Case Presentation

Ostheoarthtritis of knee

Marinda Dwi Anggrainie

SUPERVISOR:
dr. Ariyanto Arief, M.Kes, Sp.OT
Patient’s Identity

Name : Mrs. Hj. H

Age : 68 years old
Sex : Female
Address : Pare-pare
Work :-
Date of admission : January 22, 2019
Medical record : 16 10 15
History Taking

•Chief Complain : pain on both knees

•History: Both knee pain and difficulty walking 2.

Current Disease History Patients came with their families to POLI RSUD Andi
Makassau with complaints that both knees were painful and difficult to walk. This
complaint is felt by the patient suddenly.
Pain felt by the patient such as pulsating and punctured needles. The pain
also does not disappear with compresses, massage oils, or pain-reducing drugs. Pain
gets worse when the patient folds his knees and moves 1 2 legs but slightly reduced
with rest. Initially, the patient claimed to get complaints of pain and it was difficult to
walk when the patient wanted to move from his bed to the bathroom. When he is
about to stand, the patient feels that his legs are very painful and difficult to move until
the patient falls to the floor.
 Actually, the patient had long felt pain on both of his knees, namely for 1 year of
(SMRS) , but slowly felt increasingly burdensome since there was swelling on both knees and
a peak because this patient's complaint caused him to be unable to walk again. The patient
admitted that he had just realized there was a swelling on his knees - about the last 6
months (SMRS)
CLINICAL FINDING
Radiologal Finding

X-ray
Genu AP/Lateral
Laboratory Finding

Pemeriksaan Hasil Nilai normal

WBC 6,08 5.00-10.0

RBC 4,09 3.80-6.50

HGB 12,7 11.5-17.0

HCT 37,4 37.0-54.0

PLT 265 150-500

 Resume
Mrs .Hj.A, 68 years old female admitted to Andi Makkasau
Hospital with that both knees were painful and difficult to
walk. Right and left knee (+).

Localized status:

genu dextra et sinistra

Look : Deformity (+), Swelling (+)
Feel : tenderness (+)
Move : can not be evaluated due to pain.
NVD : good sensibility, CRT <2 seconds
Diagnosis

Osteoarthitis genu grade III dextra et sinistra

Initial treatment

Medikamentosa
IVFD RL 20 tpm micro drips
Ceftriaxone 1gr/IV pre-op

Operatif
Synovectomy (arthroscopy)
Anatomy of the synovial joint
Definition

• Osteoarthritis is degenerative
joint disease, characterized by
loss of articular cartilage,
hypertrophy of bone at the
Osteoarthritis margins, subcondral sclerosis
and range of biochemical and
morphological alterations of
the synovial membrane and
joint capsule.
Risk Factors

Systemic risk factors Local risk factors

Age Joint injury and trauma

Gender Obesity
Genetics hormones Occupation
Physical activity/Sports
Classification of OA

Primary OA Secondary OA

Etiology is unknown Etiology is unknown

 Diagnosis of oa

Risk factors
Symptoms
Age Pain
Radiographic changes
Gender Brief morning stiffness
Genetic hormones Functional limitation
Osteophyte
Diet
Joint space narrowing
Joint injury and trauma Signs
Subchondral sclerosis
Obesity Crepitus
Subchondral cysts
Occupation Restricted movement
Physical activity/Sports Bone enlargement

OA
Radiologic grade of oa

• Grade 1 : doubtful joint space narrowing (JSN) and possible

osteophytic lipping
• Grade 2 : definite osteophytes and possible JSN on anteroposterior
wheight bearing radiograph
• Grade 3 : multiple osteophytes, definite JSN, sclerosis, possible bone
deformity
• Grade 4 : large osteophytes, marked JSN, severe sclerosis and definite
bone deformity
Primary prevention of oa

• Regular exercises
• Weight control
• Prevention of trauma
Non pharmacologic treatment of oa

• Weight loss (if overweight)

• Aerobic exercise programs
• Physical therapy
• Bracing
• Brace
Pharmacologic treatment of oa

• Oral systemic medical agents

Analgetics
NSAIDs
Opioid analgetics
• Intraarticular agents
Hyaluronic acid
Glucocorticoids (effusion)
• Topical agents
surgical approach

• Fusion and joint lavage

• Osteotomy
• Arthroscopy
• Arthroplasty
Arthroscopy at RSUD Andi Makassau , Pare-Pare
January 23, 2019 - dr. Ariyanto Arief , M.Kes ,Sp.OT
Arthroscopic Machine
Thank You