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Osteoarthritis

Discussion

Osteoarthritis of the Knee

OA is defined as a chronic irreversible degenerative disease of articular cartilage
predisposing conditions
pathology and histology
clinical features
laboratory aspects

Osteoarthritis of the Knee »

Hip Osteoarthritis

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;
reference: A Heritable Predisposition to Osteoarthritis of the Hip

treatment options

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 insertionof 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;
- reference: Proximal femoral osteotomy as the primary operation for young adults who have osteoarthrosis of the hip.

Ankle:

reference: The Comparative Morphology of Idiopathic Ankle Osteoarthritis

Shoulder

Fingers and Hand (see also: 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 thedorsolateral aspects of DIP joints (see mucous cyst);
metacarpophalangeal (MCP) joints are typically spared

References