Osteoarthritis Dr. Faik Altıntaş Yeditepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji AD

Osteoarthritis Osteoarthritis (OA) is a degenerative joint disease, occurring primarily in older persons, characterized by Erosion of the articular cartilage, Hypertrophy of bone at the margins (osteophytes), Subchondral sclerosis, Range of biochemical and morphologic alterations of the synovial membrane and joint capsule Pathologic changes in the late stages of OA include softening, ulceration, and focal disintegration of the articular cartilage; synovial inflammation also can occur

Osteoporosis

Osteoarthritis Catabolism of cartilage results in release of breakdown products into synovial fluid which then initiates an inflammatory response by synoviocytes These antigenic breakdown products include: chondrointon sulfate, keratan sulfate, PG fragments, type II collagen peptides and chondrocyte membranes Activated synovial macrophages then recruit PMNs establishing a synovitis They also release cytokines, proteinases and oxygen free radicals (superoxide and nitric oxide) into adjacent and synovial fluid

Osteoarthritis Proinflammatory cytokines are believed to play a pivotal role in the initiation and development of the disease process Antiinflammatory cytokines are found in increased levels in OA synovial fluid TNF-α and IL-1 appear to be the major cytokines involved in OA Other cytokines involved in OA are: IL-6, IL-8, leukemic inhibitory factor (LIF), IL-11, IL-17

Osteoarthritis Symptoms Acute Pain Loss of ability Stiffness Crackling noise (called "crepitus") The joints may also be filled with fluid (Effusion)

Osteoarthritis OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. OA is the most common cause of water on the knee, an accumulation of excess fluid in or around the knee joint

Osteoarthritis Classification Primary OA Secondary OA Idiopathic When the cause is not known (as in the large majority of cases) Secondary OA When the cause is another disease or condition Infection, Deformity Injury Abnormal use of a joint Metabolic disorder (hemochromatosis, Wilson's disease Disorder that damages joint cartilage (rheumatoid arthritis, gout)

Osteoarthritis Risk Factors and Possible Causes: Age Female Obesity Muscle weakness Genetics

Osteoarthritis Diagnosis Normally done through x-rays Loss of cartilage, subchondral sclerosis, subchondral cysts from synovial fluid entering small microfractures under pressure, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes)

Osteoarthritis Treatment The process of clinically detectable osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint Gene therapy has future for cure Conservative Medical Surgical

Osteoarthritis Conservative Treatment Weight control Appropriate rest and exercise TENS Mechanical support devices Knee braces Cane Walker Applying local heat before, and cold packs after exercise, can help relieve pain and inflammation, as can relaxation techniques Schock absorbing heels and pads

Osteoarthritis Medical Treatment Analgetics Acetominophen Metamizol sodium Nonsteroidal anti-inflammatory drugs (NSAIDs) (traditional and COX 2 selective) Both relieve pain and reduce inflammation. Topical pain relievers (creams, gels, and sprays) Temporarily relieve arthritis pain and reduce inflammation in joints close to the surface of the skin Antidepressants Glucosamine , chondroitin sulfate, MSM Diacetylrhein Intraarticular corticosteroid injections Viscosupplementation Hyaluronate

Osteoarthritis Surgical Treatment Arthroskopic Debridement For meniscal tears Loose bodies Catilage repair or debridement Diluation of enflamatory substances and enzymes

Osteoarthritis Surgical Treatment Correction osteotomy for malalignment

Osteoarthritis High Tibial Osteotomy

Osteoarthritis Surgical Traetment Arthroplasty

Osteoarthritis Total knee arthroplasty

Osteoarthritis Arthroplasty

Osteoarthritis

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