OSTEOARTRITIS

ASRI AULIA RAHMAH - AYU SARY OKTAVIANI

PENDAHULUAN
 Merupakan masalah sendi degeneratif yang
berkaitan dengan kerusakan kartilago sendi.
 Pasien sering datang berobat pada saat sudah
ada deformitas sendi yang bersifat permanen
Definisi

OSTEOARTHRITIS
Gangguan kronis pada sendi kronis dimana terdapat
progresivitas perlunakan dan disintegrasi artikular
cartilage, disertai dengan pertambahan cartilage
dan tulang di sekeliling sendi (osteofit) dan fibrosis
kapsular.
Faktor Risiko dan Etiologi

① Usia > 60 tahun ⑦ Deformitas

② Menopouse ⑧ Trauma
③ Obesitas ⑨ Penuaan
④ Riwayat keluarga
⑤ Repetitive stress
⑥ Inflamasi
Pathogenesis
Loss of proteoglycan  ↑ Tekanan osmotik  ↑
Jumlah air (early)  Menyerupai bantal 
Menggesek tulang  enzim perusak kartilago 
lepas celah sendi  memicu sinovium disekitar sendi
(visceral)  ada benda asing  cairan sinvium
meningkat  efusi  tidak stabil  tarikan kaspul
 robek  lama  kalsifikasi  osteofit  ↑
tekanan  fisura  crack tulang  makin dalam 
fibrilasi  makin dalam  subcondral bone
(ebumasi)  tulang bertemu tulang masuk  retak
 masuk sinovial  subcondrial cyst  tekanan ke
segala  subcodral sklerosis (osifikasi)
Tanda dan Gejala
Gejala terasa pada pusat satu atau dua sendi
weightbearing , sendi interphalangeal, atau sendi
yang sebelumnya telah terkena
 Nyeri
 Tiba-tiba, meningkat berbulan-bulan atau bertahun-
tahun, meningkat ketika overuse dan menurun ketika
beristirahat Stiffness
 Membengkak/pembesaran sendi
 Kaku di pagi hari
 Deformitas
 Kehilangan fungsi (hambatan gerak)
Tanda dan Gejala

 Pembengkakan sendi  Gerakan terbatas

 Tell-tale scars  Krepitasi
 Muscle wasting  Instabilasitas sendi
 Deformitas  ↓ ADL
 Nyeri lokal
 (a) (b)

5.8 Osteoarthritis – x-rays The cardinal features of osteoarthritis are re

Imaging knee or (c) the ankle: loss of articular cartilage seen as narr owing of the ‘j
sclerosis, osteophyte formation and bone r emodelling.

 x-ray Radionuc
THE CARDINAL SIGNS OF OSTEOARTHRITIS shows in
Narrowing of t he ‘joint space’
subchon
increased
Subchondral sclerosis
CT and M
M arginal ost eophyt es to elucid
Subchondral cyst s
an osteo
cular nec
Bone remodelling ity gradi

5 5 5
Art hro
Arthrosc
changes
GENERAL ORTHOPAEDICS
GENERAL ORTHOPAEDICS
GENERAL ORTHOPAEDICS

much, an
chondro
some ot

Nat ura
(a) (a) (a) (b) (b) (b) (c) (c) (c) Osteoart
5.8 5.8 5.8 Osteoarthritis
Osteoarthritis
Osteoarthritis – x-rays
– x-rays
– x-rays TheThe The cardinal
cardinal
cardinal features
features
features of osteoarthritis
of osteoarthritis
of osteoarthritis are remarkably
are remarkably
are remarkably constant
constant
constant whether
whether
whether in the
in (a) inhip,
(a) (a) hip,
the the
(b) hip, (b) the
(b) the
the disorder
knee or (c) the ankle: loss of articular cartilage seen as narr owing of the ‘joint space’, subarticular cyst formation and
imaging
 Radionuclide scanning (99Tc-HDP)
 Aktivitas meningkat pada region subkondral

 CT dan MRI
 Mendeteksi fraktur osteocartilaginous, oedema tulang,
atau nekrosis avaskular

