Textbook Reading :

Osteoarthritis of the
Knee
Presented by:
C11110004 Puspita Sary
C11110292 Tenri Allo
Razak
Jamain
C11110809 Fadiah Gazzani
C11110342 Hasliani
R
C11110101 Godeberta
C11109367 St. Maghfira A
Astria P
Advisors:
C11110262 Rizna Ariani
Said
dr.
Felix Sander - dr. Zuwanda Then - dr. Angga

Anggriawan
Supervisor:
dr. M. Andry Usman, Sp.OT

Anatomy of The Knee

Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Anatomy of The Knee

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Anatomy of Cartilage

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Overview: Definition
Osteoarthritis (OA) is a chronic disorder
of synovial joints in which there is
progressive softening and disintegration
of articular cartilage accompanied by
new growth of cartilage and bone at the
joint
margins
(osteophytes),
cyst
formation
and
sclerosis
in
the
subchondral bone, mild synovitis and
capsular fibrosis.
Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Epidemiology
World Health Organization estimates that OA is a
cause of disability in at least 10% of the
population over age 60 years.
OA affects the lives of more than 20 million
Americans.
Knee OA alone was as often associated with
disability as were heart and chronic lung.
The increase in the prevalence of symptomatic
OA with age, coupled with the inadequacy of
symptom-relieving
or
disease-modifying
treatment, contributes to its impact.
The number of persons in the U.S. with arthritis is
anticipated to rise from 15% of the population (40
million) in 1995 to 18% of the population (59

Moskowitz, R. 2007. Osteoarthritis: Diagnosis and Medical/Surgical Management. 4th Edition. Lippincott

Etiology
STRESS

Cartilages
ability to
withstand
the stress

Weakening of the articular cartilage

Increased mechanical stress in some
part of the articular surface
Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Pathogenesis

Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Pathology

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Pathology

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Overview: Risk Factors

Cooper,C. 2014. Atlas of Osteoarthritis. Chapter 2: Epidemiology of osteoarthritis. Springer Healthcare

Clinical Features
Most of patient came, which is relatively obese,
complaining of chronic intermittent pain and
stiffness of the knee, difficult to go up and down
stairs, swelling
Difficult to stand after a long term of sitting and
squatting
Sometimes complain of crepitus

Diagnosis

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Diagnosis

Radiographic grading of OA :
(Kellgreen Lawrence)
0
1
2
3

:
:
:
:

normal
possible osteophytic lipping
minimal osteophyte, joint space normal
moderate marginal osteophyte, narrowing
of joint space
4 : large osteophyte marked joint
space narrowing severe sclerosis
and definite bony attrition
Solomon L. Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK:
2010.
http://www.orthobullets.com/recon/5005/osteoarthritis

Solomon L. Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK:
2010.
http://www.orthobullets.com/recon/5005/osteoarthritis

Clinical Approach to Knee Pain

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Clinical Approach to Knee Pain

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Clinical Approach to Knee Pain

McMurray
Maneuver
(menisci)

Lachman Test
(ACL)

Apley Grinding

Differential Diagnosis

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Differential Diagnosis

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Differential Diagnosis

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Differential Diagnosis

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Treatment
Three observations should be borne in mind:
(1)symptoms characteristically wax and wane, and
pain may subside spontaneously for long periods;
(2) some forms of OA actually become less painful with
the passage of time and the patient may need no
more than reassurance and a prescription for pain
killers;
(3) the recognition (from serial x-rays) that the patient
has a rapidly progressive type of OA may warrant an
early move to reconstructive surgery before bone
loss compromises the outcome of any operation.
Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Early treatment
The principles :
(1)maintain movement and muscle
strength
(2) protect the joint from overload
(3) relieve pain
(4) modify daily activities.

Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Early treatment
- Physical therapy
- Load reduction
- Analgesic medication

Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Intermediate treatment
Joint debridement (removal of
loose
bodies,
cartilage
tags,
interfering osteophytes or a torn or
impinging acetabular or glenoid
labrum)
may
give
some
improvement. This may be done
either by arthroscopy or by open
operation
Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

Late treatment
Reconstructive surgery :
- Realignment osteotomy
- Joint replacement
- Arthrodesis

Osteoarthritis . Apleys System of Orthopaedics and Fractures. Ninth edition. UK: 2010.

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