OSTEOARTHRITIS

Simposium Nasional
Palu, 2018

dr. Muh. Ardi Munir, M.Kes., Sp.OT., FICS., M.H

Orthopaedic & Traumatology Surgery Dept.

Faculty Of Medicine, Tadulako University
 BASICS DESCRIPTION

1. The most prevalent form of arthritis.

May occur in virtually any joint of the body.

2. Has no cure and leads to pain and joint

dysfunction.

3. The end result is loss of articular cartilage with

secondary bone changes, including osteophytes,
subchondral sclerosis, and subchondral cysts.

Simposium Nasional - 2018 2

Simposium Nasional - 2018 3
Simposium Nasional - 2018 4
Simposium Nasional - 2018 5
Simposium Nasional - 2018 6
 EPIDEMIOLOGY INCIDENCE

In a study of 697
The knee is the most females >65 years old,
commonly affected knee arthritis occurred
joint, followed by the in 30%, hand arthritis
hand and hip. in 15%, and hip
arthritis in 8%.

Simposium Nasional - 2018 7

PREVALENCE
Osteoarthritis, the most common form
1. of arthritis, affects females more often
than males.

In contrast to inflammatory arthritis,

osteoarthritis occurs principally in
2. individuals > 60 years old. In 1 study :
• Hand osteoarthritis occurred in 23% of
females >65 years old.
• The most commonly affected joints were
the DIP and 1st CMC joints.

Simposium Nasional - 2018

RISK FACTORS

1 Obesity

2 AV N

3 Septic Arthritis

4 Advancing Age

5 Female Gender

Simposium Nasional - 2018 9

GENETICS A genetic predisposition is
thought to exist, but genes have
not yet been identified.

Simposium Nasional - 2018 10

Etiology
No known cause of
osteoarthritis
(idiopathic
osteoarthritis) :
The common pathway is loss of
the articular cartilage with
progressive overloading of the
joint.
Many conditions that injure the joint may
lead to secondary arthritis :
 Trauma : Posttraumatic arthritis.
 Infection : Postinfectious arthritis.
 AVN : Arthritis associated with the
condition.
Simposium Nasional - 2018 11
DIAGNOSIS SIGNS & SYMPTOMS

1 Discomfort with weightbearing

and joint motion

2 Stiffness

3 Loss of function :
• Inability to do heavy work.
• Inability to tie or put on shoes.
• Limitation to short distance walking.
Simposium Nasional - 2018 12
HISTORY Pain and swelling that
increase with activity or
prolonged inactivity

Simposium Nasional - 2018 13

 1 Stiffness of ROM

2 Loss of ROM

PHYSICAL 3 Joint effusion

Limb deformity
EXAM
4

5 Painful joint motion

6 Gait disorder

Simposium Nasional - 2018 14

LABORATORY TEST
No specific laboratory features

Simposium Nasional - 2018 15

IMAGING
Radiography:
• AP and lateral radiographs are the main
imaging modalities.
• In the knee, foot, and ankle, weightbearing
radiographs are obtained.

MRI can be used to exclude other diagnoses such

as AVN, stress fractures, and neoplasms.

Simposium Nasional - 2018 16

Simposium Nasional - 2018 17
 PATHOLOGICAL FINDINGS
Loss of the thickness and organization of the articular cartilage

Simposium Nasional - 2018 18

 DIFFERENTIAL DIAGNOSIS

Tendinitis
Early arthritis can be confused
with the following conditions :
Bursitis

Stress Fractures
The diagnosis of osteoarthritis is
not difficult when the disease is in
Synovial Proliferative Disorders
the moderate or advanced stage.

Simposium Nasional - 2018 19

 TREATMENT GENERAL
MEASURES

1 Rest

2 Activity Modification

3 Weight Loss

4 NSAIDs

Simposium Nasional - 2018 20

 SPECIAL PHYSICAL THERAPY

1. Patients should begin a program to preserve muscle strength and

ROM and to avoid contractures.

2. Heavy-impact activity (such as running, contact sports, and heavy

work) exacerbates symptoms.

