Osteoarthritis

1. Osteoarthritis Marcin Sibiński Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Poland Prof. Marek Synder, M.D.

2. Osteoarthritis (OA) • 21 million people affectedin USA • 80-90% of individuals older than 65 years have evidence of primary osteoarthritis • OA of the knee and hips is the most common cause of arthritis-related disability • Commonly in the hands • Most common type of joint disease

3. Osteoarthritis (OA) • Middle-aged and older people • Age increases your risk for OA • Men under age 55 are more likely to have OA than women • After age 55, women are more commonly affected

4. Risk factors • Age • Obesity - for every kg. you gain, you add 3 kg. of pressure on your knees and 6 kg. the pressure on your hips • Injury or overuse (athletes) • Genetics • Muscle weakness • Other diseases (rheumatoid arthritis)

5. Pathophysiology • Hyaline cartilage (chondrocytes + extracellular matrix) • Protects the underlying subchondral bone • Distribution of large loads • Primarily begin in the articular cartilage • External forces accelerate the catabolic effects of the chondrocytes and disrupt the cartilaginous matrix

6. Pathological Features • Osteoarthritis represents a gradual processes of destruction & regeneration; • Early articular cartilage loses its glistening appearance; • Cartilage becomes thin and sometimes denuded;

7. Pathological Features • subchondral bone: • becomes thickened, sclerotic, & polished; • subchondral bone displays thickened trabeculae and microfractures; • cysts: • may be seen in subchondral bone; • cysts may arises from increases in intrasynovial pressure; • osteophytes: • spurlike bony outgrowths covered by hyaline cartilage, may develop at margins of joint & progressively enlarge; • small bits of cartilage-covered bone (mice) may actually break off into the joint;

8. Hip anatomy

9. Etiology - hip • Primary • associated with aging and is thought of as “wear and tear” • Secondary (predisposing condition) • Trauma (fractures) • Slipped capital femoral epiphysis • Developmental dislocation of the hip • Perthes disease Inflamatory arthritis (RA) • Osteonecrosis • Intra-articular steriods • Hyperparathyroidysa • Skeletal dysplasia • Hemochromatosis

10. Clinical Features - Hip • Pain on weitht-bearing felt in the groin, buttock, or medial thigh; • Pain during sleep; • Limping, ↓ROM • Trendelenburg gait will decrease mechanical stress on joint and thereby lessen pain; • In some cases, a patient with OA of the hip will experience acute hip pain which often correlates w/ rupture of subcondral cyst into the joint;

11. XR • Joint space narrowing • Osteophytes • Subchondral cyst formation • Subchondral sclerosis

13. Treatment • Non-operative treatment • Operative treatment: • Arthrodesis • Total hip replacement • valgus extension osteotomy

14. Total hip replacement uncemented

15. Total hip replacement cemented

16. SURFACE   HIP REPLACEMENT

18. Revision total hip replacement

19. Knee AO, symptoms

20. Goals of OA treatment • Controlling pain and other symptoms • Improving your ability to function in daily activities • Slow the disease’s progress

21. Non operative treatment • Keep fit • Non-steroidal anit-inflammatory drugs • Physical and occupational therapy

22. Non operative treatment • Injectable steroids • Viscosupplementation (hylauronic acid ) • Reduction of cartilage impact loading; • Cane, crutches • rubber heel wedges; • weight loss; • valgus unloading knee brace;

23. Operative treatment • Arthroscopy; • High tibial osteotomy; • Unicompartmental knee arthroplasty; • Total knee arthroplasty • Arthrodesis.

24. High tibial osteotomy

26. Unicompartmental knee arthroplasty

27. OA of all compartments

28. Total knee replacement

29. Ankle

30. Elbow replacement

31. Shoulder

33. Spondyloarthritis

34. Degenerative disk lesion