Dr DOSHI GURITNO SPOT

OSTEOARTHRITIS
Proses degeneratif
Non inflamasi
Kerusakan articuler cartilage dan bone formation
Definisi

WEAR AND TEAR

20 juta diderita penduduk USA
native
lutut:cina
panggul:hongkong
8 juta diderita penduduk UK
Sendi yg terkena:
GAMBARAN OA
Slow progressive
Cartilage Structure
Cartilage Components :
Water (70%-80%)
Chondrocytes (1-2%)
Solid phase (20 30%) :
- Collagen
- Other matrix proteins
- Hyaluronic acid
- Glycosaminoglycans/aggrecans
- Small proteoglycans
Matrix structure
Faktor pengaruh

Usia:>55 th
Wanita
Bone deformity
Joint injury
Obesity
Kerja khusus
Gejala:
Nyeri makin lama bertambah
Tenderness
Kekakuan sendi
Loss flexibility
Grating sensation
Bone spur
pemeriksaan

X ray
Cartilage tak terlihat
Penyempitan celah sendi
Spur formation
 OA HIP
radiologis
Radiology findings in Knee OA
 Grade OA-Ahlback
1. Celah sendi normal
2. Celah sendi menyempit, osteofit (+)
3. Celah sendi menyempit, condyle femur dan tibia
saling bertemu (kissing), osteofit (+)
4. Celah sendi sangat menyempit dengan destruksi
sendi yang jelas, terdapat kista di bawah rawan
sendi dengan alignment yang berubah menjadi
varus atau valgus.

15
 MRI
terbaik
laboratorium
Darah :untuk membedakan infesi,gout,rheumatoid

Punksi :Normal berwarna kuning jernih dan kental

Current management of Knee OA

Conservative treatment
- non pharmacological
- pharmacological
Surgical treatment
- arthroscopy
- realignment osteotomy
- arthrodesis
- unicompartment knee arthroplasty
- total knee replacement
PRINSIP PENANGANAN

Life style
RICE
Menurunkan berat badan
Kompres panas >>>>>mengurangi kekakuan
Kompres dingin>>>>>mengurangi nyeri dan spasme
.

Obat anti nyeri

Injeksi cortisone?
Injeksi lubricant
Realigntment joint
Joint replacement
.
BRACING
Arthroscopy
Role :
- Preventive
- Diagnostic
- Therapeutic
- Future
Lavage & debridement
- Wash out debris & dilute inflammatory mediators
Biological resurfacing
- Marrow stimulation
- Autologous transplantation
Realignment osteotomy
Indication :
Varus with medial compartment arthrosis
Valgus with lateral compartment arthrosis
Objectives :
Decrease medial / lateral compartment loads / redistribution
loads
Diminishes symptoms
Improves function
Disadvantages
Imbalance ligament
Laxity,
Tethering effect
Mechanical deteriorisation
Unicompartment knee arthroplasty
Knee replacement:
TKR
Hip replacement
 Future treatment of Osteoarthritis

Biological restoration of articular cartilage:

Cartilage Stimulation
to repair by biological enhancement of bone marrow progenitor
cells or growth factors
Cartilage Transplantation
1. Osteochondral autografts
- small defects (e.g. ACI)
2. Osteochondral allografts
- large, traumatic femoral osteo
- long-term success ??
3. Tissue engineering : to transplant
- cui
Platelet rich plasma therapy
Platelet-rich plasma (PRP) is a fairly new treatment tool for
a variety of musculoskeletal problems
PRP is a bioactive regenerative therapy that theoretically
augments tissue healing through the natural healing
cascade.
PRP is virtually a cocktail of many proteins that collectively
stimulate repair and regeneration
Rich of growth factors
PRP counteracts the effects of IL-1 beta and NFkB on genes
that are responsible for the building up of collagen and
breakdown of cartilage cells
KESIMPULAN
Diperlukan penanganan dini untuk memperlambat OA
Terima kasih