OSTEOARTHRITIS

OSTEOARTHROSIS

DEGENERATIVE JOINT DISEASE

Prof. Dr. Ülkü Akarırmak

 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 Normal
G2 Mild
G3 Moderate
G4 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 OA
biochemical 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 IL-1, IL-6, TNF-

Cell destruction

Membrane phospholipids

Arachidonic acid

Cox-1, Cox-2
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?