3. A cane used in the opposite hand substantially reduces the forces across
the hip joint and will relieve discomfort and improve gait.

Simposium Nasional - 2018 21

 Acupuncture may provide pain relief for
COMPLEMENTARY knee arthritis in the short term.

AND Many herbal medicines are used for the

ALTERNATIVE treatment of osteoarthritis.

THERAPIES
Evidence to support their use is limited.

Simposium Nasional - 2018 22

 MEDICATION
First Line
• NSAIDs, including COX-2 inhibitors,
are mainstays in the nonoperative
treatment of arthritis. Meta-analysis
shows these medications to be
slightly more effective than a placebo
in the short term. NSAIDs have a
high rate of side effects, including
gastrointestinal bleeding.
• Acetaminophen is widely used for
pain relief .
Second Line
• The use of nutraceuticals, such as
glucosamine and chondroitin sulfate, is
controversial, with a recent study
showing no benefit.
• Intra-articular injection : With
corticosteroids, decreases pain for
short periods. With hyaluronic acid,
may have a small effect on knee pain.
• Opioid pain medicine may be used for
severe pain in patients who are not
operative candidates.
Simposium Nasional - 2018 23
 SURGERY

Realignment Osteotomy
Joint Replacement

Simposium Nasional - 2018 24

SURGERY

Realignment osteotomy :
• The joint surfaces are repositioned by cutting the
bone and changing the axis of weightbearing.
• Purpose : Allows the healthiest articular cartilage
to bear the most weight.
• May be combined with ligament or meniscal
repair.

Simposium Nasional - 2018 25

Simposium Nasional - 2018 26
 SURGERY

Arthroplasty:
• The arthritic joint surfaces are
removed, and a new joint surface is
implanted.
• The bearing surface is typically
metal on high-density polyethylene.
• Examples are total hip arthroplasty,
total knee arthroplasty, and total
shoulder arthroplasty.

Simposium Nasional - 2018 27

Simposium Nasional - 2018 28
Simposium Nasional - 2018 29
ARTHROSCOPY

Simposium Nasional - 2018 30

ARTHROSCOPY

Simposium Nasional - 2018 31

ARTHROSCOPY

Simposium Nasional - 2018 32

 COMPLICATIONS

1. Progressive arthritis leads to worsening deformity and stiffness.

2. In the lower extremity, patients may stop walking and rely on wheelchairs.
In the upper extremity, prevents activities and leads to lack of function.

3. Treatment also may lead to complications.

• The side effects of NSAIDs include gastritis and gastrointestinal bleeding.
• Surgical intervention may lead to infection, DVT, or failure of the
replacement mechanical joint.
Simposium Nasional - 2018 33
PREVENTION
Weight loss may help prevent joint
degeneration

Simposium Nasional - 2018 34

PATIENT TEACHING

1 Taught to avoid activities that

worsen the pain.

2 Shown how to prevent contractures.

3 Encouraged to lose weight.

Simposium Nasional - 2018 35

 1 2 3

Patients should be Exercises that do not Activities with little or no impact

encouraged to maintain cause pain are best. include elliptical trainers, bicycling,
muscle strength and swimming, water aerobics / running.
joint mobility.
Simposium Nasional - 2018 36
PROGNOSIS • Osteoarthritis progressively worsens with
time.
• No cure exists.
• Modern methods of joint replacement
provide excellent function and pain relief.

Simposium Nasional - 2018 37

 QUESTION
A : In general,
interventions have not been
found to prevent
osteoarthritis. However,
Q : What can be done to
osteoarthritis is associated
prevent osteoarthritis ?
with obesity, and weight
loss may help prevent joint
degeneration.

Simposium Nasional - 2018 38

 QUESTION

A : Surgery is the final

treatment after nonoperative
Q : When is surgery measures (such as muscle
indicated for the treatment strengthening, ambulatory aids,
of osteoarthritis ? and medications) have been
tried. The most commonly
performed surgery is total knee
replacement.

Simposium Nasional - 2018 39

Thank You for
Watching!
Any Questions?