OSTEOARTHRITIS Dr Sami Abdallah

Anatomy of synovial joints:

MECHANISMS FOR MAINTAININGJOINT STABILITY Alignment of joint components Shape and fit of articular surfaces Adhesive property of synovial fluid Integrity of capsule and ligaments Muscle tone and power Neurological control of balance

THREATS TO CARTILAGE INTEGRITY Loss of joint stability Localized increase in loading stress Increased stiffness of the cartilage Inflammatory (enzymatic) degradation Restriction of free joint movement Sclerosis in the subchondral bone

Osteoarthritis (OA) is a slowly progressive chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage The commonest of all joints diseases

Asymmetrical affection No systemic manifestations Degenerative disease with some inflammatory process

New growth of cartilage and bone at the joint margins(osteophytes) Cyst formation and sclerosis in the subchondral bone Mild synovitis and capsular fibrosis

Prevalence Universal disorder Males = females All people > 65 years 40 % of people reaching 40 years Racial distribution Hips, knees and spine are commonly affected

Prevalence Risk factors Joint dysplasia Obesity Bone density Trauma Family history Occupation

Pathology The cardinal features are:  Progressive cartilage destruction  Subarticular cyst formation  Sclerosis of the surrounding bone  Osteophyte formation  Capsular fibrosis

Clinical features Symptoms Pain Swelling Deformity Stifness Loss of function

Signs Swelling Muscle wasting Tenderness Instability Crepitus

Clinical types: Monoarticular The classic form of OA

Clinical types: Monoarticular Pauciarticular

Clinical types: Monoarticular Pauciarticular Generalized The commenest type of OA Affects middle aged women Small joints

Complications Capsular herniation Loose bodies Rotator cuff dysfunction Spinal canal stenosis

Imaging X rays

Radioisotope scanning

CT and MRI

Arthroscopy

EARLY TREATMENT PRINCIPLES To maintain movement and muscle strength To protect the joint from overload To modify the daily activities

Physeotherapy

Load reduction

Physeotherapy Load reduction Analgesia

INTERMEDIATE TREATMENT Joint debridement Corrective osteotomy

LATE TREATMENT Re-alignment osteotomy Joint replacement Arthrodesis

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