ORTHOPAEDICS

1. KNEE
OSTEOARTHRITIS
DR. PAWAN K. YADAV
D.ORTHO.,DNB(ORTHO)
BIRRD HOSPITAL, TIRUPATHI

4. • The most common musculoskeletal disorder
• Also known as degenerative arthritis and wear and
tear arthritis, it is considered to be the end point
of many different joint problems
• Characterised by pain localised around affected
joints, limitation of movement and loss of function
• There is no cure and no disease modifying drugs
are available
WHAT ?

5. PREVALENCE OF OSTEOARTHRITIS
• Affects 190 million worldwide
• Mainly middle-aged and older people
• Nearly 70% of people over 65 years have X-ray evidence
of OA
Lane 1997
• Globally, population is aging: those over 65 predicted to
increase to 800 million by 2025, double the figure in 1997

6. EPIDEMIOLOGY OF OSTEOARTHRITIS
• Strongly age related - peak onset age 50-60 years
• More common in women
• Different pathologic features occur to a variable degree in
different joints/people
• OA is slow to evolve and highly variable

7. PREVALENCE OF OSTEOARTHRITIS BY AGE
(RADIOGRAPHIC EVIDENCE)
Age (Years)
10%
70%
60%
50%
40%
30%
20%
Prevalence%
-30 30 40 50 60 70

8. Cartilage: a dense, elastic connective tissue
which acts as a protective layer at the end of
bones to cushion and protect them from
rubbing together.
WHY ?

16. RISK FACTORS FOR DEVELOPING OSTEOARTHRITIS
• Age - prevalence of OA in all joints increases with age
• Gender - women are at higher risk than men
• Genetics
• Injury to joints
• Obesity
• Underuse of joints

18. CLASSIFICATION
-Idiopathic (Cause is unknown)
-Secondary
-Post-traumatic after injury
-Congenital since birth
-Other bone and joint disorders e.g RA
-Metabolic
-Anatomical
-Inflammatory insult
-Miscellaneous (Obesity)

19. HOW ?
• Replacement of cartilage cells with less resistance tissue
• Cartilage breaks down and become thinner & reduced cushioning.
• bones start to rub together
• Bone spurs can develop as the cartilage wears away
• Swelling can occur if the synovial membrane becomes irritated, which can
lead to accumulation of excess fluid in the joint

20. SIGNS OF OSTEOARTHRITIS
• Stiffness
• Crepitus
• Swelling
• Deformity

21. SYMPTOMS OF OSTEOARTHRITIS
• Deep aching pain on or near the joint
• This usually takes time to develop, is mild-to-moderate and
can be exacerbated by using the affected joint and
improved with rest

22. SYMPTOMS OF OSTEOARTHRITIS
• Pain at rest or at night is a sign of severe disease
• Loss of movement can cause stiffness
• Cracking sound due to rubbing of bones
• Squatting and sitting cross- legged.
• Going up and down the staircase.

23. SEVERITY OF OSTEOARTHRITIS
• % of OA sufferers who describe symptoms as:
• Mild 27%
• Moderate 42%
• Severe 29%

24. ROLE OF INFLAMMATION IN OSTEOARTHRITIS
• OA is not characterised by a significant systemic
inflammatory process
• Skeith & Brocks 1994
• Inflammation, where present, is usually mild
• Hochberg 1995
• However, inflammation can be present in OA, at
least in some patients at some phases of the disease
• Creamer & Hochberg 1997

25. OSTEOARTHRITIS
TREATMENT MODALITIES
• Physical and psychological measures
• Pharmacologic therapy
• Surgery

26. APPROACH TO MEDICAL MANAGEMENT OF OA
AMERICAN COLLEGE OF RHEUMATOLOGY
GUIDELINES
• Non-pharmacologic therapy
• Patient education
• Self management programs (e.g., Arthritis
Self-Help Course)
• Health professional social support
• Weight loss (if overweight)

28. Approach to Medical Management of OA
American College of Rheumatology
Guidelines
• Nonpharmacologic therapy (cont.)
• Physical therapy
• Range of motion exercises
• Quadriceps strengthening exercises
• Assistive devices for ambulation
• Occupational therapy
• Joint protection and energy conservation
• Assistive devices for ADLs
• Aerobic exercise program

29. NON-PHARMACOLOGICAL
TREATMENT
-Patient education
-Weight reduction
-Motion & strengthening exercises
-Assisting devices (e.g., walking stick, cane
etc.)
-Conditioning exercises
-Corrective footwear
-Heat treatment

30. PHARMACOLOGICAL THERAPY
- Paracetamol
- NSAIDS
- Topical analgesics
- Opiod analgesics
- Intra-articular glucocorticoids
- Intra-articular Hyaluronic acid
injections

31. PYRAMID APPROACH
1 Patient education, physical and occupational
therapy, weight reduction, exercise, assistive
devices
2 Paracetamol
3 OTC NSAIDs
4 Prescription
NSAIDs
5 Surgery
•Hochberg and Creamer, 1997

32. SUPPLEMENT THERAPY
CHONDRO-PROTECTIVE AGENTS
- Glucosamine sulphate
- Chondroitin sulphate
- Anti-oxidants
- Joint nutrients like Boron,
Manganese, minerals etc.

35. SURGICAL THERAPY
- High Tibial Osteotomy
- Total Knee replacement

36. TIBIAL OSTEOTOMY
A) MEDICAL COMPARTMENT DAMAGE
B)& C) WEDGE OSTEOTOMY OF TIBIA
D) JOINT REPLACEMENT (TKR)

37. TOTAL KNEE REPLACEMENT