FACULTY OF MEDICINE AND HEALTH SCIENCE

UNIVERSITAS MUHAMMADIYAH YOGYAKARTA

CONTINUING MEDICAL EDUCATION

THE EPIDEMIOLOGY,ETIOLOGY,DIAGNOSIS,TREATMENT

OF OSTEOARTHRITIS OF THE KNEE

Joern W.-P. Michael, Klaus U. Schluter-Brust, Peer Eysel

Arif Tantri Hartoyo

20090310216

OSTEOARTHRITIS

•

Is

a

chronic

disorder of

synovial joints in which

there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes) cyst formation and sclerosis in the subchondral bone, mild synovitis and capsular

fibrosis.

OSTEOARTHRITIS

ANATOMY OF KNEE

EPIDEMIOLOGY

EPIDEMIOLOGY

Studies have shown that knee osteoarthritis in men aged 60

to 64 is more commonly found in the right knee (23%) than

in the left knee (16.3%), while its distribution seems to be more evenly balanced in women (right knee, 24.2%; left knee, 24.7%) (3, 4). The prevalence of osteoarthritis of the

knee is higher among 70-to 74-year-olds.

RISK FACTOR

Endogenous

Age (>40 yo)

Sex Heredity Ethnic origin (more common in persons of European descent) Post-menopausal changes

Exogenous

Macrotrauma

Repetitive microtrauma Overweight (BMI > 30)

Resective joint surgery Lifestyle factors (alcohol, tobacco)

ETIOLOGY

Knee osteoarthritis is classified as either primary (idiopathic)or secondary.

PHATOGENESIS

STAGING KELLERGEN AND LAWRENCE

Stage 0

no abnormality

Stage 1

incipient osteoarthritis, beginning of osteophyte formation on eminences

Stage 2

moderate joint space narrowing, moderate subchondral sclerosis

Stage 3

50% joint space narrowing, rounded femoral condyle,extensive subchondral sclerosis, extensive osteophyte formation

Stage 4

joint destruction, obliterated joint space, subchondral cysts in the tibial head and

femoral condyle, subluxed position

DIAGNOSTIC EVALUATION

Patients suffering

HISTORY

from osteoarthritis often

complain of Pain on movement, typically occurring when movement is initiated or when the patient begins to walk.

PHYSICAL EXAMINATION

Testing of the lateral ligaments with varus or valgus

stress, and testing of the anterior and posterior cruciate

ligaments with the drawer test.

DIAGNOSTIC EVALUATION

X-RAY

•

The Goal of Treatment:

stated in the guideline

• 1. Pain relief

• 2. Improved quality of life

• 3. Improved mobility

• 4. Improved walking

TREATMENT

• 5. Delayed progression of osteoarthritis

TREATMENT

“The best treatment for knee osteoarthritis is prevention”

Acetaminopen

-Treatment effect was modest -In OA subject with moderate-to severe level of pain -1000mg tree to four times daily

NSAID

-Tend to avoid for lon-term use -low dose ibuprofen may have less serious GI toxic -Indometachin should be avoid for long-term use

in patient with hip OA

INJECTION

-CORTICOSTEROID:

Safety: High for short-term use.

TREATMENT

Efficacy: low to medium. Modest benefit. 16 point reduction in pain on 100-point scale for one month.

-Hyaluronic Acid Safety : High Efficacy: low. Recet meta analyses and reviews small clinical efect. 75% were satisfied with treatment. Last 3-4 month.

-Arthroscopic

SURGERY

The main advantages of arthroscopic procedures are minimal operative trauma and a very low infection rate.

-Total Knee replacment

Often greater improvement in pain rather than

function. Recovery can be strenous and lengthly.

OVERVIEW

There are many treatments for knee osteoarthritis. Prevention is important: If the influences that can potentially damage the knee are eliminated early enough, then the development of

osteoarthritis can be prevented, or at least the progression of

any changes that are already present can be slowed. Patient

education and counseling are the first step in any treatment plan and should include information about the course of the

disease and the range of treatment options

THANK YOU