OSTEOARTHRITIS OSTEOARTHROSİS DEJENERATIVE JOINT …

OSTEOARTHRITIS

Dr Igin Ginting Sp.OT Mkes

DEFINITION

Osteoarthritis OA is a Chronic ,

Progressive degenerative disease of

diarthrodial (synovial) joints,

characterized by Breakdown of

articular cartilage and proliferative

changes of surrounding bones

Gangguan pada satu sendi atau lebih

Lokal

Progresif

degeneratif

Perubahan patologis pada struktur sendidegenerasi kartilago hialin

EPIDEMIOLOGY

Osteoarthritis(OA) is the most common

joint disease

OA of the knee joint is found in 70% of

the population over 60 years of age

Radiological evidence of OA can be found

in over 90 % of the population

LIMITED FUNCTION

OA may cause functional loss

Activites of daily living

Most important cause of

disability in old age

Major indication for joint

replacement surgery

CLASSIFICATION OF OA

Primary OA Secondary OA

Etiology is unknown Etiology is known

Osteoarthitis primer

Penyebabnya tidak diketahui

Sering menyerang sendi penahan beban tubuh

Osteoarthitis sekunder

Akibat trauma, kongenital,

penyakit sistemik

Terjadi pada umur lebih awal

daripada OA primer

AGE

Primary OA > 40 years

Direct correlation

Aging process

RISK FACTORS PRIMARY OA

Age

Sex

Obesity

Genetics

Trauma (daily)

SECONDARY OSTOARTHRITIS

Trauma

Previous joint disorders;

Congenital hip dislocation

Infection: Septic arthritis, Brucella, Tb

Inflammatory: RA, AS

Metabolic: Gout

Hematologic: Hemophilia

Endocrine: DM

ETIOLOGY OF OA

Cartilage properties

Biomechanical problem

CLINICAL SIGNS AND SYMPTOMS

Joint pain - degenerative

Stiffness following inactivity – 30 min

Limitation of ROM – later stages

Deformity – restricition of ADL

ETIOPATHOGENESIS OF OA

Dysfunction of joint cartilage

Condrocyte function: 1- Degredative enzymes

(metalloproteases)

2- Inhibitors

Degeneration and regeneration functions are

balanced

IL-1 , degredative enzymes + synovial

inflammation results: Breakdown of cartilage

PATHOLOGY OF OA

Fibrillation

Eburnation

Osteophytes

Subcondral cysts

LABORATORY FINDINGS

There are no pathognomonic

laboratory findings for OA

Laboratory analysis is performed for

differential diagnosis

RADIOLOGIC FINDINGS

Narrowing of joint space

(due to loss of cartilage)

Osteophytes

Subchondral (paraarticular) sclerosis

Bone cysts

RADIOLOGIC GRADE OF OA

G1 Normal

G2 Mild

G3 Moderate

G4 Severe

Kellgren Lawrence Classification

DIAGNOSIS OF OA

CLINICAL FINDINGS

Joint pain

+

RADIOLOGIC FINDINGS

Osteophytes

RADIOLOGIC FINDINGS?

GRADE 1 - 4?

TREATMENT OF OA

Symptomatic treatment

Structure modifying treatment

Surgical treatment

STRUCTURE MODIFYING TREATMENT

Hyaluronic acid injection (HA)

Glycose amino glycans (GAG)

PRIMARY PREVENTION OF OA ??

Regular exercises

Weight control

Prevention of trauma

Non-Pharmacologic Treatment

Patient education

Weight loss (if overweight)

Aerobic exercise programs

Physical therapy

Range-of-motion exercises Muscle-strengthening exercises

Assistive devices for ambulation Patellar taping Appropriate footwear Lateral-wedged insoles (for genu varum)

Bracing

Occupational therapy

Joint protection and energy conservation

PHARMACOLOGIC TREATMENT

Oral Systemic Medical Agents

- Analgesics (acetaminophen)

- NSAIDs

- Opioid analgesics

Intraarticular agents:

Hyaluronan

Glucocorticoids (effusion)

Topical agents

SYMPTOMATIC TREATMENT OF OA

Decrease of joint loading

- Weight control

- Splinting

- Walking sticks

Exercises

- Swimming

- Walking

- Strengthening

Patient education

INDICATIONS OF SURGICAL

INTERVENTION

Severe joint pain,

resistant to conservative treatment methods

Limitation of daily living activities

Deformity, angular deviations, instability

INVASIVE METHODS

Joint lavage

Arthroscopy

Cartilage grafting- genetic engineering

Surgery

Osteotomy

Joint replacement