1. OSTEOARTHRITIS OSTEOARTHROSIS DEGENERATIVE JOINT DISEASE
Prof. Dr. Ülkü Akarırmak

2. DEFINITION
Osteoarthritis OA is a degenerative disease of diarthrodial (synovial) joints, characterized by
Breakdown of articular cartilage
and proliferative changes of surrounding bones

3. EPIDEMIOLOGY Osteoarthritis(OA) is the most common joint disease
OA of the knee joint is found in 70% of the population over 60 years of age
Radiological evidence of OA can be found in over 90 % of the population

4. LIMITED FUNCTION OA may cause functional loss
Activites of daily living
Most important cause of disability in old age
Major indication for joint replacement surgery

5. CHARACTERISTICS OF OA
OA is a chronic disease of the musculoskeletal system, without systemic involvement
OA is mainly a noninflammatory disease of synovial joints
No joint ankylosis is observed in the course of the disease

6. CLASSIFICATION OF OA Primary OA Secondary OA
Etiology is unknown Etiology is known

7. AGE
Primary OA > 40 years
Direct correlation
Aging process

8. RISK FACTORS FOR PRIMARY OA
Age
Sex
Obesity
Genetics
Trauma (daily)

9. SECONDARY OSTOARTHRITIS
Trauma
Previous joint disorders;
Congenital hip dislocation
Infection: Septic arthritis, Brucella, Tb
Inflammatory: RA, AS
Metabolic: Gout
Hematologic: Hemophilia
Endocrine: DM

10. ETIOLOGY OF OA
Cartilage properties
Biomechanical problem

12. Morphology of Primary OA

13. Primary Generalized OA

15. STRUCTURE OF JOINT CARTILAGE
Collagen (Type 2)
Proteoglycan
- Hyaluronic acid
- Glycoseaminoglycan
Water
Condrocyte
Regeneration and Degeneration

17. PATHOLOGY OF OA
Fibrillation
Eburnation
Osteophytes
Subcondral cysts

18. LABORATORY FINDINGS OF OA
There are no pathognomonic laboratory findings for OA
Laboratory analysis is performed for differential diagnosis

19. RADIOLOGIC FINDINGS OF OA
Narrowing of joint space
(due to loss of cartilage)
Osteophytes
Subchondral (paraarticular) sclerosis
Bone cysts

21. RADIOLOGIC GRADE OF OA G1 Normal G2 Mild G3 Moderate G4 Severe
Kellgren Lawrence Classification

22. DIAGNOSIS OF OA CLINICAL FINDINGS Joint pain + RADIOLOGIC FINDINGS
Osteophytes

23. CLINIC OF OA SIGNS AND SYMPTOMS
Joint pain - degenerative
Stiffness following inactivity – 30 min
Limitation of ROM – later stages
Deformity – restricition of ADL

24. OA OF KNEE JOINT (GONARTHROSIS)
More common in obese females
over 50 years of age
Joint stiffness (<30 minutes)
Mechanical pain
Physical examination findings: Crepitus
Pain on pressure
Painful ROM and functional limitation
Limitation of ROM in later stages of OA (first extension)
Laboratory analysis within normal limits

25. GENU VALGUM - ORTHOSIS

26. RADIOLOGIC FINDINGS? GRADE 1 - 4?

30. OA OF HIP JOINT More common in males over 40 years of age
Joint stiffness
Pain of hip, gluteal and groin areas radiating to the knee (N obturatorius)
Mechanical pain
Limited walking function

31. COXARTHROSIS Physical examination: Antalgic limping
Limitation of ROM (first internal rotation)
Painful ROM
Trendelenburg test positivity
Leg length discrepancy
Laboratory analysis within normal limits

32. BIOMECHANICS

35. X-RAY OF HIP OA

36. Peripheral Joints
Hands
Feet

37. ETIOPATHOGENESIS OF OA
Age,gender
Local
Genetic OA biochemical effects
Other factors

38. ETIOPATHOGENESIS OF OA
Dysfunction of joint cartilage
Condrocyte function: 1- Degredative enzymes
(metalloproteases)
2- Inhibitors
Degeneration and regeneration functions are balanced
IL-1  , degredative enzymes + synovial inflammation results: Breakdown of cartilage

39. PATHOGENESIS OF OA Cytokines IL-1, IL-6, TNF- Cell destruction
Membrane phospholipids
Arachidonic acid
Cox-1, Cox-2

40. IL-1 and metalloproteases have been found to play an important role in cartilage destruction.
Local growth factors, especially transforming growth factor (TGF) are involved in the formation of osteophytes

41. TREATMENT OF OA
Symptomatic treatment
Structure modifying treatment
Surgical treatment

42. STRUCTURE MODIFYING TREATMENT
Hyaluronic acid injection (HA)
Glycose amino glycans (GAG)

43. PRIMARY PREVENTION OF OA ??
Regular exercises
Weight control
Prevention of trauma

44. AIMS OF OA TREATMENT Pain relief
Preservation and restoration of joint function
Education

45. Non-Pharmacologic Treatment of OA
Patient education
Weight loss (if overweight)
Aerobic exercise programs
Physical therapy
Range-of-motion exercises Muscle-strengthening exercises
Assistive devices for ambulation Patellar taping Appropriate footwear Lateral-wedged insoles (for genu varum)
Bracing
Occupational therapy
Joint protection and energy conservation

46. PHARMACOLOGIC TREATMENT OF OA
Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
Topical agents

48. HAND OA - RESTING SPLINT

49. SYMPTOMATIC TREATMENT OF OA
Decrease of joint loading
- Weight control
- Splinting
- Walking sticks
Exercises
- Swimming
- Walking
- Strengthening
Patient education

51. INDICATIONS OF SURGICAL INTERVENTION
Severe joint pain,
resistant to conservative treatment methods
Limitation of daily living activities
Deformity, angular deviations, instability

52. INVASIVE METHODS Joint lavage Arthroscopy
Cartilage grefting- genetic engineering
Surgery
Osteotomy
Joint replacement

53. QUESTIONS?