Osteoarthritis: By: Yosra Mohammed Hussien (OPT)

OSTEOARTHRITIS
By:
Yosra Mohammed Hussien (OPT)
08/08/2021 Yosra Mohammed Hussien (OPT)- Lecturer-AL Neelain University /Faculty of Physiotherapy 2
INTRODUCTION
• Sometimes called "wear-and-tear" arthritis.
• Pain, swelling, and stiffness are the primary symptoms of arthritis.
• It can occur in any joint in the body, but most often develops in weight-bearing joints.
• Because osteoarthritis gradually worsens over time, the sooner you start treatment, the more
likely it is that you can lessen its impact on your life.
• Although there is no cure for osteoarthritis, there are many treatment options to help you
manage pain and stay active.
DEFINITION
• Osteoarthritis (OA) is a chronic disorder of synovial joints in which there is progressive
softening and disintegration of articular cartilage accompanied by reparative response of bone
and underlying cartilage at the joint margins (osteophytes), cyst formation and sclerosis in the
subchondral bone, mild synovitis and capsular fibrosis.
• Entire joint structure and function affected.
• Age is the strongest determinant of osteoarthritis in the weight bearing joints as population
ages.
Epidemiology
• Hip OA:
• Is the most common source of hip pain in older adults.
• Prevalence studies have shown rates between and 0.4% and 27%.
• Knee OA:
• 30% of persons aged 63–94 years are affected by OA of the knee
• More common in females than males (70% vs 30%)
• Second only to heart disease in causing disability among the elderly
EATIOLOGY
• The causes are complex and interrelated biological, mechanical and structural pathways.
• The initiation of osteoarthritis is associated with a kinematic change in the patterns of

ambulation of sufficient magnitude to shift load to regions of the cartilage at the knee that are
not conditioned to chronic ambulatory loading.
• Healthy cartilage responds positively to functional loads but at some point cartilage can no
longer adapt to the altered chronic ambulatory loading and begins to degrade; hence responds
negatively to loads and the rate of progression of osteoarthritis increases.
Magnitude of
load:
BMI, Surface Current or
activities, AD & previous
Muscle foot wear injury
Strength and
Motor Control
Force
Area of force Joint Stress

application
Joint
Loading
alignmen
rate
Joint mobility t
Risk factors
• Obesity • Leg Length Discrepancy (LLD)
• Gender: Female > male • Developmental Disorders:

• Joint instability • Legg-Calve-Perthes
• High-impact sports or labor • Developmental Dysplasia
• Neuromuscular dysfunction • Congential Dislocation
• Previous injury or surgery • Slipped Capitofemroal Epiphysis
• Menopause • Diet - low Vitamin D, C and K levels
• Sedentary lifestyle • History of immobilisation
• Femoroacetabular impingement • Joint hypermobility
• Avascular necrosis • Malalignment
• Ethnicity - 80-90% less prevalent in the • Cartilage defects

Asian population when compared to the • Genetic
Caucasian population in the USA
• Metabolic diseases and acromegaly
Staging system by Kellgren/Lawrence
Grade Clinical Symptoms & Radiological Findings
0
No abnormality
1
Incipient osteoarthritis, beginning of osteophyte formation on eminences
2
Moderate joint space narrowing, moderate subchondral sclerosis
3
> 50% joint space narrowing, rounded femoral condyle, extensive subchondral
sclerosis, extensive osteophyte formation
4
joint space narrowing, subchondral sclerosis, subchondral cysts, and peripheral
osteophytes
Diagnosis According to American College of
Rheumatology (ACR) criteria:
Knee OA: Knee Pain + at least 3 of the 6
Hip OA: Hip pain and at least 2 of the
• Age > 50
following 3 features:
• ESR < 20 mm/hour • Stiffness < 30 Minutes
• Radiographic femoral or acetabular • Crepitus

osteophytes • Boney Tenderness
• Radiographic joint space narrowing
• Boney Enlargement
• No Palpable Warmth
IMAGING
• Plain radiographs confirmatory for moderate to severe OA; less useful for early changes; Ultrasound
could be useful.
• Occasionally, MRI scan, CT scan, or a bone scan may be needed to determine the condition of the bone
and soft tissues.
• Examination for joint space narrowing
• Normal: 3-5 mm
• Significant change: >0.5 mm change
• Moderate OA: <2.5 mm
• Severe OA: <1.5 mm
X- RAY OA
Rt. Hip OA Rt. Knee OA
Clinical impairments of Hip OA
1. Pain:
• Primarily groin, secondary lateral
• May refer down thigh to knee
• Worsen in the morning, or after sitting or resting then improves in <1 hour
• Increases at end-ROM, particularly IR.
2. Limited ROM:
• Capsular pattern of limitation is IR > abd > flex
• >15 ⁰ IR difference vs. non-involved side considered significant
• Stiffness in the hip joint that makes it difficult to walk or bend
3. Muscle weakness: Abductors ( sign ?)
4. Functional disability
• Weight bearing activities
• Ambulation
• Stairs
• Prolonged positions: Sitting, driving, transition sit to stand after prolonged sitting
• Activities of Daily Living
• Getting dressed
• Lifting objects
Clinical impairments of Knee OA
5. Pain may cause a feeling of weakness or
1. Inflamed: warm to touch, pain and swelling
buckling in the knee.
may be worse in the morning, or after sitting
or resting. 6. Many people with arthritis note increased
joint pain with rainy weather.
2. Pain with weight-bearing activities
7. Loose fragments of cartilage and other tissue
3. Loss of motion (stiffness): pain makes it
can interfere with the smooth motion of
difficult to bend and straighten the knee.
joints. The knee may "lock" or "stick" during
4. Muscle weakness (mainly extensors) movement. It may creak, click, snap or make
a grinding noise (crepitus).
08/08/2021
MANAGEMENT
Yosra Mohammed Hussien (OPT)- Lecturer-AL Neelain University /Faculty of Physiotherapy 19
HISTORY & PHYSICAL
EXAMINATION
• Joint swelling, warmth, or redness
• Tenderness about the joint
• Range of passive (assisted) and active (self-directed) motion
• Instability of the joint
• Crepitus (a grating sensation inside the joint) with movement
• Pain when weight is placed on the joint
• Gait abnormalities
• Testing of muscle power, coordination, mobility, balance and also stability of the joint; can be tested
by active test like standing on one leg and passive manual tests.
• Any signs of injury to the muscles, tendons, and ligaments surrounding the knee
SPECIAL TESTS
• For knee OA: Mobility test (soft, capsular, hard, springy end feel)
• For hip OA:
1. Scours
• Pain
• Mechanical crepitus
2. FABER
• Pain
• ROM difference
3. Joint Distraction
• Decreased mobility
Scours test
• Decreased pain with distraction
• There are multiple interventions to treat OA of the ranges from physiotherapy and orthopedic
aids to pharmacotherapy and surgery, depending on severity, patient medical condition, and
patient preferences.
• It is best treated by using education, exercise and weight control with the addition of
pharmacological and surgical interventions when needed.
• The treatment should be tailored according to local and general risk factors, level of pain
intensity and disability, sign of inflammation; such as effusion, and the location and degree of
structural damage
LOAD MODIFICATION
1. Muscle strength and joint mobility
2. Weight Control: Diet and Aerobic Exercise
3. Assistive devices
4. Proper foot wear and orthotics
5. Modification of activity surface
6. Minimize impact loading
7. External support devices: braces & taping

