OSTEOARTHRITIS

DEGENERATIVE JOINT DISEASE

dr. Andrianto W. Nugroho SpOT
 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

RISK FACTORS FOR PRIMARY OA

• Age
• Sex
• Obesity
• Genetics
 AGE

• Primary OA > 40 years

• Direct correlation
• Aging process
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
 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
Kellgren Lawrence Classification

• G1 Light
• G2 Mild
• G3 Moderate
• G4 Severe
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
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
 OPERATIVE METHODS

• Arthroscopy
• Cartilage grafting- genetic engineering
• Surgery
Osteotomy
Joint replacement
QUESTIONS?