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DefinitionEpidemiology

Risk factors

Causes

Pathophysiology

Clinical presentationComplications

Differential diagnosis

Investigation

Management

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Osteoarthritis is a chronic jointdisorder in which there isprogressive softening anddisintegration of articular cartilageaccompanied by new growth ofcartilage and bone at the joint

margins (osteophytes) andcapsular fibrosis-Apleys

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Age >55 y/o, prevalence is greater in women & men

Gender Pattern of joint involvement is similar in men and women

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Increasing ageOccupation

Obesity

Joint trauma

Family history

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Disparity between stress applied to articular cartilathe ability of the cartilage to withstand that stress.

Weakening of articular cartilage

Possibly due to genetic defects in type II collagen

Increased mechanical stress in some part of the asurface

Excessive impact loading

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Increase stress on some partCartilage damage &

softening (chondromalacia)Preceding inflammatory

disorderProgressive disintegration of

cartilage

Bone exposedPeripheral cartilage

(unstressed) proliferate &ossifies

Producing bony growth(osteophyte)

Joint capsule thickening &

fibrosis

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Cardinal features:Progressive cartilage destruction

Subarticular cyst formation

Sclerosis of the surrounding bone

Osteophyte formation

Capsular fibrosis

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SymptomsPain

Starts insidiously & increase slowly over months and years

Late stage: pain in bed at night

Maybe referred to a distant site

Aggravated: exertion

Relieved: rest

Stiffness

Swelling

Deformity

Loss of function

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Signs

Look

Antalgic gait or assumption of a posture that allows minimum wpainful limb or joint

Muscle wasting Varus deformity

Feel

Palpable bony enlargement

Joint line tenderness

Mild joint effusion

Move

Limited range of motion

Joint tenderness on passive range of motion

Joint crepitus on motion (audible or palpable)

Limb shortening

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Capsular herniation

OA of the knee may associaa marked effusion and herniation of the posterior c(Bakers cyst)

Loose bodiesCartilage & bone fragments may gto loose bodies, resulting in episodes of locking.

Rotator cuff dysfunctionOA of acromioclavicularmay cause rotator cuff impingement, tendinitis or tears

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Avascular necrosisInflammatory arthropathies

Polyarthritis of the finger

Diffuse idiopathic skeletal hyperostosis (DISH)

Rheumatoid arthritis

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X-rays

Cardinal signs: Narrowing of the joint space

Sclerosis of the subchondral bone

Cysts close to the articular surface

Osteophytes at the margins of the joint

Remodelling of bone ends on either sideof the joint

Late features: joint displacementand bone destruction

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Depends on the joint involved, the stage of disorder, tseverity of the symptoms, the age of the patient and hfunctional needs.

EarlyAnalgesic medication

Load reduction protecting the joint from excessive load may slow down the rate o

loss effective in relieving pain

Physical therapy Maintaining joint mobility

Improving muscle strength

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Intermediate

Joint debridement (removal of interfering osteophytes, tags and loose bodies)

Late

Three basic operations:

Realignment osteotomy

Arthroplasty (total joint replacement)

Arthrodesis

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Clinical Key|OsteoarthritisApleys Concise System of Orthopaedics and Frac

3rded. Page: 41-44

ApleysSystem of Orthopaedics and Fractures. 9th

Page 87-96

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