Osteoarthritis (Nutshell)

For educational purpose of MBBS, BHMS and BAMS students.

Osteoarhritis is a chronic degenerative joint disorder that affects weight bearing joints (most commonly Knee, hip and lumbar spine) and fingers (DIP joints).
This ppt , in brief,highligts the signs and symptoms, early diagnosis and prompt treatment of osteoarthritis in order to give a better lifestyle to patients.

In case of doubts querries or feedbacks, do contact me at [email protected] or whatsapp [phone]

1. Osteoarthritis Dr Aakash Nandu M.S. Orthopaedics Smit Orthopaedic Hospital, Anand

2. What is OA ? Degenerative disease of Synovial joints characterized by focal loss of articular hyaline cartilage with proliferation of new bone and remodeling of bone contour.

3. Epidemiology Weight bearing joints ( knee and hip) Age > 60 yrs More common in women Familial Tendency

4. Etiology

5. Risk factors Ageing

6. Pathogenesis

7. Clinical features

8. Clinical features in Nodal Generalised OA Women 40-50 yrs of age Pain Stiffness Swelling on 1/1+ DIP joints Heberden’s nodes Involvement of 1 st MCP joint Predisposition to OA at other joints ( esp Knee)

9. Clinical features in knee OA Medial Tibio -femoral and patella femoral joint involvement Pain localized to anterio -medial aspect of knee and upper tibia Varus deformity Lurching / waddling gait

10. Joint-line tenderness Restricted Movement Wasting of Quads Bony swelling around the joint

11. Clinical features in OA hip Superior > Anterior aspect of hip Pain is deep in groin area Antalgic gait Wasting of Quads and Gluteal muscles Restriction of internal rotation.

12. Comparison – Differential diagnosis Osteoarthritis Rheumatoid Arthritis Gout Age of onset 50 20 35 (men) 45 (women) Morning stiffness Less than 30 min Longer than 1 hour Not seen Pain with movement Increases Decreases - Nodules Heberden’s Bouchard’s - Systemic symptoms Absent Fatigue, Malaise Chills, Malaise, Fever Lab Findings Normal to mildly + ve ESR, CRP RA and Anti-CCP + ve Uric acid raised Gouty crystals on microscopy

13. Investigations 1 Xrays Joint space narrowing Subchondral sclerosis Osteophytes Subchondral cysts

14. 2. Blood tests ESR – Normal CRP – Normal CBC – Normal RA factor – Normal Uric Acid - Normal

15. 3. Synovial fluid analysis Straw coloured fluid Viscous with low turbidity CPPD and Calcium phosphate Negative for uric acid crystals

16. Treatment

17. Non Pharmacological Lose weight Exercise Avoid sitting on floor / sitting cross-legged / squatting Avoid / reduce climbing stairs

18. 5. Avoid standing for >30min or walking >1km at a stretch 6. Regular Physiotherapy 7. Identify other mechanical issues eg. Flat foot and correct it

19. Surgery 1. HTO (high tibial osteotomy)

20. 2. Medial Hemireplacement (UKR)

21. 3. Total Knee Replacement (TKR)

22. Complications of OA Deformities Stiffness Stress fractures Neuropathies Degenerative spine diseases Indirect (lack of exercise leads to obesity, high blood pressure, diabetes, cholesterol, heart diseases)

23. Thank you !!