**Pemeriksaan lainnya:
 Arthroscopy
Grading
Kellegren and Lawrence;
radiologically:
Grade 0 : Normal
Grade 1 : Doubtful (unclear joint space
narrowing and possibly osteofit lipping) Grade 4 : OA berat / severe
Grade 2 : OA minimal :
- Osteophytes in 2 sites (minimum)
- Sklerosis subkhondral minimal
- Kista subkhondral samar-samar
- Celah sendi normal
- Tidak ada deformitas diujung tulang
Grade 3 : OA sedang / moderate
- Osteofit sedang
- Ada deformitas diujung tulang.
- Celah sendi menyempit
- Osteofit besar
- Ada deformitas diujung tulang
- Celah sendi hilang.
- Ada sklerosis
- Ada kista
Komplikasi
 Herniasi kapsular
 Disfungsi rotator cuff
 Stenosis spinal
 Spondylolishtesis
Variasi Klinis
Monarticular and Pauciarticular
 Nyeri

 Disfungsi
pada satu atau dua sendi besar
weightbearing
 Polyarticular (Generalized)

 Paling sering
 Middle-aged woman
 Nyeri, bengkak, dan kaku pada sendi jari
 Sendi facet utut dan lumbal Knees and lumbar dapat
terlibat 5

 Perubahan paling jelas terlihat pada tangan (IP joints

swollen and tender)  Tampak knobbly appearance of

Osteoarthritis
DIP (Herberden’s nodes) dan PIP (Bouchard’s nodes)
(b)
Osteoarthritis in Unusual Sites
 Bahu, siku, pergelangan tangan dan ankle

Rapidly Destructive Osteoarthritis

 Elderly women
 Berhubungan dengan deposis kristal kalsium piforosfat
dihidrat
Differential Diagnosis
 Nekrosis avaskular
 Inflammatory arthropathies (RA, ankylosing
spondylitis, Reiter’s disease)
 Polyarthritis of the fingers (RA, tophaceouse gout)
 Diffuse idiopathic skeletal hyperosthosis (DISH)
Differential Diagnosis:
RA vs. OA

RA OA
 Autoimmune disease  Degenerative disease
 Bilateral and  Unilateral and
symmetrical asymmetrical
 Even joint space  Non-uniform joint space
narrowing narrowing
Tata Laksana  mencegah progresifitas dan
mengurangi gejala
EARLY
- Physical therapy  maintaining joint mobility and
improving muscle strength (e.g. Aerobic exercise,
massage, application of warmth)
- Load reduction: weight reduction, usage of shock-
absorbing shoes, avoiding several activities
- Analgesic medication

INTERMEDIATE
- Joint debridement (by arthroscopy or open operation)
- Corrective osteotomy (if symptoms are due to localized
articular overload arising from joint malalignment or
incongruity)
 LATE
- Surgery (for the progressive):
realignment osteotomy, joint replacement, arthrodesis
5 5 5.14 Operative 5.14 treatment
OperativeThetre
operations: (a)operations:
osteotomy,(a) (b)oste
art
(c) athrodesis –(c)atathrodesis
the hip. – at th
GENERAL ORTHOPAEDICS

GENERAL ORTHOPAEDICS
Intervensi lainnya
 Weight Reduction
 Supplements
 Glucosamine
 Chondroitin
 Pharmaceuticals
 Acetaminophen
 NSAIDs – ibuprofen, naproxen
 COX-2 inhibitors – Celebrex, Vioxx
 Corticosteriods
Program
 Promotif
Jaga berat badan ideal
Rujuk untuk kasus dengan inflamasi hebat
 Preventif
Edukasi  tetap menggunakan sendinya dan melindungi sendi yang sakit
 Kuratif
Analgesik topikal
Analgesik oral – Na diclofenac, Ibuprofen, Meloksikam
Glukosamin, hyaluronic acid
Muscle relaxant
 Rehabilitatif
Latihan → isometrik (akut), isotonik, quadricep strengthening exercise,
TENS, stretching