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8/12/2019 Osteoarthritis.pptx
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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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