Osteoarthritis

Aetiology

Joint damage due uneven weight distribution Previous trauma, particularly if malunited Infection Inflammation - rheumatoid arthritis Avascular necrosis Common sites:   Hip Knee Distal interphalangeal joints (Heberden's nodes)

Clinical Features

History of previous joint trauma, surgery or arthritis Progressively worsening pain on movement - aggrevated by exercise, releived by rest Stiffness - worse after rest Swelling & deformity Muscle wasting Restricted movement Joint crepitus Joint instability

Investigations

X-Ray of affected joint     Joint space narrowing Subarticular sclerosis Subchondral cysts Osteophytes

Treatment

Conservative   Reassurance - normal wear & tear, uncomon to spread to other joints Load reduction - weight loss, walking aids, rest periods Exercise & Physiotherapy - Heat treatment & increasing movement range Medications   Analgesics NSAIDs- intermittently because it may depress joint healing Operative   Only considered if conservative treatment is inadequate Debridement   Removing osteophytes to increase movement range Only performed on small joints with severe movement restriction (hand), not on large weight bearing joints (hip & knee) Arthrodesis   Fusion of joints - converting a stiff, painful joint in bad position to a stiff, painless joint in good position Useful for smal joints in the hand, where loss of movement in one joint can be disguised by the joints around it Not performed in rheumatoid arthritis, or if joints above and below are impaired Realignment osteotomy   Cutting of bone to correct alignment Slows deterioration Performed in young, active patients Long rehabilitation required Arthroplasty   Total joint replacement with a prosthesis Performed in older, inactive patients