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Osteoarthritis (OA)
OA is the most common form of
arthritis and the most common
joint disease
Over 10 million Americans suffer
from OA of the knee alone
Most of the people who have OA
are older than age 45, and women
are more commonly affected than
men.
OA most often occurs at the ends
of the fingers, thumbs, neck,
lower back, knees, and hips.
OA
OA is a disease of
joints that affects all
of the weight-bearing
components of the
joint:
Articular
cartilage
Menisci
Bone
OA
Nodal osteoarthritis
Note bony
enlargement of distal
and proximal
interphalangeal
joints (Heberden's
nodes and
Bouchard's nodes,
respectively).
OA Risk Factors
Age
Age is the strongest risk factor for OA. Although OA can start in young
adulthood, if you are over 45 years old, you are at higher risk.
Female gender
Joint alignment
People with joints that move or fit together incorrectly, such as bow legs, a
dislocated hip, or double-jointedness, are more likely to develop OA in
those joints.
OA Risk Factors
Hereditary gene defect
Obesity
OA Symptoms
OA Articular Cartilage
Articular cartilage is the main tissue affected
OA results in:
Increased tissue swelling
Change in color
Cartilage fibrillation
Cartilage erosion down to subchondral bone
OA Articular Cartilage
OA Articular Cartilage
A) Normal articular
cartilage from 21-year old
adult (3000X)
B) Osteoarthritic cartilage
(3000X)
OA Articular Cartilage
The cartilage damage causes chondrocyte cloning in an
attempt to restore articular surface (Normal adult
chondrocytes are fully differentiated and do not proliferate)
OA Articular Cartilage
Unfortunately, the newly dividing cells do not
differentiate fully and cannot effectively synthesize the
elements needed for matrix maintenance
This results in a net loss of matrix components
Collagen content stays constant but fibrils are thinner
and more disorganized
- Decreased tensile strength
OA Articular Cartilage
Proteoglycan loss
results in an
inability to hold on
to water content:
- Decreased
resistance to
compression
especially with
repeated stress
OA vs. Aging
OA Overall Changes
OA Radiographic Diagnosis
OA Radiographic Diagnosis
Asymmetrical
joint space
narrowing
Periarticular
sclerosis
Osteophytes
Sub-chrondral
bone cysts
OA Arthroscopic Diagnosis
Arthroscopy allows earlier
diagnosis by demonstrating the
more subtle cartilage changes
that are not visible on x-ray
OA Arthroscopic Treatment
In addition to being the most accurate way of determining how
advanced the osteoarthritis is:
Arthroscopy also allows the surgeon to debride the knee joint
Debridement essentially consists of cleaning out the joint of all debris
and loose fragments. During the debridment any loose fragments of
cartilage are removed and the knee is washed with a saline solution.
The areas of the knee joint which are badly worn may be roughened with
a burr to promote the growth of new cartilage - a fibrocartilage material
that is similar scar tissue.
Debridement of the knee using the arthroscope is not 100% successful. If
successful, it usually affords temporary relief of symptoms for somewhere
between 6 months - 2 years.
OA Disease Management
OA is a condition which progresses slowly over a
period of many years and cannot be cured
Treatment is directed at decreasing the symptoms of
the condition, and slowing the progress of the
condition
OA Non-operative Treatments
Pain medications
Physical therapy
Walking aids
Shock absorption
Re-alignment through
orthotics
Limit strain to affected
areas
The ends of the femur, tibia, and patella are shaped to accept
the artificial surfaces.
The end result is that all moving surfaces of the knee are
metal against plastic
The End