Osteoarthritis

Palu
2018

CME

dr. Muh. Ardi Munir, M.Kes., Sp.OT., FICS., M.H

Orthopaedic & Traumatology Surgery Dept.

Faculty of Medicine
Case 1
 Basics Description

•The most prevalent form of

arthritis
•May occur in virtually any joint
of the body
•Has no cure and leads to pain
and joint dysfunction
•The end result is loss of
articular cartilage with
secondary bone changes,
including osteophytes,
subchondral sclerosis, and
subchondral cysts.
Epidemiology Incidence

The knee is the most commonly

affected joint, followed by the hand and
hip (1).
In a study of 697 females >65 years
old, knee arthritis occurred in 30%,
hand arthritis in 15%, and hip arthritis
in 8% (2).
 Prevalence

Osteoarthritis, the most common form of arthritis, affects

females more often than males (3).
In contrast to inflammatory arthritis, osteoarthritis occurs
principally in individuals >60 years old.
In 1 study (4):
Hand osteoarthritis occurred in 23% of females >65
years old.
The most commonly affected joints were the DIP and
1st CMC joints.
 Risk Factors

•Obesity
AVN
Septic arthritis
Advancing age
Female gender
Genetics

A genetic predisposition is thought to

exist, but genes have not yet been
identified.
Etiology

No known cause of osteoarthritis (idiopathic osteoarthritis):

The common pathway is loss of the articular cartilage with
progressive overloading of the joint.
Many conditions that injure the joint may lead to secondary
arthritis.
Trauma: Posttraumatic arthritis
Infection: Postinfectious arthritis
AVN: Arthritis associated with the condition
Case 3
 Diagnosis Signs and Symptoms
Discomfort with weightbearing and joint motion
Stiffness
Loss of function:
Inability to do heavy work
Inability to tie or put on shoes
Limitation to short distance walking
History

Pain and swelling that increase with

activity or prolonged inactivity
Case 4
Physical Exam
The principal features are:
Stiffness and loss of ROM
Joint effusion
Limb deformity
Painful joint motion
Gait disorder
Tests Lab

No specific laboratory features

Case 5
 Imaging

Radiography:
AP and lateral radiographs are the main imaging
modalities.
In the knee, foot, and ankle, weightbearing radiographs
are obtained.
MRI can be used to exclude other diagnoses such as AVN,
stress fractures, and neoplasms.
Pathological Findings

Loss of the thickness and organization of the articular

cartilage
 Differential Diagnosis

The diagnosis of osteoarthritis is not difficult when the

disease is in the moderate or advanced stage.
Early arthritis can be confused with the following conditions:
Tendinitis or bursitis
Stress fractures
Synovial proliferative disorders
Case 6
Treatment General Measures
Rest, activity modification, weight loss,
and NSAIDs
 Special Therapy Physical Therapy

•Patients should begin a program to preserve

muscle strength and ROM and to avoid
contractures (5).
•Heavy-impact activity (such as running,
contact sports, and heavy work) exacerbates
symptoms.
•A cane used in the opposite hand
substantially reduces the forces across the hip
joint and will relieve discomfort and improve
gait.
 Complementary and Alternative
Therapies
Acupuncture may provide pain relief for knee arthritis in the
short term (6).
Many herbal medicines are used for the treatment of
osteoarthritis.
Evidence to support their use is limited (7).
Medication
 First Line

NSAIDs, including COX-2 inhibitors, are mainstays in the

nonoperative treatment of arthritis.
Meta-analysis shows these medications to be slightly more
effective than a placebo in the short term (8).
NSAIDs have a high rate of side effects, including
gastrointestinal bleeding.
Acetaminophen is widely used for pain relief (9).
 Second Line

The use of nutraceuticals, such as glucosamine and

chondroitin sulfate, is controversial, with a recent study
showing no benefit (10).
Intra-articular injection:
With corticosteroids, decreases pain for short periods (11)
With hyaluronic acid, may have a small effect on knee pain
(12)
Opioid pain medicine may be used for severe pain in patients
who are not operative candidates (13).
P.285
 Surgery

2 main types of surgery: Realignment osteotomy and joint

replacement
Surgery

Realignment osteotomy:
The joint surfaces are
repositioned by cutting
the bone and changing
the axis of
weightbearing.
Purpose: Allows the
healthiest articular
cartilage to bear the
most weight
May be combined with
ligament or meniscal
repair
Surgery

Arthroplasty:
The arthritic joint surfaces
are removed, and a new
joint surface is implanted.
The bearing surface is
typically metal on high-
density polyethylene.
Examples are total hip
arthroplasty, total knee
arthroplasty, and total
shoulder arthroplasty.
 Prognosis

Osteoarthritis progressively worsens with time.

No cure exists.
Modern methods of joint replacement provide excellent
function and pain relief.
 Complications

Progressive arthritis leads to worsening deformity and

stiffness.
In the lower extremity, patients may stop walking and
rely on wheelchairs
In the upper extremity, prevents activities and leads to
lack of function
Treatment also may lead to complications.
The side effects of NSAIDs include gastritis and
gastrointestinal bleeding.
Surgical intervention may lead to infection, DVT, or
failure of the replacement mechanical joint.
 Patient Teaching

Patients are:
Taught to avoid activities that worsen the pain
Shown how to prevent contractures
Encouraged to lose weight
 Activity

Patients should be encouraged to maintain muscle strength

and joint mobility.
Exercises that do not cause pain are best.
Activities with little or no impact include elliptical trainers,
bicycling, swimming, and water aerobics or running.
 Prevention

Weight loss may help prevent joint degeneration

 Question

Q: What can be done to prevent osteoarthritis?

A: In general, interventions have not been found to prevent
osteoarthritis. However, osteoarthritis is associated with
obesity, and weight loss may help prevent joint degeneration.
 Question

Q: When is surgery indicated for the treatment of

osteoarthritis?
A: Surgery is the final treatment after nonoperative measures
(such as muscle strengthening, ambulatory aids, and
medications) have been tried. The most commonly performed
surgery is total knee replacement.