Osteoarthritis

Osteoarthritis (OA)
OA is the most common form of arthritis and the most common joint disease Most common age group : more than age 45 women are more commonly affected than men. OA most common sites ends of the fingers i.e. PIP & DIP , neck, lower back, knees, and hips.

OA
OA is a disease of joints that affects all of the weight-bearing components of the joint:

Articular cartilage Menisci Bone

OA
Nodal osteoarthritis Note bony enlargement of distal and proximal interphalangeal joints (Heberden's nodes and Bouchard's nodes, respectively).

OA Risk Factors
Age

Age is the strongest risk factor for OA. Although OA can start in young adulthood, if you are over 45 years old, you are at higher risk.

Female gender

In general, arthritis occurs more frequently in women than in men. Before age 45, OA occurs more frequently in men; after age 45, OA is more common in women. OA of the hand is particularly common among women.
People with joints that move or fit together incorrectly, such as bow legs, a dislocated hip are more likely to develop OA in those joints.

Joint alignment

OA Risk Factors
Hereditary gene defect

A defect in one of the genes responsible for the cartilage component collagen can cause deterioration of cartilage.

Joint injury or overuse caused by physical labor or sports

Traumatic injury (ex. Ligament or meniscal tears) to the knee or hip increases your risk for developing OA in these joints. Joints that are used repeatedly in certain jobs may be more likely to develop OA because of injury or overuse. Being overweight during midlife or the later years is among the strongest risk factors for OA of the knee.

Obesity

OA Symptoms
OA usually occurs slowly It may be many years before the damage to the joint becomes noticeable Only a third of people whose X-rays show OA report pain or other symptoms:

Steady or intermittent pain in a joint Stiffness that tends to follow periods of inactivity, such as sleep or sitting Swelling or tenderness in one or more joints [not necessarily occurring on both sides of the body at the same time] Crunching feeling or sound of bone rubbing on bone (called crepitus) when the joint is used

Osteoarthritis (OA) - Definition

Osteoarthritis may result from wear and tear on the joint
The normal cartilage lining is gradually worn away and the underlying bone is exposed.

The repair mechanisms of tissue absorption and synthesis get out of balance and result in osteophyte formation (bone spurs) and bone cysts

Osteoarthritis (OA) - Definition

OA Articular Cartilage
Articular cartilage is the main tissue affected
OA results in: Increased tissue swelling Change in color Cartilage fibrillation Cartilage erosion down to subchondral bone

OA Articular Cartilage

OA Articular Cartilage
Proteoglycan loss results in an inability to hold on to water content: - Decreased resistance to compression especially with repeated stress

OA Radiographic Diagnosis

Asymmetrical joint space narrowing from loss of articular cartilage

The medial (inside) part of the knee is most commonly affected by osteoarthritis.

OA Radiographic Diagnosis
Asymmetrical joint space narrowing

Periarticular sclerosis

Osteophytes
Sub-chrondral bone cysts

OA Arthroscopic Diagnosis
Arthroscopy allows earlier diagnosis by demonstrating the more subtle cartilage changes that are not visible on x-ray

Normal Articular Cartilage Ostearthritic degenerated cartilage with exposed subchondral bone

OA Arthroscopic Treatment
In addition to being the most accurate way of determining how advanced the osteoarthritis is: Arthroscopy also ALLOWS THE SURGEON TO DEBRIDE THE KNEE JOINT
Debridement essentially consists of cleaning out the joint of all debris and loose fragments. During the debridment ANY LOOSE FRAGMENTS OF CARTILAGE ARE REMOVED and the KNEE IS WASHED WITH A SALINE SOLUTION. The areas of the knee joint which are badly worn may be roughened with a burr to promote the growth of new cartilage - a fibrocartilage material that is similar scar tissue. Debridement of the knee using the arthroscope is not 100% successful. If successful, IT USUALLY AFFORDS TEMPORARY RELIEF of symptoms for somewhere BETWEEN 6 MONTHS - 2 YEARS.

OA Disease Management
OA is a condition which progresses slowly over a period of many years and cannot be cured Treatment is directed at decreasing the symptoms of the condition, and slowing the progress of the condition

Functional treatment goals: Limit pain Increase range of motion Increase muscle strength

OA Non-operative Treatments
Pain medications Physical therapy Walking aids Shock absorption Re-alignment through orthotics Limit strain to affected areas

Proximal Tibial Osteotomy

Osteoarthritis usually affects the inside half (medial compartment) of the knee more often than the outside (lateral compartment). This can lead to the lower extremity becoming slightly bowlegged, or in medical terms, a genu varum deformity

Total Knee Replacement

The ultimate solution for osteoarthritis of the knee is to replace the joint surfaces with an artificial knee joint:
Usually only considered in people over the age of 60 Artificial knee joints last about 12-15 years in an elderly population Not recommended in younger patients because:
The younger the patient, the more likely the artificial joint will fail Replacing the knee the second and third time is much harder and much less likely to succeed. Younger patients are more active and place more stress on the artificial joint, that can lead to loosening and failure earlier Younger patients are also more likely to outlive their artificial joint, and will almost surely require a revision at some point down the road.

Younger patients sometimes require the surgery (simply because no other acceptable solution is available to treat their condition)

Total Knee Replacement

The ends of the femur, tibia, and patella are shaped to accept the artificial surfaces. The end result is that all moving surfaces of the knee are metal against plastic

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Total Knee Replacement

Photographs of total knee components on model bone

Total Knee Replacement

Unicompartmental Knee Replacement

When only one part of the knee joint is arthritic, it may be possible to replace just this part of the joint The procedure is similar to a total knee replacement, but only one side of the joint is resurfaced

A metal component is fit onto the femur and a plastic bearing is inserted either directly onto the tibia or onto a metal tray which has been fit onto the tibia Recovery time is generally slightly shorter following this kind of surgery.

The End