Osteoarthritis
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Osteoarthritis is a degenerative joint disease characterized by the breakdown of cartilage. It most commonly affects weight-bearing joints like the hips and knees. The cartilage, bone, synovial membrane, capsule, ligaments and muscles are all affected as the disease progresses. Symptoms include joint pain and stiffness that worsens with use of the affected joint. Treatment focuses on reducing pain and inflammation, maintaining joint mobility, and may include joint replacement surgery for severe cases.
Osteoarthritis
- 2. DEFINITION Osteoarthritis is a non-inflammatory, degenerative condition of joints Characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.
- 3. Common in weight-bearing joints such as hip and knee. Also seen in cervical , lumbosacral spine and in hands (DIP, PIP, base of thumb). Both male and females are affected. But more common in older women i.e. above 50 yrs,particularly in postmenopausal age.
- 4. JOINT PROTECTIVE MECHANISMS SYNOVIAL FLUID JOINT CAPSULE AND LIGAMENTS MUSCLE SENSORY AFFERENTS UNDERLYING BONE
- 5. SYNOVIAL FLUID Reduces friction between articulating cartilage surfaces Hyaluronic acid + lubricin Concentration of the above – reduced in injury/ inflammation of synovium
- 6. LIGAMENTS, SKIN, TENDONS Contain mechanoceptor sensory afferent nerves Provide feedback via spinal cord to muscles + tendons
- 7. CARTILAGE Impact absorbing capacity along with synovium Earliest OA changes occur here Healthy cartilage – avascular due to angiogenesis inhibitors in cartilage Diseased cartilage – invasion of blood vessels into cartilage from bone and proliferation in synovium VEGF synthesis in bone + cartilage is implicated OA cartilage – depletion of aggrecan, loss of type 2 collagen, unfurling of collagen matrix
- 9. PATHOLOGY OA is a degenerative condition primarily affecting the articular cartilage. 1.articular cartilage 2.Bone 3.Synovial membrane 4.capsule 5.Ligament 6.muscle
- 10. Articular Cartilage o Cartilage - 1st structure to be affected. o Erosion occurs, often central & frequently in wt. bearing areas. o Fibrillation - causes softening, splitting and fragmentation of cartilage,in both wt. bearing & non-wt. bearing areas. o Collagen fibres split , disorganisation of proteoglycan-collagen relationship o Further softening and flaking. o Flakes of cartilage break off, may be impacted b/w jt.surfaces locking and inflammation.
- 11. Right: Early OA with area of cartilage loss in the center. Left: More advanced changes with extensive cartilage loss and exposed underlying bone
- 12. Arthroscopic appearances in OA of the knee joint: fibrillated surface of the cartilage on the medial femoral condyle
- 13. Bone(Eburnation) Bone surface become hard & polished as there is loss of protection from the cartilage. Cystic cavities form in the subchondral bone because eburnated bone is brittle and microfractures occur. Venous congestion in the subchondral bone.
- 14. Gross superior view of a femoral head from a patient with radiographic stage I OA. This shows an area of complete cartilage loss, with polishing or eburnation of the underlying bone.
- 15. Osteophytes form at the margin of the articular surface,which may get projected into the jt. Or into capsule & ligament,bone of the wt.-bearing jt. There is alteration in the shape of the femoral head which becomes flat and mushroom shaped. Tibial condyles become flatened.
- 16. Osteophyte at margin of articular surface
- 17. Synovial Membrane o Synovial membrane undergo hypertrophy and become oedematous (which can lead to ‘cold’ effusions). o Reduction of synovial fluid secretion results in loss of nutrition and lubricating action of articular cartilage. o Capsule o It undergoes fibrous degeneration and there are low-grade chronic inflammatory changes
- 19. Ligament Undergoes fibrous degeneration There is low grade chronic inflammatory changes and acc.to the aspect joint become contracted or elongated. Muscles Undergoes atrophy, as pt. is not able to use the jt. Because of pain which further limits movts. and function.
- 22. CLINICAL FEATURES JOINT PAIN – ACTIVITY RELATED IN EARLY DISEASE – Episodic, triggered by overuse of diseased joint Progressively, continuous pain, even disturbs sleep at night Stiffness of the joint. Morning stiffness – brief ( <30min) In knee- buckling, catching, locking Pain with activities requiring knee flexion ( climbing stairs, rising from a chair )
- 24. Osteoarthritis of the DIP joints. This patient has the typical clinical findings of advanced OA of the DIP joints, including large firm swellings (Heberden’s nodes), some of which are tender and red due to associated inflammation of the periarticular tissues as well as the joint.
- 26. A patient with typical OA of the knees. In the normal standing posture there is a mild varus angulation of the knee joints due to symmetrical OA of the medial tibiofemoral compartments.
- 27. Radiographic Classification Stage 1 Stage 2 Stage 3 Stage 4 Bony spur only Narrowing of jt. Space,less than half of the normal jt. space Narrowing of jt. Space,more than half of the normal jt. space Obliteration of jt. space Stage 5 Subluxation or sec.lateral arthrosis
- 29. Special Investigations • Blood tests: Normal • Radiological features: – Cartilage loss – Subchondral sclerosis – Cysts – Osteophytes
- 31. Treatment Principles • Education • Physiotherapy – Exercise program – Pain relief modalities • Aids and appliances • Medical Treatment • Surgical Treatment
- 33. Aids and appliances • Braces / splints • Special shoes/insoles • Mobility aids • Aids: dressing, reaching, tap openers, kitchen aids • Taping of patella in patello femoral OA
- 34. Use of a cane, stick or other walking aid. This patient, who has hip OA, has found that she can reduce the pain in her damaged left hip by leaning on the stick in the right hand as she walks. The reduction in loading can be huge, and the effect on symptoms and confidence with walking very beneficial.
- 37. Joint replacement surgery • Indications: pain affecting work, sleep, walking and leisure activities • Complications – sepsis – loosening – lifespan of materials (mechanical failure)