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DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha
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Page 1: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

DEGENERATIVE DISEASE IN ORTHOPAEDICGede Chandra P. Yudha

Page 2: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede 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

Page 3: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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)

Page 4: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 5: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

Normal Knee vs OS Knee

Page 6: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

Derajat Kerusakan Sendi – Arthroscopic View

Page 7: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 8: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

• Klasifikasi : Kellgren - Lawrence

Page 9: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

X-ray Appearance

Page 10: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

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

Page 11: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 12: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 13: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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.

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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

Page 19: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 20: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

Osteoporosis - Workup• Laboratory• Blood/ serum

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

• Urine• Hydroxyproline

• Bone Mineral Density• Ultrasound• DEXA• QCT

Page 21: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

Dual Energy X-ray Absorptiometry (DEXA)

Page 22: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 23: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 24: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 25: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 26: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 27: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 28: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 29: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 30: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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

Page 31: DEGENERATIVE DISEASE IN ORTHOPAEDIC Gede Chandra P. Yudha.

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


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