Osteoarthritis

Question 1

OA of hand - pathophysiology

Answer 1

It results from the loss of cartilage at synovial joints and is often accompanied by the degeneration of underlying bone. Inflammation is not usually involved.

Question 2

Risk factors for OA of hand

Answer 2

Genetics: genes that encode for collage type II- thought to be involved - interphalangeal involvement

• previous trauma of joint increases risk of having OA in that joint
• Obesity
• Hypermobility
• Occupation- cotton workers and farmers are more susceptible to hand OA
• Osteoporosis reduces the risk fo OA

Question 3

Features of OA in hand

Answer 3

Usually bilateral: usually one joint at a time is affected- CMC, distal interphalangeal joints

• Episodic joint pain
• Stiffness: MORNING stiffness but UNLIKE RA (only lasts a few minutes)
• Painless nodes (bony swellings): Herbeden’s nodes at the DIPJs, Bouchard’s Nodes at the PIPJs,

Question 4

Ix

Answer 4

X-ray: radiologically: oseophytes and joint space narrowing

Question 5

OA of hip features

Answer 5

History of groin ache following exercise and relieved by rest

• Red flag features suggest alternative diagnosis- rest pain, night pain and morning stiffness
• Oxford hip score

Question 6

Ix of OA of hip

Answer 6

Clinical diagnosis if typical features or plain x-rays

Question 7

Management of OA

Answer 7

Oral analgesia
Intra-articular injections- short term benefit
Total hip replacement

Question 8

Complications of total hip replacement in OA

Answer 8

venous thromboembolism
intraoperative fracture
nerve injury

Question 9

Reasons for total hip replacement in OA

Answer 9

aseptic loosening (most common reason)
pain
dislocation
infection