MEDICAL TREATMENT
1. Pharmacologic:
• Acetaminophen
• Oral and topical "NSAIDS"
• Tramadol
• Intraarticular corticosteroid injections.
2. Non-pharmacological:
• Debridement arthroscopy
• Joint replacement (treatment of choice in severe cases)
• Stem cell engineering to help reform the lost cartilage
• Pulsed electromagnetic fields to retard articular damage are promising
PHYSIOTHERAPY TREATMENT of KNEE OA
1. Regular participation in physical activity
2. Strengthening exercise (isokinetic and isotonic)
3. Avoid excessive compressive forces or shear forces at knee
4. Balance and coordination
5. Manual therapy (capsular stretching, joint mobilisation)
6. Avoid prolonged standing, kneeling and squatting
7. Use soft and cushioned foot wear
8. Physiotherapy modalities to decrease pain
PHYSIOTHERAPY TREATMENT of
HIP OA
1. Patient education
2. Strengthening
3. Stretching
4. Aerobic exercise
5. Aquatic exercise
6. Functional, Gait, and Balance Training
7. Mobilisation ex
08/08/2021
THANK YOU
Assignment: Advices to patients with hip & Knee OA
Yosra Mohammed Hussien (OPT)- Lecturer-AL Neelain University /Faculty of Physiotherapy 35

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OSTEOARTHRITIS

• Pain, swelling, and stiffness are the primary symptoms of arthritis.

• Entire joint structure and function affected.

• Is the most common source of hip pain in older adults.

• More common in females than males (70% vs 30%)

• Second only to heart disease in causing disability among the elderly

• The initiation of osteoarthritis is associated with a kinematic change in the patterns of

Area of force Joint Stress

• Gender: Female > male • Developmental Disorders:

• High-impact sports or labor • Developmental Dysplasia

• Neuromuscular dysfunction • Congential Dislocation

• Previous injury or surgery • Slipped Capitofemroal Epiphysis

• Sedentary lifestyle • History of immobilisation

• Femoroacetabular impingement • Joint hypermobility

• Avascular necrosis • Malalignment

• Ethnicity - 80-90% less prevalent in the • Cartilage defects

• ESR < 20 mm/hour • Stiffness < 30 Minutes

• Radiographic femoral or acetabular • Crepitus

• Examination for joint space narrowing

• Significant change: >0.5 mm change

• Moderate OA: <2.5 mm

• Severe OA: <1.5 mm

• Primarily groin, secondary lateral

• May refer down thigh to knee

• Increases at end-ROM, particularly IR.

• Capsular pattern of limitation is IR > abd > flex

• >15 ⁰ IR difference vs. non-involved side considered significant

• Stiffness in the hip joint that makes it difficult to walk or bend

• Weight bearing activities

• Activities of Daily Living

• Tenderness about the joint

• Range of passive (assisted) and active (self-directed) motion

• Instability of the joint

• Crepitus (a grating sensation inside the joint) with movement

• Pain when weight is placed on the joint

• For hip OA:

2. Weight Control: Diet and Aerobic Exercise

4. Proper foot wear and orthotics

5. Modification of activity surface

6. Minimize impact loading

7. External support devices: braces & taping

• Oral and topical "NSAIDS"

• Intraarticular corticosteroid injections.

• Joint replacement (treatment of choice in severe cases)

• Stem cell engineering to help reform the lost cartilage

• Pulsed electromagnetic fields to retard articular damage are promising

2. Strengthening exercise (isokinetic and isotonic)

3. Avoid excessive compressive forces or shear forces at knee

4. Balance and coordination

5. Manual therapy (capsular stretching, joint mobilisation)

6. Avoid prolonged standing, kneeling and squatting

7. Use soft and cushioned foot wear

8. Physiotherapy modalities to decrease pain

6. Functional, Gait, and Balance Training

Yosra Mohammed Hussien (OPT)- Lecturer-AL Neelain University /Faculty of Physiotherapy 35

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