Osteoarthritis

Karina Puspa Dewata

03012139
 Cartilage Anatomy

Fibroelastic
cartilage
(meniscus) Elastic
cartilage
Hyaline/Articu
lar • Trachea

Fibrocartilage Physeal
• Tendon Cartilage
• Ligament Cartilage • Growth plate
insertion of the
bone
 Articular/Hyaline
Function

Shock absorbent  Friction Allowing bone gliding

Distribute loads cartilage exhibits stress-

shielding of the solid matrix components
Articular/Hyaline
Composition

Extracellular
Matrix
• Water (90%)
• Type 2 collagen
• Proteoglycans

Cells
• Chondrocytes
Layers of Articular
Cartilage
https://musculoskeletalkey.com/articular-cartilage-and-
labrum-composition-function-and-disease/
 Osteoarthritis Definition
 Degenerative disease of synovial joints that causes
progressive loss of articular cartilage

 a disease in the joint that is chronic, slowly progressive,

non inflamed, with a sign of deterioration and abrasion
in the cartilage and causes form of a new bone in the
joint surface
 Incidence
 Hip OA
 88 per 100.000 per year
Hip Knee
 Knee OA
Lumbal
 240 per 100.000 per year & Finger
cervical Weight Joints
vertebrae bearing
joints
 Risk Factors

Non- Modifiable
modifiable

• Gender (females > males)

• Increased Age (>50 years) • Articular Trauma ( previous joint
• Genetics injury)
• Malalignment/ lower leg deformity • Occupation -> repetitive knee
(bow legs, knock knees) bending
• Race
• African American & Asian are
• Muscle weakness
more prone than Hispanic & • Large body mass
caucasian • Metabolic syndrome
Components
Etiopathogenesis
Pathogenesis
Pathogenesis
 OA Symptoms
 Pain in the joint  Crepitation
 Excacerbated with exercise  Bone effusion
 Relieved with rest
 Severe OA:
 Stiffness of the joint
 Pain in the joint at rest &
 Limitation in movement at night
(cannot do full extension)  Malalignment of the knee
joint: Genu Varus, Genu
 Local touch pain Valgus
 Bone enlargement around
the joint
 Diagnose
History: Trauma, Fever

Examination

INVESTIGATION

L: LOSS OF JOINT SPACE

O: OSTEOPHYTES
S: SUBCHONDRAL SCLEROSIS
S: SUBCHONDRAL CYST
Osteoarthritis
Classification
Based on Etiology: Idiopatic
(primer), secondary
Based on the Joint Location
OA Classification Based
on American College of
Rheumatology
Knee Osteoarthritis
 Risk Factors
 modifiable

 articular trauma
 occupation, repetitive knee bending
 muscle weakness
 large body mass
 metabolic syndrome
 central (abdominal) obesity, dyslipidemia (high triglycerides and low-density lipoproteins), high blood
pressure, and elevated fasting glucose levels.
 non-modifiable

 gender
 females >males
 increased age
 genetics
 race
 African American males are the least likely to receive total joint replacement when compared to whites and
Hispanics
 Symptoms
 function-limiting knee pain
 effect on walking distances
 pain at night or rest
 activity induced swelling
 knee stiffness
 mechanical
 instability, locking, catching sensation
 Physical exam

 inspection
 body habitus
 gait
 often an increased adductor moment to the limb during gait
 limb alignment
 effusion
 skin (e.g. scars)
 range of motion
 lack of full extension (>5 degrees flexion contracture)
 lack of full flexion (flexion <110 degrees)
 ligament integrity
 Histology
 loss of superficial chondrocytes

 replication and breakdown of the tidemark

 fissuring

 cartilage destruction with eburnation of subchondral

bone
 Imaging
 Radiographs

 recommended views

 weight-bearing views of affected joint

 optional views

 knee
 sunrise view
 PA view in 30 degrees of flexion
 findings

 pattern of arthritic involvement

 medial and/or lateral tibiofemoral, and/or patellofemoral

 characteristics
 joint space narrowing
 osteophytes
 eburnation of bone
 subchondral sclerosis
 subchondral cyst
 Treatment
 Nonoperative
 non-steroidal anti-inflammatory drugs
 indications
 first line treatment for all patients with symptomatic arthritis
 technique
 Non-steroidal anti-inflammatory drugs (first choice)
 selection should be based on physician preference, patient
acceptability and cost
 duration of treatment based on effectiveness, side-effects and past
medical history
 rehabilitation, education and wellness activity

