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Muscluloskeletal Systems > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is the strongest predictor in osteoarthritis?

A

Age

therefore extended life expectancy will result in a greater occurence of the disease

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2
Q

What percentage of adukts over 60 in england and wales have some degree of OA?

A

10-15%

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3
Q

What are the radiological features of osteoarthritis?

4 marks

A

Loss of joint space
Sub-chondral sclerosis
Cyst formation
Osteophytes

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4
Q

What is the critical change to articular cartilage in osteoarthritis?

A

Loss of proteoglycans

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5
Q

Describe the 4 main features of arthritis of the hip on x-ray

A

Narrowed joint space
-loss articular cartilage

Osteophytes
-Extra bone formed by body to take extra load

Sclerosis
-Seen as increased whitening of bone, caused by hardening of bone around joint caused by increasing loads

Cyst
-Change of bone to cartilaginous tissue due to load change

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6
Q

Describe the features that make osteoarthritis different to “normal” age change?

A

Normal aged cartilage

  • Yellowing, fibrillated
  • Less resistant to biomechanical insults
  • Reduced cellular activity related to lack of use

Osteoarthritic cartilage

  • Metabolically active
  • Inflammatory component
  • Seen in areas of high cyclical loading
  • Age accelerated disorder
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7
Q

What are the primary and secondary aetiologies of osteoarthritis?

A

Primary

  • Genetic
  • Multifocal

Secondary

  • Trauma
  • Anatomic
  • Disease
  • Other
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8
Q

What two types of trauma can lead to osteoarthritis?

Think outside the box

A

Direct joint trauma

Malignant

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9
Q

Give 5 causes of osteoarthritis that come under developmental/ anatomy

A 
Dysplasia
SUFE
Perthes
OsteoDysplasias
Impingement lesions
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10
Q

Give 3 causes of osteoarthritis that come under disease

A

Inflammatory
Haemophilia
Haemachromatosis

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11
Q

Femoroacetabular impingement is another cause of osteoarthritis of the hip.

What are the two types?

A

CAM

Pincer impingement

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12
Q

What is the strongest modifiable risk factor of osteoarthritis?

A

Obesity

overweight at 36-37 is a risk factor for knee OA

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13
Q

How can bone density effect OA?

A

Increased density -> increased risk

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14
Q

How does exercise and occupation effect OA?

A

Exercise:
-High impact sports present an increase for OA

Occupation:
-More common in those performing heavy physical work

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15
Q

How does gender effect OA?

A

Men 50 = higher prevalence and incidence

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16
Q

What are the 3 main presenting symptoms in OA?

A

Pain
Swelling
Stiffness

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17
Q

Describe the pain in OA

A

Exacerbated by activity

Night time

Gradual deterioration over time

May get episodes of increased intensity

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18
Q

Describe the stiffness in OA

A

Start up
Reduced movement
Difficult daily activities

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19
Q

What are the signs of OA?

6 marks

A 
Visible deformity
Swelling
Warmth
Crepitus
Reduced movement
Pain
20
Q

What investigations can be carried out in OA?

A

X-ray
MRI (early)
Bone scan
CT

21
Q

How can you manage patients pain in OA?

A

Analgesia ladder:

  • Paracetamol/ topical NSAID
  • Oral NSAID
  • Opiates
22
Q

How can muscle strengthening be used for OA?

how is it being delivered, effective

A

Proven in knee
Specific exercises
Proven amount required

Delivered by:

  • Physiotherapy
  • Groups
  • Online

Reduction in pain
Delays surgery

23
Q

How can activity modification be used in OA?

A

Reduce high impact activities
Reduce distance
Alter work
Reduce load carrying

24
Q

How can weight loss help with OA?

A

Reduce load on joint
Reduce pro-inflammatory state
Reduce surgical problems
Help other co-morbidities

25
Q

Give some offloading supports that can take increasing weight through upper body and offload lower limb

A

Splints
Stick
Crutch
Zimmer

26
Q

How does the effectiveness of intra-articular steroid change over time?

A

Reducing effectiveness with repeats and disease progression

27
Q

What is the mode of action for hyaluronic acid?

A

Restoration of elastoviscous properties

“Normalisation” of HA synthesis by synoviocytes

Anti-inflammatory effect

Analgesic effect

28
Q

Describe the process of platelet rich plasma (PRP) injection

A

Collect blood
-30-60ml from patients arm

Separate the platelets
-Blood placed in centrifuge

Extract platelet rich plasma
-3-6ml

Inject injured area with PRP

29
Q

What is the benefits of PRP injection?

A

Increase the growth factors up to eight times, which promotes temporary relief and stops inflammation

Limited evidence but this is increasing in knees

Stimulates hyaluronic acid production

Lasts severeal months

30
Q

Describe the efficacy of DMARDs in OA

A

Currently no effective DMARD for OA

Trials in variety of drugs

31
Q

Name 3 DMARDs that are being trialed for OA

A

Strontium Ranalate

Methotrexate

Biologics (antibodies to interleukin etc)

32
Q

Name the two broad types of joint surgery in OA?

A

Joint sparing -> conservative

Joint replacing

33
Q

Osteoarthritis of the toe is named what?

A

Hallux rigidus

34
Q

What is Cheilectomy?

A

A cheilectomy is a surgical procedure that removes bone spurs from the base of the big toe.

35
Q

What are the principles of osteotomy in OA?

A

Mechanical realignment

Offload arthritic cartilage

Load normal cartilage

Recovery arthritic cartilage

36
Q

What is Keller’s procedure?

A

A first metatarsophalangeal (MTP) joint resection arthroplasty treats arthritis of the big toe.

37
Q

What is arthrodesis?

A

Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery.

Pain on movement so remove joint to remove movement

Inevitable limitation activity

38
Q

Name the common and less common joints to replace in the upper and lower limb

A

Common:

  • Shoulder
  • Elbow
  • Hip
  • Knee

Less common:

  • Wrist
  • MCP
  • PIP
  • Ankle
  • MTP
39
Q

List the 4 types of joint replacement

A

Hemi-arthroplasty

Uni-compartmental Arthroplasty

Resurfacing

Total Joint Arthroplasty

40
Q

What is a hemiarthroplasty?

A

One side joint replacement

e.g. hip, shoulder, toe

41
Q

What is unicompartmental knee replacement?

A

In unicompartmental knee replacement (also called “partial” knee replacement) only a portion of the knee is resurfaced. This procedure is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee.

42
Q

The majority of unicompartmental knee replacements are on which area of the knee?

A

Medial

43
Q

What is a total joint replacement?

A

Both sides of the joint are replaced

Variety of bearing surfaces

Varying bearing size

44
Q

What is the chemical name of the cement used in surgery?

A

Polymethylmethacrylate

45
Q

Uncemented fixation in joint replacement was developed due to cement disease.

What is cement disease?

A

the osteolysis that frequently occurs in association with loosening of cemented total hip replacements; the microscopic particles of polymethylmethacrylate cement induce a biologic reaction by osteoclasts leading to bone resorption and progressive bone loss.

46
Q

Give 3 ways joint replacement may fail

A

Aseptic loosening (wear)

Dislocation (hip)

Infection

47
Q

Describe the factors that lead to aseptic loosening

A 
Particulate debris -> macrophages
\+
Hydrostatic pressure
\+
Immune response

Leads to
-Cytokines, inflammatory mediators

AND SO:
Osteolysis

Muscluloskeletal Systems (29 decks)

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