Osteoarthritis

58 Osteoarthritis





Questions



image Which joints are commonly affected by osteoarthritis?

image What are the typical features on plain radiograph?

image What are the complications of total joint replacement?

Osteoarthritis is the most common chronic joint disease and is a major cause of morbidity and disability. It commonly affects the hips, knees, hands and spine. (Rheumatoid arthritis is an autoimmune disease directed against synovial joints (see the orthopaedic chapters 54–66).)




Aetiology


Osteoarthritis is a wear and tear disease of the articular cartilage in weight-bearing joints. Where there is no clear cause, this is primary arthritis; the risk factors for this include:


image age: prevalence increases with age; 10% of men and 20% of women over 60 are affected

image genetic inheritance: family history, Heberden’s nodes, specific gene identification

image obesity: causal relationship

image physical factors: occupations e.g. athletes.

Previous damage can cause altered joint dynamics, symptoms starting years later (secondary osteoarthritis). Underlying causes include:


image previous trauma or infection

image congenital: genu valgum of the knee, slipped upper femoral epiphysis, developmental dysplasia of the hip (DDH), hypermobility disorders

image bone disease: avascular necrosis, Paget’s disease, neuropathic joints (Charcot’s).


Pathology


The joint cartilage becomes soft, splits and fragments (fibrillation). The joint erodes and joint space is lost. Hypertrophy of the bone causes subchondral sclerosis and osteophyte formation. Synovial hypertrophy and capsular fibrosis leads to joint stiffness.



Clinical features


Osteoarthritis is characterized by pain of gradual onset, which ranges from mild discomfort to pain whilst weight-bearing (mechanical pain); it may prevent sleeping or require oral analgesia. Stiffness is worse after a period of rest.


Arthritis of the hip causes groin pain on walking (it may radiate to the knee), stiff and limited movements (initially on internal rotation), a fixed flexion deformity and a true leg length discrepancy (resulting in a Trendelenburg gait). That of the knee is painful and stiff. Crepitus and knee effusion are commonplace and the quadriceps muscle may become wasted. Both the tibiofemoral and patellofemoral joints are affected. Arthritis of the hands is described in Ch. 56.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Osteoarthritis

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