osteoarthritis + osteomalacia

Question 1

score used to assess hip OA severity

Answer 1

Oxford hip score

Question 2

Hip OA investigations

Answer 2

if features typical = clinical

x-ray = 1st line

Question 3

complications of total hip replacement

Answer 3

perioperative - VTW, nerve injury, surgical sit infection

leg length discrepancy

posterior dislocation
- occur during extremes of hip flexion
- internal rotation + shortening of leg

prosthetic joint infection

Question 4

commonest reason for hip replacement revision

Answer 4

aseptic loosening
- failure of a prosthetic joint to remain properly fixed to bone in the absence of infection or trauma

Question 5

management of OA

Answer 5

advice - weight loss, strengthen muscle, general aerobic fitness

first line = topical NSAIDs
second = oral NSAIDs + PPI
- avoid if taking aspirin

strong opiods NOT recommended

intraarticular steroid injection = short term relief (2-10wks)

–> if fail, consider for surg

Question 6

xray changes in osteoarthritis

Answer 6

Loss of joint space
Osteophyte forming at joint margin
Subchondral sclerosis
Subchondral cysts

Question 7

basic advice to minimise the risk of dislocation post hip replacement

Answer 7

avoid flexing hip >90degrees
avoid low chairs
do not cross legs
sleep on back for first 6 wks

LMWH for 4weeks post-surg to prevent VTE

Question 8

risk factors for hand OA

Answer 8

prev traum of a joint
obesity
hypermobility of a joint
occupation - cotton workers+farmers

osteoporosis REDUCES risk of OA

Question 9

what causes heberden + bouchards nodes

Answer 9

result of osteophyte formation

• heb = DIP
• bouch = PIP

Question 10

squaring of thumb - OA or RA

Answer 10

OA!!
-> deformity of carpometacarpal joint of thumb resulting in fixed adduction of thumb

Question 11

stiffness in hand OA

Answer 11

worse after long periods of inactivity - waking up

-> only a few mins, unlike longer in RA

Question 12

osteomalacia

Answer 12

softening of bones secondary to low vit D levels leading to low bone mineral content

in kids = rickets

Question 13

causes of osteomalacia

Answer 13

vit D deficiency
- malabsorption -> coeliac!
- lack of sunlight
- diet

CKD
drug induced - anticonvulsants
cirrhosis

Question 14

osteomalacia presentation

Answer 14

bone pain
bone/muscle TENDERNESS
fractures - NOF

proximal myopathy = waddling gait

Question 15

osteomalacia investigaitons

Answer 15

blood
- low vit D
- low ca, low phosphate
- raised ALP

xray = translucent bands (Loosers zones or pseudofractures)

Question 16

management of osteomalacia

Answer 16

vit D supplementation
–> inital loading dose often needed

Ca supplement if diet inadequte