Osteoarthritis

A case report
ADIB LUQMAN C 111 12 814
NURATHIFAH C 111 12 806
AINUL BARAAH C 111 12 811
Supervisor : Prof dr. Chairuddin Rasjad,MD , Ph.D

Subdivision of Orthopaedics Surgery

Department of Surgery
Medical Faculty Hasanuddin University
Patient Identity

Name : Mrs A
Age : 41 years old
Sex : Female
Admission : 19 October 2017
Occupation : Coto Seller
History Taking

Chief complaint: Pain

Alloanamnesis:
Since a month ago before she came to
the clinic. Dull pain localized at the left
knee , the pain is intermittent , aggravated
by walking and standing , reduced at rest
, not radiating , does not vary.
Shes been complaining of inability to
walk properly since the pain started and
cannot bend her leg without pain.
History Taking
There is no history of any trauma or
mechanical injury.
There is no previous history of other illness.
History Taking

There
is no family history of the same
complaint.
Sheis a Coto Seller, and always work
hard for her family, she always climb
up the stairs in her house, does not
smoke or consume alcohol.
Physical Examination
General examination
Vital Signs
BP: 120/70 mm/hg
Respiratory rate: 18 x/ min
Pulse rate: 80 x/ mins
Temperature: 36,7
VAS: 4/10
BMI: 26 (Pre-obese)
Physical Examination
Local Status:
Look: Hematoma (-), Swelling (+), Wound (-)
Deformity (-)
Feel: tenderness (-) on the left knee.
Crepitation (+)
Power: Grade 3
Move: flexion of the knee joint is restricted
with pain, extension is normal.
NVD: Normal sensibility, CRT normal,
Posterior Tibial Artery and Dorsalis Pedis
Artery palpable.
Diagnostic
Plain X-ray AP/lateral
Femur

Narrowing/reduced of joint space

Tibia
 Diagnostic

Plain X-ray lateral

Intact alignment
Absent of fracture or bones destruction
Reduced/narrowing of femuropatella joint
space
Soft tissue is normal

Dx :- Osteoarthritis Genu Grade 1 (Kellgren-

Lawrence Classification)
Management

Conservative treatment
Patient
Education
Weight loss.

Pharmacology
Celebrex 100mg 2x daily (Analgesic)
Etighobal 500mg1x daily
Discussion Osteoarthritis
Definition

Joint disease
It is a chronic degenerative disorder
arising from biochemical breakdown
of articular cartilage of synovial joint
that may affect the entire joint organ.
Mainlyaffect the weight- bearing joint
such as hip, knee, cervical and
lumbosacral spine.
Anatomy
 Etiology Predisposing Factor
Trauma Age
Genetics Sex
Metabolic diseases Race
Genetics
Occupation
Weather
Diet
Pathophysiology
Pathophysiology
Pathology

Progressive cartilage destruction

Subarticular Cyst Formation
Sclerosis of the surrounding bone
Osteophyte formation
Capsular fibrosis
Clinical variants

Monoarticular and pauciarticular

Osteoarthritis
Polyarticular(Generalized)
Osteoarthritis
Osteoarthritis in unusual sites
Rapidly Destructive Osteoarthritis
Clinical Presentation

Pain aggravated by walking

Stiffness
Tenderness & swelling
ROM restriction ( loss of function)
Deformity
Presence of nodules
Clinical Approach to Knee Pain

Valgus Test (MCL) Varus Test (LCL) Lachman Test (ACL)

McMurray Maneuver Duck Waddle

(menisci) (stability)
Workup

Laboratorium
CBC , ESR , Blood cholesterol ,
Rheumatic factor
Imaging
X-ray AP/Lateral , MRI , CT scan , USG ,
Bone scanning
Treatments
The goals of osteoarthritis treatment
include alleviation of pain and
improvement of functional status.
Patient education
Heat & cold
Exercise
Physical therapy
Unloading in certain joints
Analgesic Medications
Treatments

Invasive Approach can be performed

for intermediate treatment
Joint
debridement through
Arthroscopy
Realignment Osteotomy
Joint Replacement