DEGENERATIVE DISEASE IN ORTHOPAEDICGede Chandra P. Yudha

DEGENERATIVE DISEASE• a disease in which the function or structure of the affected

tissues or organs will increasingly deteriorate over time• Aging related• Degeneratif orthopedi degenerasi pada sistem

muskuloskeletal• Hard tissue joint, bone• Soft tisue

DEGENERATIVE JOINT DISEASE• Osteoarthritis (OA)• Local deterioration of articular

cartilage• Characterized by :• Progressive deterioration of articular

cartilage• Secondary inflammation of synovium• Capsular fibrosis• Subchondral remodelling

(subchondral sclerosis)• Cyst formation• Osteophyte formation

• Most common type of arthritis• 2 type :• Primary develop spontaneously• Secondary secondary due to other

cause (injury, deformity, disease)

Patophysiology• Articular cartilage function as “shock absorber”• In order to do so, it has several physical and biomechanical

properties :• Resilience• Low friction and smooth surface

• Resiliency due to water content decreasing over time due to loss of proteoglycans

• Decrease proteoglycans decrease water content cartilage softening fibrillation fissuring cartilage erosion eburnation

Normal Knee vs OS Knee

Derajat Kerusakan Sendi – Arthroscopic View

CLINICAL FEATURES

• SYMPTOMS• Pain• Stiffness• Alteration in shape• Functional impairment• anxiety,depression

SIGNS• Crepitus• Restricted movement• Tenderness• Bony swelling• Deformity• Muscle wasting/weakness• Effusion, increased warmth

• Instability

Radiographic Changes• 4 GAMBARAN UTAMA RADIOLOGIS• Penyempitan celah sendi• Sklerosis subchondral• Pembentukan kista subchondral• Osteofit

• Klasifikasi : Kellgren - Lawrence

X-ray Appearance

Management – Non Surgical• Pharmacological• Analgesics• NSAIDs• DMOADs• Glucosamines• Viscosupplements• PRP

• Non pharmacological• Physical theraphy• Occupational theraphy• Braces• Lifestyle modification• Weight reduction

Management – Surgical • Arthroscopy + debridement• Osteotomy• Joint replacement

DEGENERATIVE BONE DISEASE

• OSTEOPOROSIS• Definition (WHO) : a condition characterized by reduced

bone mass and disruption of bone architecture, resulting in increased bone fragility and increased fracture risk• 2 types :• Primary

• Post menopausal osteoporosis• Senile osteoporosis

• Secondary (due to other disease)• Drug induce• Chronic disease• Neoplasm • Endocrine abnormality• Disuse

Osteoporosis• Epidemiology• An estimated 8 million women and 2 million men in the United

States have bone density levels in the diagnostic range of osteoporosis.

• The percentage of patients with osteoporosis increases progressively with age -- of US women, 13% in their 50s, 27% in their 60s, 47% in their 70s, and 67% in their 80s meet the diagnostic criteria for osteoporosis.

• For every 10% decline in bone mass, there is an approximate doubling of fracture risk in the population.

Osteoporosis Risk Factors

Non modifiable

• Sex• Race• Age• Frame size

Modifiable

• Alcohol• Smoking• Low BMI• Poor nutrition• Vitamin D deficiency• Estrogen deficiency• Eating disorders• Insufficient exercise• Steroids and other

medication

Osteoporosis – Clinical Findings

• Mostly no symptoms – silent disease

• Other symptoms :• Back pain• Pathologic fracture• Decrease body height

• Osteoporosis tests :• Bone Mineral Density

• DEXA, CT, X-ray, Ultrasound• Bone scan• Laboratory test

• CTx, PTH, Vitamin D, Blood calcium

Osteoporosis - Workup• Laboratory• Blood/ serum

• Ca, P• Vitamin D level• Serum PTH• CTx, Osteocalcin (Bone markers)

• Urine• Hydroxyproline

• Bone Mineral Density• Ultrasound• DEXA• QCT

Dual Energy X-ray Absorptiometry (DEXA)

Osteoporosis - Management • Prevention• Treatment• Osteoporosis• Osteoporosis complications

Osteoporosis – Prevention • Calcium rich diet• Vitamin D• Maintain active lifestyle• Avoid smoking, alcohol• Sunlight exposure

Osteoporosis – Treatment • Osteoporosis treatment :• Calcium• Vitamin D• Hormone Replacement teraphy• Anti resorbtion drugs• Treatment of primary disease (in secondary osteoporosis)

• Osteoporosis complication treatment :• Non surgical

• Supportive treatment• Bed rest

• Surgical• Vertebroplasty• Joint replacement• Osteosynthesis

DEGENERATIVE DISEASE OF THE SOFT TISSUE• Supraspinatus tendinitis• Tennis elbow• Golfer’s elbow• De Quervain’s Tenosynovitis• Trigger finger• Bursitis

SUPRASPINATUS TENDINITIS• Inflammation of the Supraspinatus tendon• Due to wearing and tearing• If severe can cause torn • Clinical signs & symptoms :• Painful arc• Tenderness• Decreasing ROM

• Treatment• Rest• Physiotheraphy• Arthroscopic debridement• Repair

TENNIS ELBOW & GOLFER’S ELBOW

• Tennis elbow• Inflammation of LATERAL

epicondyle• Golfers elbow• Inflammation of MEDIAL epicondyle

• Due to repetitive chronic injury• Clinical findings :• Pain• Swelling

• Treatment :• Non surgical : NSAIDs, injection,

physiotheraphy• Surgical : release

DE QUERVAIN’S TENOSYNOVITIS

• Inflammation of tendon sheath of APL & EPB tendon (dorsal extensor tendon 1st compartment)

• Clinical findings :• Pain - Finklestein test • Swelling, nodule

• Treatment :• Non Surgical

• Rest• Brace • NSAIDs• Physiotheraphy

• Surgical • Release

TRIGGER FINGER• Inflammation of flexor tendon underneath

the pulley fibrosis nodule unable to pass smoothly under the pulley

• Clinical findings :• Pain• Nodule• Triggering

• Treatment :• Non surgical : rest, NSAIDs, physiotheraphy• Surgical : release

BURSITIS• Inflammation of bursae• Bursae :• a small fluid-filled sac where friction would

otherwise occur. Bursae function to facilitate the gliding of muscles or tendons over bony or ligamentous surfaces.

• Clinical findings :• Pain • Swelling (over bony prominences)

• Treatment• Non surgical

• Ice• Eliminate the cause (friction, pressure)• Padding • NSAIDs

• Surgical• Excision

RS ORTHOPEDI & TRAUMATOLOGI SURABAYAJl. Emerald Mansion TX 10 Citraland - Surabaya