Osteoarthritis


Definition

  • Osteoarthritis is degenerative joint disease. It can affect all joints, but mostly affect knees and hips.

Etiology

  1. Multi factorial.
  2. Wear and tear of joint.

Types

  • Primary 
  • Secondary 
  • Primary is usually age related (old age), in weight bearing joint like knee, is more common than secondary.
  • Secondary due to under lying cause such as post traumatic, alcoholism, chronic liver disease, patient on steroid, patient on dialysis, coxa vara, mal united fracture.

Pathology

  • Degenerative condition primarily affecting articular cartilage, increase in water content and depletion of proteoglycan from cartilage matrix.
  • Fibrillation
  • Rubbing 
  • Exposed bone
  • Margins hypertrophy called osteophyte
  • Deformity

Clinical features

  1. Elderly people.
  2. Joint of lower limb.
  3. Bilateral involvement.
  4. Pain is earliest symptom.
  5. Intermittent initially then constant.
  6. Become worse on activity.
  7. Presence of coarse crepitus.
  8. Swelling of joint.
  9. Stiffness of joint.
  10. On examination tenderness, crepitus irregular and enlarged joint deformity effusion subluxation limitation of joint movement wasting of associated muscle.

Investigations

  • RADIOLOGY Narrowing of joint space, subchondral sclerosis, osteophyte formation loose bodies, deformity of joint. 
  • Other serological test and ESR for RA arthroscopy.

Treatment

Principles 

Delay occurrence

Stall progress

Rehabilitation

  1. Drug analgesic.
  2. Chondro protective agent glucosamine and chondroitin sulphate.
  3. Viscosupplementation sodium hylarunonate.
  4. Supportive therapy with reduction avoidance of stress and strain, local heat exercise.
  5. Surgical Osteotomy near joint to relieve symptoms. Joint replacement. Joint debridement. Arthroscopic procedure.