Osteoarthritis osteoarthrosis degenerative joint disease
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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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OSTEOARTHRITIS OSTEOARTHROSIS DEGENERATIVE JOINT DISEASE

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DR. IMTIAZ AHMED TAGOMBBS,FCPS (ORTHOPEDIC SURGERY)ASSISTANT PROFFESSORDOST UNIT II LUMHS JAMSHORO


OSTEOARTHRITISOSTEOARTHROSISDEGENERATIVE JOINT DISEASE


DEFINITION

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

  • Breakdown of articular cartilage

  • and proliferative changes of surrounding bones


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

  • OA may cause functional loss

  • Activites of daily living

  • Most important cause of disability in old age

  • Major indication for joint replacement surgery


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

  • Primary OA Secondary OA

    Etiology is unknown Etiology is known


AGE

  • Primary OA > 40 years

  • Direct correlation

  • Aging process


RISK FACTORS FOR PRIMARY OA

  • Age

  • Sex

  • Obesity

  • Genetics

  • Trauma (daily)


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

  • Cartilage properties

  • Biomechanical problem


Morphology of Primary OA


Primary Generalized OA


STRUCTURE OF JOINT CARTILAGE

  • Collagen (Type 2)

  • Proteoglycan

    - Hyaluronic acid

    - Glycoseaminoglycan

  • Water

  • Condrocyte

    Regeneration and Degeneration


PATHOLOGY OF OA

  • Fibrillation

  • Eburnation

  • Osteophytes

  • Subcondral cysts


LABORATORY FINDINGS OF OA

  • There are no pathognomonic laboratory findings for OA

  • Laboratory analysis is performed for differential diagnosis


RADIOLOGIC FINDINGS OF OA

  • Narrowing of joint space

    (due to loss of cartilage)

  • Osteophytes

  • Subchondral (paraarticular) sclerosis

  • Bone cysts


RADIOLOGIC GRADE OF OA

  • G1 Normal

  • G2 Mild

  • G3 Moderate

  • G4 Severe

  • Kellgren Lawrence Classification


DIAGNOSIS OF OA

CLINICAL FINDINGS

Joint pain

+

RADIOLOGIC FINDINGS

Osteophytes


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)

  • 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


GENU VALGUM - ORTHOSIS


RADIOLOGIC FINDINGS? GRADE 1 - 4?


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

Physical examination:

  • Antalgic limping

  • Limitation of ROM (first internal rotation)

  • Painful ROM

  • Trendelenburg test positivity

  • Leg length discrepancy

    Laboratory analysis within normal limits


BIOMECHANICS


X-RAY OF HIP OA


Peripheral Joints

  • Hands

  • Feet


ETIOPATHOGENESIS OF OA

  • Age,gender

    Local

  • Genetic OA biochemical effects

  • Other factors


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

  • 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

  • Symptomatic treatment

  • Structure modifying treatment

  • Surgical treatment


STRUCTURE MODIFYING TREATMENT

  • Hyaluronic acid injection (HA)

  • Glycose amino glycans (GAG)


PRIMARY PREVENTION OF OA ??

  • Regular exercises

  • Weight control

  • Prevention of trauma


AIMS OF OA TREATMENT

  • Pain relief

  • Preservation and restoration of joint function

  • Education


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

  • Oral Systemic Medical Agents

    - Analgesics (acetaminophen)

    - NSAIDs

    - Opioid analgesics

  • Intraarticular agents:

    Hyaluronan

    Glucocorticoids (effusion)

  • Topical agents


HAND OA - RESTING SPLINT


SYMPTOMATIC TREATMENT OF OA

  • Decrease of joint loading

    -Weight control

    - Splinting

    - Walking sticks

  • Exercises

    - Swimming

    - Walking

    - Strengthening

  • Patient education


INDICATIONS OF SURGICALINTERVENTION

  • Severe joint pain,

    resistant to conservative treatment methods

  • Limitation of daily living activities

  • Deformity, angular deviations, instability


INVASIVE METHODS

  • Joint lavage

  • Arthroscopy

  • Cartilage grefting- genetic engineering

  • Surgery

    Osteotomy

    Joint replacement


QUESTIONS?


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