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osteoarthritis
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Textbook Reading :
Osteoarthritis of the Knee
Presented by:
Advisors:dr. Felix Sander - dr. Zuwanda Then - dr. Angga Anggriawan
Supervisor:dr. M. Andry Usman, Sp.OT
C11110004 – Puspita Sary RazakC11110809 – Fadiah Gazzani RC11109367 – St. Maghfira A C11110262 – Rizna Ariani Said
C11110292 – Tenri Allo JamainC11110342 – HaslianiC11110101 – Godeberta Astria P
Anatomy of The Knee
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Anatomy of The Knee
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Anatomy of Cartilage
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Overview: Definition
Osteoarthritis (OA) is a chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes), cyst formation and sclerosis in the subchondral bone, mild synovitis and capsular fibrosis.
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Epidemiology• World Health Organization estimates that OA is a
cause of disability in at least 10% of the population over age 60 years.
• OA affects the lives of more than 20 million Americans.
• Knee OA alone was as often associated with disability as were heart and chronic lung.
• The increase in the prevalence of symptomatic OA with age, coupled with the inadequacy of symptom-relieving or disease-modifying treatment, contributes to its impact.
• The number of persons in the U.S. with arthritis is anticipated to rise from 15% of the population (40 million) in 1995 to 18% of the population (59 million) by 2020.Moskowitz, R. 2007. Osteoarthritis: Diagnosis and Medical/Surgical Management. 4th Edition. Lippincott Williams & Wilkins
Etiology
• Weakening of the articular cartilage• Increased mechanical stress in some part of
the articular surface
STRESSCartilage’s ability to withstand the
stress
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Pathogenesis
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Pathology
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Pathology
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Overview: Risk Factors
Cooper,C. 2014. Atlas of Osteoarthritis. Chapter 2: Epidemiology of osteoarthritis. Springer Healthcare
• Most of patient came, which is relatively obese,
complaining of chronic intermittent pain and
stiffness of the knee, difficult to go up and down
stairs, swelling
• Difficult to stand after a long term of sitting and
squatting
• Sometimes complain of crepitus
Clinical Features
Diagnosis
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Radiographic grading of OA :(Kellgreen – Lawrence) 0 : normal 1 : possible osteophytic lipping 2 : minimal osteophyte, joint space normal 3 : moderate marginal osteophyte, narrowing of joint space 4 : large osteophyte marked joint space narrowing severe sclerosis and definite bony attrition
Solomon L. Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.http://www.orthobullets.com/recon/5005/osteoarthritis
Diagnosis
Solomon L. Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.http://www.orthobullets.com/recon/5005/osteoarthritis
Clinical Approach to Knee Pain
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Clinical Approach to Knee Pain
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Clinical Approach to Knee Pain
Apley GrindingLachman Test (ACL)McMurray Maneuver(menisci)
Differential Diagnosis
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Differential Diagnosis
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Differential Diagnosis
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Differential Diagnosis
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
TreatmentThree observations should be borne in mind:
(1)symptoms characteristically wax and wane, and pain may subside spontaneously for long periods;
(2) some forms of OA actually become less painful with the passage of time and the patient may need no more than reassurance and a prescription for pain killers;
(3) the recognition (from serial x-rays) that the patient has a rapidly progressive type of OA may warrant an early move to reconstructive surgery before bone loss compromises the outcome of any operation.
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Early treatment
The principles :(1)maintain movement and muscle
strength(2) protect the joint from ‘overload’(3) relieve pain(4) modify daily activities.
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Early treatment
- Physical therapy- Load reduction- Analgesic medication
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Intermediate treatment
Joint debridement (removal of loose bodies, cartilage tags, interfering osteophytes or a torn or impinging acetabular or glenoid labrum) may give some improvement. This may be done either by arthroscopy or by open operation
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
Late treatment
Reconstructive surgery : - Realignment osteotomy- Joint replacement- Arthrodesis
Osteoarthritis . Apley’s System of Orthopaedics and Fractures. Ninth edition. UK: 2010.
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