Osteoarthritis (OA)

OA •  Osteoarthritis is a poor name for

degenerative joint disease. Articular cartilage is involved more than bone, and inflammation is secondary to the disease, not the cause.

•  ‘Osteoarthrosis’ is sometimes used as an alternative, and ‘Osteochondrosis’ would be more accurate.

•  Dandy. D.J.(1989)

Classifying OA

•  Primary OA – no clear-cut cause (although there are well-known risk factors)

•  Secondary OA – Known cause For example Trauma Skeletal abnormalities Inflammatory arthritis Metabolic causes (eg Acromegaly, CPPD,

Haemochromatosis)

Risk factors for primary OA

•  Obesity •  There is a hereditary influence on some forms of

OA, especially hand and knee OA in women, the genetic basis of this is yet to be discovered.

•  Occupation (OA in hips in farmers, midfoot joint OA in ballet dancers, finger OA in rock climbers)

•  Women with osteoporosis have a lower risk of developing OA and vice versa.

•  (Stein,M. & Taylor,G. 2004)

Symptoms of OA

•  Pain •  Stiffness •  Joint swelling •  Altered function

Conservative treatment for OA •  Explanation of the condition and reassurance

(widespread and severe OA can be disabling, but it is fairly uncommon)

•  Advice to be active, but to modify activities to protect the joints.

•  Assistive aids •  Physiotherapy •  Drug therapy (Analgesics, NSAIDs, Steroid injections) •  Complementary therapies •  Weight loss (if overweight) •  Heat and cold

Surgical treatment of OA

•  Debridement If osteophytes seriously obstruct joint movement, or are unsightly, it is possible to remove them. They can recur, however.

•  Arthrodesis, the fusion of the joint, converts a stiff, painful joint in a bad position, to a stiff, painless joint in a good position. It should only be performed if the neighbouring joints are healthy and have a good range of movement. The joint should be fixed in the most functional position.

•  Osteotomy can correct deformity and alters the architecture at the site of healing, allowing for some remodelling. The operation can be painful, can require a long period of rehabilitation, and the symptoms can recur. In its favour, the operation does not destroy the joint irreparably.

•  Joint replacement surgery can give remarkable results. But infection is a possibility and can be catastrophic. The prosthesis can also fail or become loose, usually requiring further surgery.

References

•  Dandy,D.J. 1989 Essential Orthopaedics and Trauma. Churchill Livingstone, Edinburgh

•  Stein,M. & Taylor,G. 2004. The Encylopedia of Arthritis. Facts on File, New York

Questions……?