 indications

 first line treatment for all patients with symptomatic

arthritis
 technique

 self-management and education programs

 combination of supervised exercises and home
program have shown the best results
 these benefits lost after 6 months if exercises are stopped
 weight loss programs

 indications

 patients with symptomatic arthritis and BMI > 25

 technique

 diet and low-impact aerobic exercise

 Operative Treatment
 high-tibial osteotomy
 indications
 younger patients with medial unicompartmental OA
 technique
 valgus producing proximal tibial oseotomy
 outcomes
 AAOS guidelines: limited evidence for
 unicompartmental arthroplasty (knee)
 indications
 isolated unicompartmental disease
 outcomes
 TKA have lower revision rates than UKA in the setting of
unicompartmental OA
 total knee arthroplasty
 indications
 symptomatic knee osteoarthritis
 failed non-operative treatments
 techniques
 cruciate retaining vs. crucitate sacrificing implants show no difference
in outcomes
 patellar resurfacing
 no difference in pain or function with or without patella resurfacing
 lower reoperation rates with resurfacing
 drains are not recommended
 Total Knee
Replacement
Hip Osteoarthritis
 Histology Hip OA

 loss of superficial chondrocytes

 replication and breakdown of the tidemark

 fissuring

 cartilage destruction with eburnation of subchondral

bone
 Risk Factors
 modifiable

 articular trauma
 muscle weakness
 heavy physical stress at work
 high impact sporting activities
 non-modifiable

 gender
 females >males
 increased age
 genetics
 developmental or acquired deformities
 hip dysplasia
 slipped capital femoral epiphysis
 Legg-Calvé-Perthes disease

 Symptomps
 Function-limiting hip pain
 Effect on walking distance
 Pain at night or rest

 Hip Stiffness

 Mechanical
 Instability, locking, catching sensation
 Physical Exam
 Inspection
 Body habitus
 Gait
 Leg length discrepancy
 Skin (scars)
 Range of Motion
 Lack of full extension (>5 degrees flexion contracture)
 Lack of full flexion (flexion <90-100 degrees)
 Limited internal rotation
 Neurovascular exam
 Straight leg test negative
 Imaging
 Standing AP Pelvis
 AP + lateral hip
 Findings:
 OA: a. Joint space narrowing
 Osteophytes
 Subchondral sclerosis
 Subchondral cysts
 Pelvic Obliquity
 May be secondary to spinal deformity
 May cause leg length issues
 Acetabular retroversion
 Makes appropriate positioning of acetabular component more diffucult
intraoperatively
 Treatment
 Non operative

 NSAIDs and/or tramadol

 indications
 first line treatment for all patients with symptomatic
arthritis
 technique
 NSAID selection should be based on physician preference,
patient acceptability and cost
 walking stick
 decreases the joint reaction force on the affected hip when used
in the contralateral upper extremity
 weight loss, activity modification and exercise program/physical
therapy
 indications
 first line treatment for all patients with symptomatic arthritis
 BMI > 25
 technique
 exercise aimed at increasing flexibility and aerobic capacity

 corticosteroid joint injections, sodium hyaluronate injections

 indications
 can be therapeutic and/or diagnostic of symptomatic hip
osteoarthritis
 Treatment
 Operative
 Athroscopic debridement
 indications
 controversial
 degenerative labral tears
 periacetabular osteotomy +/- femoral osteotomy
 indications
 symptomatic dysplasia in an adolescent or young adult with
concentrically reduced hip and mild-to-moderate arthritis
 femoral head resection

 indications
 pathological hip lesions
 painful head subluxation
 hip resurfacing

 indications
 young active, male, patients with hip osteoarthritis
 total hip arthroplasty (THA)

 indications
 end-stage, symptomatic or severe osteoarthritis arthritis
 preferred treatment for older patients (>50) and those with advanced
structural changes
Periacetabular
Osteotomy
Femoral Head Resection

Hip Resurfacing
Total Hip Arthoplasty