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OSTEOARTHRITIS OSTEOARTHROSIS DEGENERATIVE JOINT DISEASE - PowerPoint PPT Presentation


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DR. IMTIAZ AHMED TAGO MBBS,FCPS ( ORTHOPEDIC SURGERY ) ASSISTANT PROFFESSOR DOST UNIT II LUMHS JAMSHORO. OSTEOARTHRITIS OSTEOARTHROSIS DEGENERATIVE JOINT DISEASE. DEFINITION. Osteoarthritis OA is a degenerative disease of diarthrodial ( synovial ) joints , characterized by

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Dr imtiaz ahmed tago mbbs fcps orthopedic surgery assistant proffessor dost unit ii lumhs jamshoro
DR. IMTIAZ AHMED TAGOMBBS,FCPS (ORTHOPEDIC SURGERY)ASSISTANT PROFFESSORDOST UNIT II LUMHS JAMSHORO


Osteoarthritis osteoarthrosis degenerative joint disease
OSTEOARTHRITISOSTEOARTHROSISDEGENERATIVE JOINT DISEASE


Definition
DEFINITION

  • Osteoarthritis OA is a degenerative disease of diarthrodial (synovial) joints, characterized by

  • Breakdown of articular cartilage

  • and proliferative changes of surrounding bones


Epidemiology
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
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


Character i st i cs of oa
CHARACTERISTICS OF OA

  • OA is a chronic disease of the musculoskeletal system,without systemic involvement

  • OA is mainly a noninflammatory disease of synovial joints

  • No joint ankylosis is observed in the course of the disease


Classification of oa
CLASSIFICATION OF OA

  • Primary OA Secondary OA

    Etiology is unknown Etiology is known


AGE

  • Primary OA > 40 years

  • Direct correlation

  • Aging process


Risk factors for primary oa
RISK FACTORS FOR PRIMARY OA

  • Age

  • Sex

  • Obesity

  • Genetics

  • Trauma (daily)


Secondary ostoarthritis
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
ETIOLOGY OF OA

  • Cartilage properties

  • Biomechanical problem




Structure of joint cartilage
STRUCTURE OF JOINT CARTILAGE

  • Collagen (Type 2)

  • Proteoglycan

    - Hyaluronic acid

    - Glycoseaminoglycan

  • Water

  • Condrocyte

    Regeneration and Degeneration


Pathology of oa
PATHOLOGY OF OA

  • Fibrillation

  • Eburnation

  • Osteophytes

  • Subcondral cysts


Laboratory findings of oa
LABORATORY FINDINGS OF OA

  • There are no pathognomonic laboratory findings for OA

  • Laboratory analysis is performed for differential diagnosis


Radiologic findings of oa
RADIOLOGIC FINDINGS OF OA

  • Narrowing of joint space

    (due to loss of cartilage)

  • Osteophytes

  • Subchondral (paraarticular) sclerosis

  • Bone cysts


Radiologic grade of oa
RADIOLOGIC GRADE OF OA

  • G1 Normal

  • G2 Mild

  • G3 Moderate

  • G4 Severe

  • Kellgren Lawrence Classification


Diagnosis of oa
DIAGNOSIS OF OA

CLINICAL FINDINGS

Joint pain

+

RADIOLOGIC FINDINGS

Osteophytes


Clinic of oa signs and symptoms
CLINIC OF OA SIGNS AND SYMPTOMS

  • Joint pain - degenerative

  • Stiffness following inactivity – 30 min

  • Limitation of ROM – later stages

  • Deformity – restricition of ADL


Oa of knee joint gonarthrosis
OA OF KNEE JOINT (GONARTHROSIS)

  • More common in obese females

  • over 50 years of age

  • Joint stiffness (<30 minutes)

  • Mechanical pain

  • Physical examination findings: Crepitus

  • Pain on pressure

  • Painful ROM and functional limitation

  • Limitation of ROM in later stages of OA (first extension)

  • Laboratory analysis within normal limits




Oa of hip joint
OA OF HIP JOINT

  • More common in males over 40 years of age

  • Joint stiffness

  • Pain of hip,gluteal and groin areas radiating to the knee (Nobturatorius)

  • Mechanical pain

  • Limited walking function


Coxarthrosis
COXARTHROSIS

Physical examination:

  • Antalgic limping

  • Limitation of ROM (first internal rotation)

  • Painful ROM

  • Trendelenburg test positivity

  • Leg length discrepancy

    Laboratory analysis within normal limits




Peripheral joints
Peripheral Joints

  • Hands

  • Feet


Etiopathogenesis of oa
ETIOPATHOGENESIS OF OA

  • Age,gender

    Local

  • Genetic OA biochemical effects

  • Other factors


Etiopathogenesis of oa1
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


Pathogenesis of oa
PATHOGENESIS OF OA

  • Cytokines IL-1, IL-6, TNF-

  • Cell destruction

  • Membrane phospholipids

  • Arachidonic acid

  • Cox-1, Cox-2


  • IL-1 and metalloproteases have been found to play an important role in cartilage destruction.

  • Local growth factors,especially transforming growth factor (TGF) are involved in the formation of osteophytes


Treatment of oa
TREATMENT OF OA

  • Symptomatic treatment

  • Structure modifying treatment

  • Surgical treatment


Structure mod i fy i ng treatment
STRUCTURE MODIFYING TREATMENT

  • Hyaluronic acid injection (HA)

  • Glycose amino glycans (GAG)


Primary prevention of oa
PRIMARY PREVENTION OF OA ??

  • Regular exercises

  • Weight control

  • Prevention of trauma


Aims of oa treatment
AIMS OF OA TREATMENT

  • Pain relief

  • Preservation and restoration of joint function

  • Education


Non p harmacolog i c treatment o f o a
Non-Pharmacologic Treatment of OA

  • Patient education

  • Weight loss (if overweight)

  • Aerobic exercise programs

  • Physical therapy

  • Range-of-motion exercises Muscle-strengthening exercises

  • Assistive devices for ambulationPatellar tapingAppropriate footwear Lateral-wedged insoles (for genu varum)

  • Bracing

  • Occupational therapy

  • Joint protection and energy conservation


Pharmacologic treatment of oa
PHARMACOLOGIC TREATMENT OF OA

  • Oral Systemic Medical Agents

    - Analgesics (acetaminophen)

    - NSAIDs

    - Opioid analgesics

  • Intraarticular agents:

    Hyaluronan

    Glucocorticoids (effusion)

  • Topical agents



Symptomatic treatment of oa
SYMPTOMATIC TREATMENT OF OA

  • Decrease of joint loading

    -Weight control

    - Splinting

    - Walking sticks

  • Exercises

    - Swimming

    - Walking

    - Strengthening

  • Patient education


Indications of surgical intervention
INDICATIONS OF SURGICALINTERVENTION

  • Severe joint pain,

    resistant to conservative treatment methods

  • Limitation of daily living activities

  • Deformity, angular deviations, instability


Invas i ve methods
INVASIVE METHODS

  • Joint lavage

  • Arthroscopy

  • Cartilage grefting- genetic engineering

  • Surgery

    Osteotomy

    Joint replacement



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