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OSTEOARTHRITIS. Dr S ami Abdallah. Anatomy of synovial joints:. MECHANISMS FOR MAINTAININGJOINT STABILITY Alignment of joint components Shape and fit of articular surfaces Adhesive property of synovial fluid Integrity of capsule and ligaments Muscle tone and power
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OSTEOARTHRITIS Dr Sami Abdallah
MECHANISMS FOR MAINTAININGJOINT STABILITY • Alignment of joint components • Shape and fit of articular surfaces • Adhesive property of synovial fluid • Integrity of capsule and ligaments • Muscle tone and power • Neurological control of balance
THREATS TO CARTILAGE INTEGRITY • Loss of joint stability • Localized increase in loading stress • Increased stiffness of the cartilage • Inflammatory (enzymatic) degradation • Restriction of free joint movement • Sclerosis in the subchondral bone
Osteoarthritis (OA) is a slowly progressive chronic disorder of synovial joints in which there is progressive softening and disintegration of articularcartilage • The commonest of all joints diseases
Asymmetrical affection • No systemic manifestations • Degenerative disease with some inflammatory process
New growth of cartilage and bone at the joint margins(osteophytes) • Cyst formation and sclerosis in the subchondral bone • Mild synovitis and capsular fibrosis
Prevalence • Universal disorder • Males = females • All people > 65 years • 40 % of people reaching 40 years • Racial distribution • Hips, knees and spine are commonly affected
Prevalence Risk factors • Joint dysplasia • Obesity • Bone density • Trauma • Family history • Occupation
Pathology • The cardinal features are: • Progressive cartilage destruction • Subarticularcyst formation • Sclerosis of the surrounding bone • Osteophyte formation • Capsular fibrosis
Clinical features Symptoms • Pain • Swelling • Deformity • Stifness • Loss of function
Signs • Swelling • Muscle wasting • Tenderness • Instability • Crepitus
Clinical types: • Monoarticular The classic form of OA
Clinical types: • Monoarticular • Pauciarticular
Clinical types: • Monoarticular • Pauciarticular • Generalized The commenest type of OA Affects middle aged women Small joints
Complications • Capsular herniation • Loose bodies • Rotator cuff dysfunction • Spinal canal stenosis
Imaging • X rays
EARLY TREATMENT PRINCIPLES • To maintain movement and muscle strength • To protect the joint from overload • To modify the daily activities
Physeotherapy • Load reduction
Physeotherapy • Load reduction • Analgesia
INTERMEDIATE TREATMENT • Joint debridement • Corrective osteotomy
LATE TREATMENT • Re-alignment osteotomy • Joint replacement • Arthrodesis