Osteoarthritis is a Chronic joint disorder in

which there is progressive softening and

disintegration of articular cartilage
accompanied by new growth of
cartilage and bone at the joint margins
(osteophytes) and capsular fibrosis
After the age of 60 years
25% of women, and
15% of men have symptoms
After the age of 75 years
80% affected
Primary or idiopathic is more common in
adult women
Secondary type is more common in
adult men.
Primary idiopathic Degenerative Joint
Diseases
Secondary Degenerative Joint Diseases
Normal aging process in cartilage
Obesity, not an initiating factor, but
aggravates any existing degeneration ni
weight-bearing joints
Congenital abnormalities of joints
Infections of joints
Nonspesific inflammatory disorders
Metabolic Arthritis
Repeated hemarthrosis
Injury
Acquired incongruigity of joint surfaces
Extra-articular deformities with malalignment of
joints
Joint instability
Iatrogenic damage to cartilage
Joint dysplasia
Trauma
Obesity
Family History
Bone Density
Occupation
Pain
Stiffness
Swelling
Deformity
Loss of function
Plain Radiographs






Arthrocentesis : diagnostic joint aspiration for
synovial fluid to exclude inflammatory
arthritis, infection or crystal arthropathy
Radionuclide Scanning
CT and MRI







Kellgren & Lawrence Classification of Osteoarthritis
Grade Criteria
0 Normal / no radiographic features of OA are present
1 doubtful joint space narrowing (JSN) and possible osteophytic
lipping
2 the presence of definite osteophytes and possible JSN on
anteroposterior weight-bearing radiograph.
3 multiple osteophytes, definite JSN, sclerosis, possible bony
deformity
4 large osteophytes, marked JSN, severe sclerosis and definitely
bony deformity
Aims of treatment
Alleviation of pain and improvement of
functional status
Non-pharmacologic Therapy
Weight Loss
Exercise
Physiotherapy
Pharmacologic treatment (AAOS guidelines)
Symptomatic arthritis of the knee
Oral NSAIDs
Topical NSAIDs (diclofenac)
Tramadol
The AAOS was unable to recommend for or against the use of
the following for symptomatic knee osteoarthritis:
Acetaminophen
Opioids
Pain patches
Intra-articular corticosteroid injections
Growth factor injections and/or platelet rich plasma

For elevated risk of GI toxicity include PPI
Intra-articular injections injections of a
corticosteroid or sodium hyaluronate
Glucosamine and chondroitin suphate

A procedure of low invasiveness and morbidity
Arthroscopy is indicated for removal of meniscal
tears and loose bodies; less predictable
arthroscopic procedures include debridement of
loose articular cartilage with a microfracture
technique and cartilaginous implants in areas of
eburnated subchondral bone

Osteotomy is used in active patients younger than 60 years
The principle underlying this procedure is to shift weight
from the damaged cartilage on the medial aspect of the
knee to the healthy lateral aspect of the knee.
Osteotomy is most beneficial for significant genu varum, or
bowleg deformity.
Contraindications for osteotomy are as follows:
Knee flexion of less than 90
A flexion-extension contracture of more than 15
Varus over 15-20
Instability from previous trauma or surgery
Severe arterial insufficiency


Arthroplasty consists of the surgical removal
of joint surface and the insertion of a metal
and plastic prosthesis
The prosthesis is held in place by cement or
by bone ingrowth into a porous coating on
the prosthesis.

Capsular herniation
Loose bodies
Rotator cuff dysfunction
Spinal stenosis
Spondylolisthesis