Textbook Reading

OSTEOARTHRITIS














PEMBIMBING:
dr. Salman Al Wahaby
dr. Rangga Arieza
dr. Fahroni Cahyono Winata

SUPERVISOR
dr. Karya Triko Biakto, Sp.OT (K) Spine

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
BAGIAN ORTOPEDI DAN TRAUMATOLOGI
FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
MAKASSAR
2013

Muh. Zulfadli
Devy Lianto
Hadriani
Inayah S. Abubakar
Muh. Nirsyad


DEFINITION
Osteoarthritis (OA) is a chronic disorder of
synovial joints in which
Progressive softening and disintegration of articular
cartilage
New growth of cartilage and bone at the joint
margins (osteophytes)
Cyst formation
Sclerosis in the subchondral bone
Mild synovitis
Capsular fibrosis.
Etiology
Primer
Genetic
Endocrine
Metabolism
Secondary
Trauma
Infection
Obesity
Congenital
PREVALENCE
The primary or idiopathic type: more
common in adult women
The secondary type: more common in adult
men.
The knee is the most commonly affected
joint, followed by hand and hip.

RISK FACTOR
Trauma
Occupation
Obesity
Family history
PATHOPHYSIOLOGY
Theory 1
Initiating event is fatigue fracture of collagen
meshwork, followed by:
Increased hydration of articular cartilage
Loss of proteoglycans from matrix
Increased collagenolytic activity collagen loss
PATHOPHYSIOLOGY
Initial lesions
microfractures of
subchondral bone
Healing
Ingrowth of blood
vessels from
subchondral bone
Osteophyte
formation
Stress gradient
Fibrillation of
cartilage, & deep
clefts
PATHOLOGY
Cardinal features:
Progressive cartilage desruction
Subarticular cyst formation
Sclerosis of the surrounding bone
Osteophyte formation
SITE OF SYMPTOMPS
Centre either on one or two of the
weightbearing joints:
Hip
Knee
Interphalangeal joint
Any joint that has suffered a previous
affliction
SYMPTOMPS AND SIGNS
SYMPTOMPS
Pain
Stiffness (Articular
Gelling)
Swelling, may be
intermittent or
continous
Deformity
Loss of function
SIGNS
Joint swelling
Muscle wasting
Deformity
Local tenderness
Crepitus
Limited movement
Instability
HEBERDENS NODES
LABORATORY EXAMINATION
Does not reveal any evidence of systemic
disease
Synovial fluid:
Increased in mucin content
OA is non-inflammatory, with a white blood cell
count <2000/mm3
IMAGING: X-RAY
Cardinal Signs of
Osteoarthritis:
Narrowing of the Joint
Space
Subchondral sclerosis
Marginal osteophytes
Subchondral cysts
Bone remodelling
IMAGING: X-RAY
KELLGREN-LAWRENCE CLASSIFICATION
Grade I: Small osteophytes, joint space normal
Grade II: Small osteophytes, possible narrowing of
the joint
Grade III: Multiple, moderately sied osteophytes,
definite joint space narrowing, some sclerotic
areas, possible deformation of bone ends
Grade IV: Multiple large osteophytes, severe joint
space narrowing, marked sclerosis and definite
bony and deformity
OTHER IMAGING MODALITIES
Arthroscopy
Cartilage damage before x-ray changes
appear
Radionuclide Scanning
Increased activity during the bone phase in
the subchondral regions of affected joints
CT and MRI
TREATMENT
Non operative treatment
Non pharmacologic
Pharmacologic
Operative
PROGNOSIS
Osteoarthritis progressively worsen with
time.
Modern methods of joint replacement provide
excellent function and pain relief.

COMPLICATION
Deformity and stiffness.
Treatment also may lead to complications.
The side effects of NSAIDs gastritis and
gastrointestinal bleeding.
Surgical intervention may lead to infection, DVT,
or failure of the replacement mechanical joint.

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