OSTEOARTHRITIS

Osteoarthritis (OA) is a common,

degenerative disease, which is

characterized by local degeneration of

joint cartilage and new bone

formation at the base of the cartilage

lesion (subchondral bone) and at the

joint margins (osteophytes).

Osteoarthritis is the result of both mechanical and biologic events that destabilize the normal coupling of degradation and synthesis of articular cartilage and subchondral bone

Risk factors• Older age - Osteoarthritis typically occurs in older adults. People

under 40 rarely experience osteoarthritis. • Sex - Women are more likely to develop osteoarthritis, though it

isn't clear why. • Bone deformities - Some people are born with malformed joints or

defective cartilage, which can increase the risk of osteoarthritis. • Joint injuries - Injuries, such as those that occur when playing

sports or from an accident, may increase the risk of osteoarthritis. • Obesity - Carrying more body weight places more stress on your

weight-bearing joints, such as your knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.

• Other diseases - that affect the bones and joints. Bone and joint diseases that increase the risk of osteoarthritis include gout, rheumatoid arthritis, Paget's disease of bone and septic arthritis.

Risk factors

Older age Osteoarthritis typically occurs in older adults. People under 40 rarely experience osteoarthritis.

Risk factors

Sex Women are more likely to develop osteoarthritis, though it isn't clear why.

Risk factors

Bone deformities Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.

Risk factors

Joint injuries Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.

Risk factors

Obesity Carrying more body weight places more stress on your weight-bearing joints, such as your knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.

Risk factors

Other diseases That affect the bones and joints. Bone and joint diseases that increase the risk of osteoarthritis include gout, rheumatoid arthritis, Paget's disease of bone and septic arthritis.

FACTORS

1. Genetic

2. Developmental

3. Metabolic

4. Traumatic

Classification

Primary• Aging• Sex

Secondary• Congenital disorders of joints • Diabetes. • Inflammatory diseases (such as

Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.

• Injury to joints, as a result of an accident or orthodontic operations.

• Septic arthritis (infection of a joint ) • Ligamentous deterioration or

instability may be a factor. • Marfan syndrome • Obesity • Alkaptonuria • Hemochromatosis and

Wilson's disease

OA may affect every joint

OA may affect every joint

DEGENERATION OF THE ARTICULAR CARTILAGE

Symptoms• Pain in a joint during or after use, or after a

period of inactivity • Tenderness in the joint when you apply light

pressure • Stiffness in a joint, that may be most noticeable

when you wake up in the morning or after a period of inactivity

• Loss of flexibility may make it difficult to use the joint

• Grating sensation when you use the joint • Bone spurs, which appear as hard lumps, may

form around the affected joint • Swelling in some cases

Heberden's nodes may form in osteoarthritis

DiagnosisX-RAY

Primary osteoarthritis of the left knee. Note the osteophytes, subchondral cyst formation, narrowing of the joint space (arrow), and increased subchondral bone density (arrow).

Diagnosis

Arthroscopy

NON-DRUG TREATMENT

•weight loss (normal weight people have a 20% risk of hip OA, overweight have 25% risk, and obese have 39% risk) •water exercise programs •physical therapy (range of motion and strengthening exercises) •occupational therapy (assistive devices, joint protection) •patient education

DRUG TREATMENT

• Acetaminophen• Non-steroidal anti-inflammatory drugs • Tanezumab (monoclonal antibody)• Chondroitin sulfate • Glucosamine • S-Adenosyl methionine

Surgery

INTRAARTICULAR INJECTION

• Artificial synovial fluid• Steroids• Enzyme inhibitors• Chondroprotectors

INTRAARTICULAR INJECTION

Surgeory

• Autologous chondrocyte implantation • Microfracture surgery • Arthroscopic surgery• Osteotomy • Limb lengthening• Arthrodesis• Joint replacement

Deformity correction

Deformity correction

Limb lengthening

Arthrodesis of ankle joint

Arthrodesis of ankle joint

Subtalar arthrodesis

Subtalar arthrodesis

TOTAL SHOULDER REPLACEMENT

TOTAL ELBOW REPLACEMENT

TOTAL HIP REPLACEMENT

TOTAL KNEE REPLACEMENT

TOTAL ANKLE REPLACEMENT