Osteoarthritis and Principles of Management

Question 1

How common is osteoarthritis?

Answer 1

Commonest form of joint problem

Affects more than half of the UK population over 60

Question 2

Describe the pathogenesis of osteoarthritis

Answer 2

• Trauma due to mechanical imbalances causes injury to articular cartilage
• Inflammation and pain in response to injury
• Ongoing repair processes around the joint (eventually overwhelmed by extent of injury)

Question 3

What are some biomechanical factors that lead to the development of osteoarthritis?

Answer 3

• Abnormal anatomy (esp. of hip)
• Intra-articular fracture
• Ligament rupture (ACL) / meniscal injury
• Persistent heavy activity (sports / runners)
• Obesity

Question 4

What changes are seen in the joint during the inflammatory component of osteoarthritis?

Answer 4

• Synovial hypertrophy
• Subchondral changes: thickening of subchondral bone
• Joint effusion

Question 5

Symptoms / signs of osteoarthritis?

Answer 5

• 45+ years old
• Activity related joint pain
• Either no morning stiffness, or morning stiffness lasting <30 minutes
• Gradual symptom worsening, not rapid deterioration

Question 6

Investigations for confirmation of osteoarthritis?

Answer 6

X-Ray (no noticeable changes initially)

Question 7

What radiographic changes are indicative of osteoarthritis?

Answer 7

• Loss of joint space
• Osteophytes
• Subchondral sclerosis
• Subchondral cysts

Question 8

What is an important step in determining the treatment plan for patients with osteoarthritis?

Answer 8

Holistic assessment of the effect of the condition on the patients daily life:

• Occupational
• Social
• Pain assessment
• etc.

Question 9

What are some of the non-surgical, non-pharmacological methods of managing osteoarthritis?

Answer 9

• Lifestyle changes (esp. weight loss)
• Physio / occupational therapy
• Aids & devices (splints / walking aids)
• Thermotherapy / Electrotherapy

Question 10

What are some pharmacological methods of treating osteoarthritis?

Answer 10

• Oral analgesia: paracetamol / NSAIDs
• Topical treatments: NSAIDs / capsaicin
• IA injections: steroids / hyaluronic acid

Question 11

What are some of the surgical methods of treating osteoarthritis?

Answer 11

• Arthroplasty (eg. hip replacement)
• Osteotomy: scan the patients joint, make 3D computer model, plan how to cut the bone and design jigs to attach to joint - corrects malalignment)

Question 12

When is surgery done on osteoarthritic patients?

Answer 12

When QOL is being significantly affected and all other treatment options have been exhausted