osteoarthritis dr sami abdallah. anatomy of synovial joints:

OSTEOARTHRITIS

Dr Sami Abdallah

• Anatomy of synovial joints:

MECHANISMS FOR MAINTAININGJOINT STABILITY• Alignment of joint components• Shape and fit of articular surfaces• Adhesive property of synovial fluid• Integrity of capsule and ligaments• Muscle tone and power• Neurological control of balance

THREATS TO CARTILAGE INTEGRITY• Loss of joint stability• Localized increase in loading stress• Increased stiffness of the cartilage• Inflammatory (enzymatic) degradation• Restriction of free joint movement• Sclerosis in the subchondral bone

• Osteoarthritis (OA) is a slowly progressive chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage

• The commonest of all joints diseases

• Asymmetrical affection• No systemic manifestations• Degenerative disease with some inflammatory

process

• New growth of cartilage and bone at the joint margins(osteophytes)

• Cyst formation and sclerosis in the subchondral bone

• Mild synovitis and capsular fibrosis

Prevalence

• Universal disorder• Males = females• All people > 65 years • 40 % of people reaching 40 years• Racial distribution• Hips, knees and spine are commonly affected

Prevalence

Risk factors• Joint dysplasia• Obesity • Bone density• Trauma• Family history• Occupation

Pathology

• The cardinal features are: Progressive cartilage destruction Subarticular cyst formation Sclerosis of the surrounding bone Osteophyte formation Capsular fibrosis

Clinical features

Symptoms • Pain• Swelling• Deformity • Stifness • Loss of function

Signs• Swelling • Muscle wasting• Tenderness• Instability • Crepitus

Clinical types:• Monoarticular The classic form of OA

Clinical types:• Monoarticular• Pauciarticular

Clinical types:• Monoarticular• Pauciarticular• Generalized The commenest type of OAAffects middle aged womenSmall joints

Complications• Capsular herniation• Loose bodies• Rotator cuff dysfunction• Spinal canal stenosis

Imaging

• X rays

• Radioisotope scanning

• CT and MRI

• Arthroscopy

EARLY TREATMENT

PRINCIPLES

• To maintain movement and muscle strength• To protect the joint from overload• To modify the daily activities

• Physeotherapy

• Physeotherapy• Load reduction

• Physeotherapy• Load reduction• Analgesia

INTERMEDIATE TREATMENT

• Joint debridement• Corrective osteotomy

LATE TREATMENT

• Re-alignment osteotomy• Joint replacement• Arthrodesis

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