Osteoarthritis

Question 1

Osteoarthritis is the …..

Answer 1

Loss of cartilage

Question 2

Causes of osteoarthritis (primary, secondary)

Answer 2

Primary-
Aging and genetics

Secondary: Joint injury, obesity, trauma, overuse, diseases

Question 3

Assessment of OA

Answer 3

• Chronic joint pain and stiffness that diminishes after rest but worsens with activity
• ROM: May be limited, crepitus, pain
• Enlarged, hardened joints
• Seconday synovitis
• Heberden’s nodes
• Bouchard’s nodes
• Joint effusions
• Atrophy of skeletal muscles
• Limp

Question 4

Diagnostics for OA

Answer 4

• Based on H&P exam
• XRs may be degenerative changes
• MRI and CT for vertebral and knees
• Erythrocyte sedimentation rate and c-reactive protein

Question 5

Interventions for OA

Answer 5

-Management of pain: tylenol (first), lidoderm patches, other topical medications, NSAIDs, Topical Nsaids, muscle relaxants, opioids (try to avoid)

Question 6

Non pharm interventions of OA

Answer 6

• Exercise and rest balance
• Hot/cold therapy (focus on heat)
• Weight control
• Supplements (glucosamine and chondritin)
• Position
• Shoes
• Surgery
• PT/OT
• Swimming/walking/ cycling/ aerobics
• Home adjustments
• Beware of curative remedies

Question 7

Joint arthroplasty

Answer 7

surgical creation of joint

• knees and hips are more common
• only recommended when QOL can’t be maintained
• Majority are over >60
• Contraindications: infection, (not absolute) advanced osteoporosis, severe inflammation, severe DM, dialysis

Question 8

Pre op Joint

Answer 8

• Acquire equipment
• Clean entire body with antibiotic soap
• blood transfusions
• Pre-op antibiotic
• NPO
• Education (dental work and antibiotics) (positioning/ restrictions)

Question 9

Peri op joint

Answer 9

• Minimally invasive versus traditional
  HIP: acetabular and femoral component
• may be press fitted and cemented
  Knee: femoral and tibial component

Question 10

Post-op

Answer 10

Hip:

• dislocation ( shortening of leg, leg rotation)
• See hip precautions: weight bearing versus non weight bearing (cement vs press fit)
• DVT/ PE
• Infection
• Bleeding
• Neurovascular Compromise (Assess -> compromise)

Question 11

Do not have people do what after operation

Answer 11

• bend knees, cross legs

Question 12

Abduction pillow only for

Answer 12

• confused elderly

- post side

Question 13

Cement

Answer 13

• things are being held together like glue

- can bear weight immediatley

Question 14

Press fitted

Answer 14

• take awhile for things to heal

- can not due weight bearing

Question 15

Post op Knee

Answer 15

• Continuous passive motion machine
• ICe
• Pressure dressing
• Prevention of adduction is not necessary
• keep in neutral position
• risk of DV/ PE, bleeding, infection, NV compromise

Question 16

Expected outcomes for OA

Answer 16

Client will be able to maintain level of mobility that allows independent function
- client able to maintain activities of daily living independently

Question 17

Posterior approach worry and rotation for

Answer 17

about adduction!!

rotation for hips and knee