Dr. Md.

Golam Sarwar
M.S (Ortho), AO-Fellow (India), WHO-Fellow ( Indonesia)
Consultant, Ortho- Surgery,
Sadar Hospital, Bhola.
 Primary Secondary
 Old age  Post infective
 Female  Post Menisectomy
 Life style  Post traumatic
 Over weight
 Symptoms & signs which are associated
with defective integrity of articular
cartilage, in addition to related changes
in the underlying bone at the joint
margins.
American College of Rheumatology- 2005

 Also known as degenerative joint

disease, is the most common form of
arthritis, and a leading cause of
disability worldwide.
 OA Knee is one of the five leading causes
of physical disability in non- hospitalized
elderly men & women.
 The risk for disability is as great as
cardiovascular disease & greater than
that due to any other medical condition
in elderly.
 7.35% of the total population are
suffering from osteoarthritis.
 7% population in Indian are above the
age of 60 years.
 Out of that 20% are suffering from OA
knee & needs some kind of treatment
(Physical, medical, Surgical)
 But only a few get treatment (Surgeries/
joint replacement).
 Bangladesh data are not available.
 Young patients age less than 55
presenting with uni-compartmental
symptom.
 Older patient presenting with symptoms
of bi-compartment with patello-femoral
arthritis.
 Patient with inflammatory arthritis- any
age group.
 Osteoarthritis of the
knee increase in
prevalence with age & is
more common in women
than in men.
 OA affects all structures within
joint.
 Loss of hyaline articular
cartilage.
 Synovial inflammation.
 Capsular stretching and
weakness of periarticular
muscles.
 Mal-alignment-
Tibia vara/Genu Varum
 Genu valgum or knock knee
(Lateral compartment arthritis)
 Osteitis, synovial inflammation & a
stretched joint capsule filled with fluid are
to be sources of pain. Bursitis may add.
 Hyaline Articular cartilage is destroyed &
sub-chondral bone is exposed leads to
painful knee.
 Age & sex
 Obesity
 Previous existing deformity
 Knee injury
 Repetitive Stress injuries
 High impact sports
 Repetitive episodes of
TB/gout/septic arthritis
hemophilic arthritis/Psoriatic
arthritis/ neuropathic arthritis
 Gradual destruction of
Articular cartilage
 Mild thickening of synovium
& inflammation
 Thickening of joint capsule.
 Gradual destruction
of hyaline cartilage

 Complete loss of
medial joint
cartilage with
osteophytes
formation
 Cell stress

Cytokine
IL-1, IL-6, TNF-

Cartilage Synovial Sub-chondral

destruction destruction bone
destruction

OA.
 Clinical diagnosis
 Laboratory diagnosis

 Radiological diagnosis
 Pain – Bone angina
 Restricted joint movement- stiffness
 Swelling ]
 Mild joint instability
 Crepitus (on movement)
 Effusion
 Joint deformity & instability
  General Examination
- Vital Sign
- obesity
- Neurological status
- DM
- HTN
 Local Examination
- Site of pain, tenderness, crepitus
- Deformity
Varus (OA)
Valgus (RA)
- Synovitis
- Osteophytes
- Instability

-  ROM
 General Examination
- Vital Sign
- obesity
- Neurological status
- DM
- HTN
 Local Examination
- Site of pain, tenderness, crepitus
- Deformity
Varus (OA)
Valgus (RA)
- Synovitis
- Osteophytes
- Instability
-  ROM
- Gait (Wadding/ Trendelenberg)
 CBC - For infective/ inflammatory pathology
 ESR – Inflammatory condition
 CRP – For differentiate with infection
 RA Factor – RA.
 ANA titre – RA.
 Synovial Fluid examination – D/D
 Crystal examination – For gout / pseudo gout
 HLA – B27 – AS.
 X- Ray – AP standing, Lateral, stress view
sky-line view (Digital X-Ray are
preferred)

• CT scan
• MRI
If necessary
• Bone scanning
• Ultra sonography
 Prevention
 Physical treatment

 Medical treatment

 Surgical treatment
 Pain control
 Increase mobility

 Further degeneration

prevention
 Enhance healing process

 Improve quality of life

 Education about the problem & fate
 Habit change & life style modification
- Avoidance of squatting, cross leg
sitting
 Weight reduction
 Physiotherapy
 Control of DM. Endocrine disorders.
 Physiotherapy
- Quadriceps strengthening
- Hamstring strengthening
 Local treatment
- SWD
- UST
- knee cap.
 Load reduction over knee
- Use of support – stick
- Valgus brace
- wedged insole
- weight reduction
- gait modification
- out toeing
- slow walking
 Symptom modifying drugs
- NSAIDs
- Analgesics- tramadol, paracetamol
- Safer drug – naproxen.
 Nutraceuticals
- Glucosamine sulfate
- chondroitin sulfate
 Disease modifying anti- OA drugs-
Diacerein
 Calcium supplement
 Muscle relaxant - ??
 Visco supplementation
 Arthroscopic

debridement
 HTO

 Unicondylar knee

replacement.
 Total knee replacement
 Joint space narrowing (Grade-
1)

 Obliteration of joint
space (Grade-2)
HTO + Arthroscopy/UKA
 For joint debridement & lavage
 Abrasion arthroplasty
 Degenerative meniscal tears
 Synovectomy in RA
 Chondrocyte implantation
 Post traumatic arthrofibrosis
 Marrow stimulation techniques
 Abrasion chondroplasty
 Microfracture techniques
(Steandman JR CORR) 2001; 391 (Suppl): S 362 –
S 369
 Cartilage restoration
procedure
- Osteo chondral auto –
graft transfer (mosaic plasty)
- Autogenous chondrocyte
implantation (ACI)
- Cartilage transplantation
- Osteo chondral allograft
trasplantation
 Grde 1 – 2 of medial compartment arthritis
 Relatively young patient < 60 yrs
 No or minimal deformity
 Non inflammatory disease pathology.
 Arthroplasty
 Unicondylar knee arthroplasty
(UKA)
 Total knee arthroplasty (TKA)
 Almost 70% of arthritic knee are confined to
medial compartment (Till death)
 Replacing only the diseased or affected part of
Tibio-Femoral joint
- Available since 30 yrs
- Popularized in last decade.
 Symptomatic uni-compartmental arthritis
 Varus/ Valgus deformity less than 150
 Flexion contracture less than 100
 Passive ROM more than 800
 Young active patients
 Intact PCLs
 Bi-compartmental / tri-compartmental
arthritis
 Rheumatoid arthritis
 PCL deficit
 More than 150 varus/valgus deformity
 More than 100 flexion contracture
 Stiff knee
 Obesity
 Considered to be gold
standard in treatment
of advanced arthritis
or inflammatory
arthritis (RA)

 For patient with

advance disease,
gross deformity,
limited activity in life.
 Young patient (age<55)
- Cruciate retaining
- Bone consenving design
- cement less TKR
 Older patient (age> 55)
- High flexion TKR
- PS/CR
 Current surgical trends
 Minimally invasive surgery
 Use of navigation
 OA is very common clinical condition
seen in out patient department
 Conservative management includes
drugs & physiotherapy should be first line
of management
 In selected patient uni-condylar knee
replacement gives good, long-lasting
results.
 Set up new isolated upgraded unit for
proper clinical, laboratory & radiological
examination
 OT set up with training manpower
including OT nurse, stuffs & surgeons.
 Collaboration between neighboring
country & exchange of views & good
bilateral technical exchange.
 Good support & patronization by BOS &
Government.