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Sunday, February 13, 2011

OSTEOARTHRITIS

Osteoarthritis is characterized by thinning and destruction of the hyaline cartilage of joints, followed by remodelling of underlying bony surfaces. It is essentially noninflammatory.

Repeated heavy occupational stress on joints may increase the prevalence of osteoarthritis for example, osteoarthritis of fingers, knees and elbows has been found increasingly in dock workers. Some forms of osteoarthritis are genetically related.

Clinical features
  • Gradual onset with pain in creasing over several years.
  • Patients are usually past middle-age.
  • Joints affected early tend to be painful after sustained use.
  • Movements become slowly restricted and rest will relieve pain.
OSTEOARTHRITIS KNEE
The medial compartment of the knee transmits a higher proportion of weight than the lateral compartment. As the cartilage begins to degenerate, stress of weight bearing frequently leads to narrowing of medial compartment. This may ultimately lead to genu varum, similar to bow legs where the knees curve outward.

Pathogenesis
Osteoarthritis may be due to abnormal stress to the joints with increased mechanical wear and tear (primary) and may also occur in post-traumatic malalignment of joints. (secondary).
Despite the causes, of OA, ultimately the changes in articular cartilage are same. Firstly the damage of the collagen fibres result in decreased proteoglycans with occasionally depleted hydration of the articular cartilage by mechanical stress. Secondly, the repeated stress to the joints results in microtrauma to the subchondral bone eventually leading to articular cartilage proliferation, proteoglycans synthesis bony sclerosis and osteophyte formation. There is no bony ankylosis as in rheumatoid arthritis.
When articular cartilage has been damaged patients may complain of sensation or audible crackling on movements of the joint. This is known as crepitus." Grating' may be felt or heard on movement of the patella and the femur, the patellofemoral joint undergoes compressive forces when rising from squatting position, climbing stairs, hills, which can aggravate pain. Thus, pain associated with osteoarthritis of knee will worse on activities involving climbing or prolonged standing. Most patients are female, elderly, and fat. The prime muscle for stability in the knee, the quadriceps is wasted. OA is often associated with decreased bone density osteoporosis.

General Management
Drugs; NSAIDs to reduce inflammation, glucosamine and chondroitin sulphate dietary supplements.

Patient Education
Use of assistive devices, for example a knee brace, may reduce forces on damaged joints. Referral to a direction may be important when there is obesity.

Physiotherapy
  • To control pain
  • To prevent further strain or damage of affected joints
  • To improve movements
  • To improve muscle power
  • To maintain and improve functional independence
  • To improve gait.

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