OSTEOARTHRITIS

OSTEOARTHROSIS DEGENERATIVE JOINT DISEASE

Prof. Dr. lk Akarrmak

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

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

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

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

CLASSIFICATION OF OA
Primary OA Secondary OA

Etiology is unknown

Etiology is known

AGE
Primary OA > 40 years
Direct correlation Aging process

RISK FACTORS FOR PRIMARY OA

Age Sex Obesity Genetics Trauma (daily)

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

ETIOLOGY OF OA
Cartilage properties Biomechanical problem

Morphology of Primary OA

Primary Generalized OA

STRUCTURE OF JOINT CARTILAGE

Collagen (Type 2) Proteoglycan - Hyaluronic acid
- Glycoseaminoglycan

Water Condrocyte Regeneration and Degeneration

PATHOLOGY OF OA
Fibrillation
Eburnation Osteophytes Subcondral cysts

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

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

RADIOLOGIC GRADE OF OA
G1 G2 G3 G4 Normal Mild Moderate Severe

Kellgren Lawrence Classification

DIAGNOSIS OF OA
CLINICAL FINDINGS Joint pain + RADIOLOGIC FINDINGS Osteophytes

CLINIC OF OA SIGNS AND SYMPTOMS

Joint pain - degenerative Stiffness following inactivity 30 min Limitation of ROM later stages Deformity restricition of ADL

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

GENU VALGUM - ORTHOSIS

RADIOLOGIC FINDINGS? GRADE 1 - 4?

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

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

BIOMECHANICS

X-RAY OF HIP OA

Peripheral Joints
Hands Feet

ETIOPATHOGENESIS OF OA
Age,gender
Local Genetic biochemical OA effects

Other factors

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

PATHOGENESIS OF OA
Cytokines
Cell destruction Membrane phospholipids Arachidonic acid Cox-1, Cox-2

IL-1, IL-6, TNF-

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

TREATMENT OF OA

Symptomatic treatment Structure modifying treatment

Surgical treatment

STRUCTURE MODIFYING TREATMENT

Hyaluronic acid injection (HA)

Glycose amino glycans (GAG)

PRIMARY PREVENTION OF OA ??
Regular exercises

Weight control
Prevention of trauma

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

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

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

Topical agents

HAND OA - RESTING SPLINT

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

INDICATIONS OF SURGICAL INTERVENTION

Severe joint pain, resistant to conservative treatment methods Limitation of daily living activities Deformity, angular deviations, instability

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

QUESTIONS?