Osteoarthritis

1. Osteoarthritis Dr. Faik Altıntaş Yeditepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji AD

2. Osteoarthritis • Osteoarthritis (OA) is a degenerative joint disease, occurring primarily in older persons, characterized by • Erosion of the articular cartilage, • Hypertrophy of bone at the margins (osteophytes), • Subchondral sclerosis, • Range of biochemical and morphologic alterations of the synovial membrane and joint capsule • Pathologic changes in the late stages of OA include softening, ulceration, and focal disintegration of the articular cartilage; synovial inflammation also can occur

3. Osteoporosis

4. Osteoarthritis • Catabolism of cartilage results in release of breakdown products into synovial fluid which then initiates an inflammatory response by synoviocytes • These antigenic breakdown products include: chondrointon sulfate, keratan sulfate, PG fragments, type II collagen peptides and chondrocyte membranes • Activated synovial macrophages then recruit PMNs establishing a synovitis • They also release cytokines, proteinases and oxygen free radicals (superoxide and nitric oxide) into adjacent and synovial fluid

5. Osteoarthritis • Proinflammatory cytokines are believed to play a pivotal role in the initiation and development of the disease process • Antiinflammatory cytokines are found in increased levels in OA synovial fluid • TNF-α and IL-1 appear to be the major cytokines involved in OA • Other cytokines involved in OA are: IL-6, IL-8, leukemic inhibitory factor (LIF), IL-11, IL-17

6. Osteoarthritis • Symptoms • Acute Pain • Loss of ability • Stiffness • Crackling noise (called "crepitus") • The joints may also be filled with fluid (Effusion)

7. Osteoarthritis • OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees • In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. • OA at the toes leads to the formation of bunions, rendering them red or swollen. • OA is the most common cause of water on the knee, an accumulation of excess fluid in or around the knee joint

8. Osteoarthritis • Classification • Primary OA • Idiopathic • When the cause is not known (as in the large majority of cases) • Secondary OA • When the cause is another disease or condition • Infection, • Deformity • Injury • Abnormal use of a joint • Metabolic disorder (hemochromatosis, Wilson's disease • Disorder that damages joint cartilage (rheumatoid arthritis, gout)

9. Osteoarthritis • Risk Factors and Possible Causes: • Age • Female • Obesity • Muscle weakness • Genetics

10. Osteoarthritis • Diagnosis • Normally done through x-rays • Loss of cartilage, subchondral sclerosis, subchondral cysts from synovial fluid entering small microfractures under pressure, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes)

11. Osteoarthritis • Treatment • The process of clinically detectable osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint • Gene therapy has future for cure • Conservative • Medical • Surgical

12. Osteoarthritis • ConservativeTreatment • Weight control • Appropriate rest and exercise • TENS • Mechanical support devices • Knee braces • Cane • Walker • Applying local heat before, and cold packs after exercise, can help relieve pain and inflammation, as can relaxation techniques • Schockabsorbingheelsandpads

13. Osteoarthritis • Medical Treatment • Analgetics • Acetominophen • Metamizol sodium • Nonsteroidal anti-inflammatory drugs (NSAIDs) (traditional and COX 2 selective) • Both relieve pain and reduce inflammation. • Topical pain relievers (creams, gels, and sprays) • Temporarily relieve arthritis pain and reduce inflammation in joints close to the surface of the skin • Antidepressants • Glucosamine , chondroitin sulfate, MSM • Diacetylrhein • Intraarticular corticosteroid injections • Viscosupplementation • Hyaluronate

14. Osteoarthritis • Surgical Treatment • Arthroskopic Debridement • For meniscal tears • Loose bodies • Catilage repair or debridement • Diluation of enflamatory substances and enzymes

15. Osteoarthritis • Surgical Treatment • Correction osteotomy for malalignment

16. Osteoarthritis • High Tibial Osteotomy

17. Osteoarthritis • Surgical Traetment • Arthroplasty

18. Osteoarthritis • Total knee arthroplasty

19. Osteoarthritis • Arthroplasty

20. Osteoarthritis