Ortho Oracle - orthopaedic operative atlas

Proteoglycans in Cartilage

(see also: cartilage topics) Discussion proteoglycan is a macromolecule constructed of a protein core to which many glycosaminoglycan chains are attached – protein with bound side chains (glycosaminoglycans); to this proteoglycan aggregate, hyaluronic acid is non covalently bound; in osteoarthritis, there is a characteristic reduction in a aggregrating proteoglycans; about 10% of wt of proteoglycan … Read more

Hyaluronic Acid

(see also: osteoarthritis of the knee) Discussion hyaluronic acid is a glycosaminoglycan found in synovial fluid & cartilage; complex sugar (not a protein) ancient molecule, highly conserved- identical function acts as lubricant and shock absorber; acts as barrier permitting metabolites to pass thru it by diffusion but resists penetration by bacteria and other infectious agents; … Read more

Hyaline Cartilage

Discussion hyaline cartilage is the most common variety of cartilage; it is found in costal cartilages, articular cartilages, epiphyseal plates, & majority of fetal skeleton that is later replaced by bone; chondrocytes, occupy lacunae generously distributed through the matrix; each peripheral lacuna typically houses a single chondrocyte; deeper lacunae may contain two or more chondrocytes; … Read more

Septic Arthritis

Discussion » orthopaedic infection menu general orders and treatment differential diagnosis » (also consider Brucella melitensis, Borrelia burgdorferi and Treponema pallidum) Painful knee–an unusual cause secondary to pseudomonas septic arthritis of the hip. Septic until proven otherwise: approach to and treatment of the septic joint in adult patients. Indicators for detection of septic arthritis in … Read more

Rheumatoid Arthritis

Discussion ARA criteria for RA pathogenesis differential diagnosis: spondyloarthropathies & related chronic seroneg arthritides; systemic lupus erythematosus; scleroderma; dermatomyositis; juvenile rheumatoid arthritis Clinical Aspects » Laboratory Aspects » Radiographic Aspects » Treatment of RA Medical Management of RA » Surgical Treatment cervical spine hand wrist elbow and shoulder: frequently there is concomitant shoulder and elbow … Read more

Psoriatic Arthritis

(see also: Spondyloarthropathies) Discussion psoriasis affects 1-2 % of U.S. population & typically presents w/ well-defined erythematous scaly plaques; only a minority of pts with psoriasis develop arthritis; when arthritis develops, it most often is an asymmetrical oligoarthritis, which at times may be quite destructive; some patients may develop spondylitis (usually will have HLA-B27 antigen); … Read more

Pseudogout and Chondrocalcinosis

Discussion acute arthritis caused by CPPD crystal-induced inflammation; almost as common as gout & may perfectly mimic gout during acute flare; pseudogout attacks occurring before age 50 are uncommon; see: pseudogout occurence after joint replacement references: A histological study of calcium pyrophosphate dihydrate crystal-deposition disease. Clinical features of pseudogout attack. A survey of 50 cases. … Read more

Polyarthralgia in the Child

(See also: synovial fluid exam:) Def: child w/ 2 to 4 swollen, warm, & moderately painful or tender joints; Symmetric Involvement Polyarticular JRA. Asymmetry suggests JRA: Polyarticular/Pauciarticular Trauma Leukemia Tuberculosis Fungal infections Hemophilia Lyme Disease Acute Rheumatic Fever Septic Arthritis Child Abuse


Discussion 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 … Read more

Juvenile Rheumatoid Arthritis

Discussion JRA is a persistent non infectious arthritis lasting more than 6 wks to 3 months after other possible etiologies have bee ruled out; most common chronic childhood rheumatoid dz; affects girls more than boys; synovial proliferation leads to joint destruction (chondrolysis) & soft tissue destruction; severe joint destruction is seen in only 5% of … Read more