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Osteoarthritis
Osteoarthritis is an idiopathic disease Characterized by degeneration of articular cartilage Leads to fibrillation, fissures, gross ulceration and finally disappearance of the full thickness of articular cartilage
Factors responsible
Ageing Genetics Hormones Mechanics
Pathologic lesions
Primary lesion appears to occur in cartilage Leads to inflammation in synovium Changes in subchondral bone, ligaments, capsule, synovial membrane and periarticular muscles
Normal Cartilage
Avascular, alymphatic and aneural tissue Smooth and resilient Allows shearing and compressive forces to be dissipated uniformly across the joint
OA cartilage
The equilibrium between anabolism and catabolism is weighted in favor of degradation Disruption of the integrity of the collagen network as occurs early in OA allows hyperhydration and reduces stiffness of cartilage
Degenerative cartilage
Synovial changes
Cytokines in OA
It is believed that cytokines and growth factors play an important role in the pathophysiology of OA Proinflammatory cytokines are believed to play a pivotal role in the initiation and development of the disease process Antiinflammatory cytokines are found in increased levels in OA synovial fluid
Proinflammatory cytokines
TNF- and IL-1 appear to be the major cytokines involved in OA Other cytokines involved in OA are: IL-6, IL-8, leukemic inhibitory factor (LIF), IL-11, IL-17
TNF-
Formed as propeptide, converted to active form by TACE Binds to TNF- receptor (TNF-R) on cell membranes TACE also cleaves receptor to form soluble receptor (TNF-sR) At low concentrations TNF-sR seems to stabilize TNF- but at high concentrations it inhibits activity by competitive binding
IL-1
Formed as inactive precursor, IL-1 is active form Binds to IL-1 receptor (IL-1R), this receptor is increased in OA chondrocytes This receptor may be shed from membrane to form IL-1sR enabling it to compete with membrane associated receptors
IL-6
Increases number of inflammatory cells in synovial tissue Stimulates proliferation of chondrocytes Induces amplification of IL-1 and thereby increases MMP production and inhibits proteoglycan production
IL-8
Chemotactic for PMNs Enhances release of TNF-, IL-1 and IL-6
Antiinflammatory cytokines
3 are spontaneously made in synovium and cartilage and increased in OA IL-4, IL-10, IL-13 Likely the bodys attempt to reduce the damage being produced by proinflammatory cytokines, these two processes are not balanced in OA
IL-4
Decreases IL-1 Decreases TNF- Decreases MMPs Increases IL-Ra (competitive inhibitor of IL-1R) Increases TIMP (tissue inhibitor of metalloproteinases) Inhibits PGE2 release
IL-1Ra
Competitive inhibitor of IL-1R, not a binding protein of IL-1 and it does not stimulate target cells Blocks PGE2 synthesis Decreases collagenase production Decreases cartilage matrix production
IL-10, IL-13
IL-10 decreases TNF- by increasing TNFsR IL-13 inhibits many cytokines, increases production of IL-1Ra and blocks IL-1 production
Knee Arthroplasty
90% + report increased ROM following surgery 25% report loosening of prosthesis @ 10 years Caused by osteolysis; inflammatory response: reabsorption of bone Lots of isometric exercises and walking
Hip Arthroplasty
Dislocation Prevention (2-3% Occurrence)
using 2-3 pillows between your legs while sleeping and not crossing your legs not bending forward 90 degrees
Exercise
Lots of isometric exercises will be prescribed to strengthen muscles surrounding joint Lots of walking, cycling, swimming, etc. Avoid high impact exercises and follow guidelines listed above regarding prevention of dislocation.
Hip Arthroplasty
90 95% success rate @ 10 years post op. Average lifespan 12 15 years
Less if active (IE Younger person)
Hip Fractures
*
Post operative Exercise Isometrics, ROM exercises SLOWLY progress to weight bearing exercises as directed by Physician
Hip Fractures
One year post mortality is as high as 40% (leading cause of traumatic death in elderly) Very small percentage regain previous mobility 20% require nursing home care following fracture Often results in accumulation / increase in incidence of other health problem
CAD, diabetes, stroke, pneumonia,etc