DEGENERATIVE BONE DISEASES

Shaheer Hassan
2023084
 CONTENTS

• Definition
• Prevalence
• Risk Factors
• Pathogenesis
• Pathology
• Clinical Presentation
• Imaging
• Management
 DEFINITION

• Chronic disorder of synovial joints in which there is a progressive softening

and disintegration of articular cartilage accompanied by new growth of
cartilage and bone, cyst formation, sclerosis, synovitis and capsular fibrosis
• Not a purely degenerative disorder as there is destruction and repair going on at
the same time
• Basically a process in which the load exposed to an articular cartilage exceeds
its ability to bear that stress
 DIFFERENTIALS

• Avascular necrosis
• Inflammatory arthropathies
• Polyarthritis of the fingers
• Diffuse idiopathic skeletal hyperostosis
 PREVALENCE

• Commonest of all joint diseases

• 50% incidence over the age of 60
• Changes seen in everyone over the age of 65
• Men and woman ae equal at risk but more joints are involved in woman
• More common in fingers, hip, knee and spine joints
• Affected by prevalence of other diseases such as acetabular dysplasia,
developmental displacement of the hip, Perthes’ disease and slipped femoral
epiphysis
 RISK FACTORS

• Joint dysplasia
• Trauma
• Occupation
• Bone density (increased)
• Obesity (endocrine, metabolic)
• Family history (first degree relatives)
 PATHOGENESIS

Loss of integrity of
articular cartilage
Failure of the Regeneration of
– increased force
matrix – increased remaining
on subchondral
water content in cartilage -
bone – trabecular
the cartilage and endochondral
degeneration, cyst
loss of ossification -
formation, reactive
proteoglycans osteophytes
sclerosis, increased
vascularization
 PATHOLOGICAL CHANGES

• Progressive cartilage destruction

• Subarticular cyst formation
• Sclerosis
• Osteophyte formation
• Capsular fibrosis.
 CLINICAL PRESENTATION

• Patients present after middle age

• Joints involved are:
1. Weight bearing joints like the hip or the knee
2. Interphalangeal joints in women greater than 70
3. Joint previously affected
• Family history positive in polyarticular involvement
 SYMPTOMS

• Pain aggravated by exertion and relieved by rest

• Stiffness with inactivity
• Intermittent (effusion) or continuous (osteophytes) swelling
• Deformity (cause or consequence)
• Loss of function
• Intermittent course of all symptoms
 SIGNS

• Joint swelling
• Tell tale scars
• Deformity (varus)
• Local tenderness
• Limited movement
• Crepitus during passive movement
• Instability
• Examine other joints and asses function in everyday activities
 CLINICAL PRESENTATIONS

• Monoarticular or Pauciarticular
• Polyarticular (generalized) – commonest, middle aged woman with pain,
swelling and stiffness of the finger joints, Heberden (DIP) and Bouchard (PIP)
nodes
• OA in unusual sites – shoulder, elbow, wrist and ankle, suspect previous
congenital or traumatic abnormality
• Rapidly destructive OA – elderly woman, associated with psuedogout
 IMAGING

• X-ray 1st CHOICE

• Radionuclide scanning
• CT and MRI
• Arthroscopy – shows changes even before x-ray
 X-RAY FINDINGS

• LOSS
• Loss of joint space
• Osteophytes
• Subchondral sclerosis
• Subchondral cysts
X-RAY FINDINGS
 COMPLICATIONS

• Capsular herniation (baker’s cyst)

• Loose bodies causing episodes of locking
• Rotator cuff dysfunction due to AC joint OA
• Spinal stenosis (lumbar OA, do CT and MR)
• Spondylolisthesis
 MANAGEMENT

• SYMPTOMATIC
1. Maintain movement and muscle strength
2. Protect the joint from overload
3. Relieve pain
4. Modify daily activities.
 EARLY TREATMENT

1. Physical therapy
2. Load reduction - weight loss, shock absorbing shoes, avoiding stairs, using
walking aid
3. Analgesics
 INTERMEDIATE TREATMENT

• Joint debridement by arthroscopy or open surgery

• Corrective osteotomy if an underlying secondary disorder (varus deformity,
dysplasias)
 LATE TREATMENT

• Reconstructive surgery if increasing pain, instability and deformity

1. Realignment osteotomy: redistribution of loading to undamaged parts of the
joint and vascular decompression of the subchondral bone, only done if the
joint is still stable and mobile, and x-rays show that a major part of the
articular surface (the radiographic joint space) is preserved
2. Joint replacement
3. Arthrodesis
 JOINT REPLACEMENT

Procedure of choice for OA in patients with intolerable symptoms, marked loss of

function and severe restriction of daily activities
 ARTHRODESIS

Fusion of joint causing immobilization, for pain relief, done in small joints of
hands and foot
 REFERENCES

• Apley’s System of Orthopaedic sand Fractures

• Salaffi, Fausto & Ciapetti, A & Carotti, M. (2014). The sources of pain in
osteoarthritis: A pathophysiological review. Reumatismo. 66. 57-71.
10.4081/reumatismo.2014.766.
• Google Images
THANKYOU!