Functional impairment
surgery
OSTEOTOMY – prolong the life of malaligned
joint ,relive pain by reducing interosseous pressure
JOINT REPLACEMENT
criteria
Pain severity ( walking limited to 10 mins ,severe rest
or night pain
Older age (prosthesis has limited lifespan app 15 yrs)
Fitness for surgery and anaesthesia
Exclusion – active sepsis,leg ulcers or severe
peripheral vascular disease.
DO NOT ASK GOD TO GUIDE YOUR
FOOTSTEPS IF YOU ARE NOT WILLING TO
MOVE YOUR FEET
THANK YOU
