Académique Documents
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Perspective
Jose Ramon C.Pascual,MD
Fellow Philippine Orthopedic Association
Department of Orthopedics
De La Salle College of Medicine
To review normal joint structure and
function
To identify the different types of
arthritides
To learn how to formulate a management
plan
Objectives
Contents
Joint
with cavity is called a synovial joint
Made up of several types of tissue that
may be involved in disease processes
Normal Joint
Bone
Cartilage
Synovium
Synovial Fluid
Ligaments/tendons and
entheses
Normal Joint
Bone
Normal Joint
Cartilage
◦ Articular cartilage is
primarily hyaline
◦ Avascular and aneural
◦ Loadbearing areas that are
damaged rarely rethicken
and heal
Normal Joint
Synovium
◦ Modified fibroblasts in the
intima produce hyaluronic
acid which passes into the
synovial fluid
◦ Macrophages in the intima
are rich in the receptor
FcgRIIIa which mediates
cytokine release in
response to small immune
complexes
Normal Joint
Synovial Fluid
◦ Syn ovium (like an egg)
◦ Viscosity is due to the
presence of hyaluronan
◦ Hyaluronan helps maintain
a thin layer of lubricin at
the surface of the articular
cartilage
Normal Joint
Ligaments/tendons and
entheses
◦ Entheses are the points at
which the ligaments,
aponeuroses and tendons
are attached to the bone
◦ Entheses are a main
target in a group of
inflammatory disorders
associated with the HLA-
B27 Class I allotype - the
seronegative
spondarthropathies
Normal Joint
Etiology
◦ Disease process of synovial joint characterized
by focal areas of hyaline cartilage loss with
increased activity of marginal and subchondral
bone
◦ Malfunction
◦ Deformity
Management
Nonoperative
Nonpharmacologic
◦ Dietary Modification for Gout
Food Group Allowed Restricted
Vegetable All except those Asparagus,
restricted cauliflower,
mushroom, spinach
Rice or Substitute Rice, cereals Oatmeal, whole wheat,
whole grain cereals
Management
Nonoperative
Viscosupplementation
Management
Nonoperative
Debridement/ Synovectomy
Indications
2.Early inflammatory
arthritis without significant
joint destruction
3.Early degenerative joint
disease (i.e. degenerative
meniscal tears with minimal
cartilage damage)
Contraindications
6.Infectious arthritis
7.Extensive destruction of
joint surface
Management
Operative
Corrective Osteotomy
Indications
2.Noninflammatory
arthritis
3.Arthritis or prearthritic
conditions in young
individuals
Contraindications
6.Inflammatory arthritis
7.Infectious arthritis
8.Extensive destruction
of joint surface
Management
Operative
Corrective Osteotomy
Management
Operative
Arthrodesis
Indications
2.Arthritic joints in young patients who plan to
engage in heavy physical activity
3.Failed/ infected arthroplasties
Contraindications
6.Contralateral fused joint
Management
Operative
Arthroplasty
Indications
2.Noninflammatory and
inflammatory arthritis with
severe joint destruction
3.Conversion of ankylosed
joint
Contraindications
6.Post septic arthritis
7.Young patients (relative
contraindication)
Management
Operative
Arthroplasty
Management
Operative
Picture 2
ir William Osler
Osteoarthritis http://www.emedicine.com/radio/topic492.htm
Rheumatoid Arthritis
http://www.emedicine.com/pmr/TOPIC124.HTM
Gout http://www.emedicine.com/Radio/topic313.htm
Joint Replacement Arthroplasty
http://www.emedicine.com/orthoped/topic347.htm
http://www.emedicine.com/radio/topic830.htm
Arthroscopy
http://www.wheelessonline.com/ortho/arthroscopy_of_the_knee
Arthrodesis
http://www.wheelessonline.com/ortho/hip_arthrodesis
http://www.wheelessonline.com/ortho/ankle_arthrodesis
http://www.wheelessonline.com/ortho/knee_arthrodesis
http://www.wheelessonline.com/ortho/wrist_arthrodesis
Osteotomy http://www.medscape.com/viewarticle/421043
http://www.wheelessonline.com/ortho/high_tibial_osteotomy
References