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1. Osteoarthritis Dr.hasan abdulhadi mohammed M.D.ortho.surgery Medical college/Alanbar university

2. Definition : Degenerative joint disease with progressive softening and Disintegration of articular cartilage. .

3. Epidemiology: More common in female More common in elderly Bilateral more than unilateral Weigth bearig joint like knee,hip

4. Risk factors Age Obesity ,metabolic syndrome( dyslipedymia,hypertension,diabetic) Occupation Increase mechanical load Hereditary factor Female Developmental and congenital deformity

5. Classification: Primary or secondary Progressive or non-progressive Primary/more common than secondary,unknown cause,in elderly,due to tear and wear mechanism Secondary/ there is underlying etiology: Infection Trauma Inflammatory Tumor .

6. Pathoanatomy: All the following structure are affected by osteoarthritis: the first one is articular cartilage Bone Synovial memmbrane Muscle Ligament Capsule

7. Pathoanatomy Cartilage affected by :erosion,fibrillation,splitting Bone affected by :cystic change,hardening,flattening and at the end deformity Synovial membrane :hypertrophy,edematous,decrease secretion of synovial fluid.. Capsule :inflammed and contracted,its the most causes of pain Ligament :fibrous degeneration,contraction Muscle :atrophied,wasted,loss function

8. Cell biology Increase in matrix metaloprotease enzym e( M.M.P) Decrease in tissue inhibitors m.m.p (T.I.M.M.P.) Increase in the inflammatory marker which include the following” T.N.F alpha Interleukin -1 Interlukin-6

9. Pathogenesis: Increase water Decrease prteoglycan Decrease cartilage stiffnes Damage chondrocyte cells Release M.M.P enzyme Further cartilage damage Loss shock absorption function Increase stress on subchondral bone

10. Clinical feature: Pain ,started at weight bearing then at rest and in late stage occur at night Stiffness Limitation range of motion Swelling Instability Deformity of joint and surrounding structure.

11. Stage of osteoarthritis: Usually depended on pain and radiological change: mild Moderate Severe

12. Managment: History Examination Investigation Treatment ...

13. History: Chief complain of patient Age Occupation Medical hx Family hx Trauma Previous infection Inflammatory disease

14. Examination: The orthopedic examination include the following, Look for,deformity,previous scar,aligment,gait,swelling Feel ;for tenderness,effusion,temperature, Move ,for stiffness and assesment range of motion Special test which depended on the affected joint like p.c.l and collateral ligament of knee joint Dont forget neurovascular examination..

15. Investigation: Laboratory test ,like E.S.r,wbcs,c.r.p,crystal analysis,Anti c.c.p,A.N.A to exclude secondary causes,usually normal in primary O.A Imaging mainly x- ray,ct-scanogram for malaligment and preoperative assesment . Diagnostic arthroscope in early stage

16. Radiological stage of osteoarthritis: Stage1 ,bony spur only Stage2 ,narrowing joint space less than half Stage3 ,narrowing joint space more than half with osteophyte formation Stage4 ,complete obliteration of joint space ,osteophyte formation and subchondral bone sclerosis Stage 5 ,joint subluxation and deformity

17. Treatment: Divided in to nonoperative and operative treatment depended on, Primary or secondary proplem Age of patients Stage of disease Medical conditions

18. Nonoperative treatment: Education ,avoid mechanical load,weight loss,change work,using waling aid like cratch and splint and change life sytle Phsiotherapy ,maily quadriceps muscle exersice,aerobic exercise,core and abdominal muscle exercise to decrease stiffness and inflammation and increase range of motion.. Medical treatment (N.S.A.I.D,tramadol,corticosteroid injection) Acunpucture,visicoelastic injection, glucosamine , chondrtin sulphate ara( contraversial )

19. Operative treatment: Diagnostic and therapuetic arthroscope . Osteotomy mainly in young patient Arthrodesis Joint arthroplasty ( know most commonly used)

20. Differential diagnosis: Avascular necrosis Inflammatory arthropathy Diffuse idiopathic skeletal hyperosreosis.

21. Complications: Usually depended on the affected join t, Capsule herniation Rotattor cuff dysfunction(shoulder) Spinal canal stenosis(spine) Locking,crepitus (hip,knee) Instability and deformity

22. Thank you