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Predisposing Conditions
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Pathology and Histology
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Clinical Features
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Laboratory Aspects
- Osteoarthritis of the Knee:
- Hip:
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clinical features:
- pain on wt-bearing felt in the groin, buttock, or medial thigh;
- trendelenburg gait will decrease mechanical stress on joint and thereby lessen pain (see
forces acting on hip joint);
- pain during sleep results from loss of protective function of muscular splinting;
- in some cases, a patient w/ OA of the hip will experience acute hip pain which often correlates
w/ rupture of subcondral cyst into the joint;
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treatment options:
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arthrodesis
-
total hip replacement
- valgus extension osteotomy:
- may be indicated in younger patients with DJD w/ flattened or mushroom shaped head, an osteophyte on the medial side of femoral head, and an
osteophyte partially covering the true acetabular floor;
- technique is less useful for patients with primary hip disease or reduced range of motion;
- technique considerations:
- abductor lever arm is maintained by elevation of greater trochanter through the insertion of a portion of wedge taken from osteotomy, as
a graft under the greater trochanter;
- osteotomy shifts the center of the stress medially which improves joint mechanics;
- extension of the femoral head, recenters the head, and prevents anterior subluxation;
- anterior capsule is opened using the lateral approach;
- guide wires are inserted to help determine the proper bone cuts;
- proximal osteotomy is made 2 cm distal to the entry side for the blade plate;
- Proximal femoral osteotomy as the primary operation for young adults who have OA of the hip. SR D'souza et al. JBJS. Vol 80-A. No 10. Oct 1998. p 1428.
- Shoulder:
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arthrodesis
-
shoulder arthroplasty
- Fingers and Hand: (see
CMC arthritis)
- occurs most often in fifth or sixth decade of life;
- gradual onset of pain in the distal interphalangeal (DIP) joints;
- aggravating nocturnal fingertip pain and paresthesias may develop;
- Heberden's nodes:
- cystic swellings containing gelatinous hyaluronic acid appear on the dorsolateral aspects of DIP joints (see
mucous cyst);
- metacarpophalangeal (MCP) joints are typically spared;
Intertrochanteric osteotomy for osteoarthritis. A long term follow up. H. Weisl. JBJS Vol 62-B (1): 1980. p 37-42.
An Aggrecanase and Osteoarthritis.
