OSTEOARTHRITIS

dr. Ahmad Fariz Malvi Zamzam Zein, SpPD

FK UNSWAGATI RSUD WALED
DEFINITION

A common degenerative disorder of the articular

cartilage associated with hypertrophic changes in the
bone.
Risk factors : genetic, female, past trauma, advancing
age, & obesity.
PATHOPHYSIOLOGY
Sign & Symptoms

The most common symptoms: joint pain worsen w/

activity, esp following a period of rest ~ gelling
phenomenon
Morning stiffness < 30 min
Crepitation
Often asymmetric
Risk factors : genetic, female, past trauma, advancing
age, & obesity.
Diagnosis

Primarily clinical diagnosis Hx & PE important

Plain radiography can be helpful
Laboratory testing usually is NOT REQUIRED
Management
SURGERY

Surgery pts whose symptoms

have not responded to other
treatments
The most effective surgical
intervention total joint
replacement
Surgical outcome:
hip>knee>shoulder
OA HAND
OA HAND: SIGN & SYMPTOMS

Pain on range of motion

Hypertrophic changes at DIP &
PIP joints (Heberden nodes &
Bouchard nodes)
Tenderness over carpo-
metacarpal joint of digiti I
OA HAND:
PLAIN RADIOGRAPHY

1. Joint space narrowing

2. Osteophytes
3. Joint destruction
4. carpo-metacarpal joint
changes
HAND OA:
NON-PHARMACOLOGIC
MANAGEMENT

Evaluate the ability to perform activities of daily living

Joint protection techniques
Provide assistive devices, as needed
Use thermal modalities relief of pain & stiffness
Provide splints for pts w/ trapeziometacarpal joint OA
HAND OA:
PHARMACOLOGIC MANAGEMENT

Should use 1 or more of the following:

Topical capsaicin
Topical NSAID (esp > 75 yo, if compared w/ oral NSAID)
Oral NSAID
tramadol
Should NOT use the following:
Intraarticular therapies
Opioid analgesics
KNEE OA
KNEE OA: SIGN & SYMPTOM

Pain on ROM
Joint effusion
Crepitus on ROM
Presence of popliteal cyst
(Baker cyst)
Lateral instability
Valgus or vagus deformity
KNEE OA: PLAIN RADIOGRAPH

A anteroposterior view
B lateral view
1. Joint space narrowing
2. Osteophyte formation
KNEE OA:
NON-PHARMACOLOGIC
MANAGEMENT

Strongly recommend: Wear contralat wedge insoles with

compartement OA
Aerobic &/or resistance land-
Use of thermal agent
based exercise
Receive walking aids, as needed
Aquatic exercise
Tai chi program
Lose weight
acupuncture
Conditionally recommend:
No recommendation regarding:
Self-management program
Balance exercise
Manual therapy + supervised
Manual therapy w/o supervision
exercise
Wearing knee braces
Psychosos intervention
Use laterally directed patellar
Medially directed patellar taping
taping
KNEE OA:
PHARMACOLOGIC MANAGEMENT

Conditionally recommend:
Acetaminophen
Oral NSAID
Topical NSAID
Tramadol
Steroid intraarticular injection
Conditionally recommend SHOULD NOT:
Chondroitin sulfate
Glucosamine
Topical capsaicin
KNEE OA:
HYALURONIC ACID INTRAARTICULAR
INJECTION

Ideal indication :
Mechanisms:
moderate femorotibial OA
w/o effusion Chondroprotection
Possible indication : Proteoglycan &
condropathy glycosaminoglycan synthesis
Antiinflammatory
femoropatellar OA
Mechanical
Subchondral
Analgesic effect
OA HIP
HIP OA: SIGN & SYMPTOM

Pain on ROM
Pain in buttock
Limitation of ROM, esp
internal rotation
HIP OA: PLAIN RADIOGRAPH

Anteroposterior view
1. Joint space narrowing
2. Osteophyte formation
HIP OA:
NON-PHARMACOLOGIC
MANAGEMENT

Strongly recommend:
Aerobic &/or resistance land-
based exercise
Aquatic exercise
Lose weight
Conditionally recommend: No recommendation
Self-management program regarding:
Manual therapy + supervised Balance exercise
exercise
Psychosos intervention
Manual therapy w/o
Use of thermal agents supervision
Receive walking aids, as needed Tai chi
HIP OA:
PHARMACOLOGIC MANAGEMENT

Conditionally recommend:
Acetaminophen
Oral NSAID
Tramadol NO recommendation
Steroid intraarticular injection
regarding:
Conditionally recommend
Topical NSAID
SHOULD NOT:
Chondroitin sulfate Duloxetine
Glucosamine Opioid analgesics
HIP OA:
HYALURONIC ACID INTRAARTICULAR
INJECTION

Ideal indication :
moderate hip OA w/o
effusion, not hip
replacement candidate
Possible indication :
dysplasia (impingement)
NO indication:
Advanced hip OA
Rapidly destructive hip OA
TERIMA KASIH