08/11/2016

Degeneratif sendi
= pengapuran, osteoarthrosis, osteoarthritis

Osteoarthritis Genu
(gonarthrosis)

Taufin Warindra, dr, SpOT

SMF ORTHOPAEDI & TRAUMATOLOGI
RS PHC / FK UKWM SURABAYA

OA (osteoarthritis/osteoarthrosis) Anatomi sendi lutut

Insidens : wanita > pria
Umur : > 40 tahun
Obesitas
Paska trauma / OA sekunder
Obat-obatan
Usia > 60 tahun 80% OA secara
radiologis
20% dengan keluhan

OA (osteoarthritis) Klinis
Nyeri
Kaku / berkurangnya ruang gerak
sendi
Bengkak / deformitas
Instabilitas
Sendi mengunci locking

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OA (osteoarthritis/pengapuran ) Trauma / cedera

Patah tulang
Primer Dalam sendi
Luar sendi
Sekunder
trauma
infeksi
congenital, etc

Infeksi & peradangan

Cedera jaringan lunak

Robekan : Infeksi kuman

ACL, Coccus
PCL,
tuberculous
Meniscus
salmonella
LCL,
MCL, Peradangan
Muscle
gout arthritis / asam urat
rheumatoid arthritis / rematik

Kongenital & Gangguan

Tumor perkembangan
Anak (osteochondroma,osteosarcoma) Hemophilic arthropaty
Dewasa (GCT, chondrosarcoma) Genu varus/valgus (kaki X atauO)

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Pemeriksaan Radiology

Klinis
X-rays
Laboratorium
Grading
(CT Scan/ MRI) jarang di perlukan
Clinical :-
Pembedahan (arthroscopy diagnostic , open biopsi)
Radiology :+
Arthroscopy :+

Radiologi Derajat Osteoarthritis

Classification Kellgren and Lawrence (1957)

Grade 0 : normal Derajat 1 Ubah gaya hidup

Grade I : minimal osteophyte
normal joint space Derajat 2 Medikasi
Grade II : definite osteophyte
possible joint space narrowing
Fisioterapi
Grade III : definite osteophyte and joint space narrowing
Grade IV : definite osteophyte and joint space narrowing Derajat 3 Bedah
with sclerosis and abnormal joint contour.
Derajat 4

Penanganan OA
1. Life style modification
high impact low impact
3. Fisioterapi
Aerobic, running, jumping, contact sport
renang, sepeda, stretching, jalan Exercise, heat
Turunkan berat badan External support/brace
2. Medikasi 4. Bedah
NSAID (anti nyeri: parasetamol, asam Arthroscopy (debridement, microfracture, aci,
mefenamat, opioid) stem cell)
DMOAD (glukosamin , chondroitin, diacerein, Osteotomi (realigntment/HTO)
dll) Joint fusion ( ditinggalkan )
Injeksi sendi (steroid, hyaluronic acid,PRP) Joint replacement (TKR, UKR)

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Quadriceps Exercise Injeksi Sendi

Steroid
Asam Hyaluronan
Platelet Rich Plasma

Arthroscopy pada OA Osteotomi

Luka operasi minimal
Perdarahan minimal
Nyeri minimal
Masa pemulihan operasi cepat

Debridement & lavage

Lateral release
Microfracture
ACI/MACI
Stem Cell

Joint Replacement UKR / Unicompartment Knee

Replacement

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TKR / Total Knee Replacement TKR

New Technique
MIS/ Minimal Invasive Surgery
Navigation/ CAS (computer aided surgery)

PHC Sby,
2007

Okt 2012

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Hari ke 2

Hari ke 5 Bulan ke 2

Knee replacement

problematika sendi lutut, surabaya 30 januari 2010

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Hip replacement

problematika sendi lutut, surabaya 30 januari 2010

Life is motion
motion is life