OSTEOARTHRITIS

dr. Ahmad Fariz Malvi Zamzam Zein, SpPD

FK UNSWAGATI – RSUD WALED
DEFINITION

A common degenerative disorder of the articular

cartilage associated with hypertrophic changes in the
bone.
Risk factors : genetic, female, past trauma, advancing
age, & obesity.
PATHOPHYSIOLOGY
Sign & Symptoms

 The most common symptoms: joint pain  worsen w/ activity,

esp following a period of rest ~ gelling phenomenon
 Morning stiffness < 30 min
 Crepitation
 Often asymmetric
 Risk factors : genetic, female, past trauma, advancing age, &
obesity.
Diagnosis

Primarily clinical diagnosis  Hx & PE important

Plain radiography can be helpful
Laboratory testing usually is NOT REQUIRED
Management
SURGERY

Surgery  pts whose symptoms

have not responded to other
treatments
The most effective surgical
intervention  total joint
replacement
Surgical outcome:
hip>knee>shoulder
OA HAND
OA HAND: SIGN & SYMPTOMS

Pain on range of motion

Hypertrophic changes at DIP &
PIP joints (Heberden nodes &
Bouchard nodes)
Tenderness over carpo-
metacarpal joint of digiti I
OA HAND:
PLAIN RADIOGRAPHY

1. Joint space narrowing

2. Osteophytes
3. Joint destruction
4. carpo-metacarpal joint
changes
HAND OA:
NON-PHARMACOLOGIC MANAGEMENT

Evaluate the ability to perform activities of daily living

Joint protection techniques
Provide assistive devices, as needed
Use thermal modalities  relief of pain & stiffness
Provide splints for pts w/ trapeziometacarpal joint OA
HAND OA:
PHARMACOLOGIC MANAGEMENT

Should use 1 or more of the following:

Topical capsaicin
Topical NSAID (esp > 75 yo, if compared w/ oral NSAID)
Oral NSAID
tramadol
Should NOT use the following:
Intraarticular therapies
Opioid analgesics
KNEE OA
KNEE OA: SIGN & SYMPTOM

Pain on ROM
Joint effusion
Crepitus on ROM
Presence of popliteal cyst
(Baker cyst)
Lateral instability
Valgus or vagus deformity
KNEE OA: PLAIN RADIOGRAPH

A anteroposterior view
B lateral view
1. Joint space narrowing
2. Osteophyte formation
KNEE OA:
NON-PHARMACOLOGIC MANAGEMENT

 Wear contralat wedge insoles with

 Strongly recommend: compartement OA
 Aerobic &/or resistance land-  Use of thermal agent
based exercise
 Receive walking aids, as needed
 Aquatic exercise
 Tai chi program
 Lose weight
 acupuncture
 Conditionally recommend:
 No recommendation regarding:
 Self-management program
 Balance exercise
 Manual therapy + supervised
exercise  Manual therapy w/o supervision
 Psychosos intervention  Wearing knee braces
 Medially directed patellar taping  Use laterally directed patellar
taping
KNEE OA:
PHARMACOLOGIC MANAGEMENT

 Conditionally recommend:
 Acetaminophen
 Oral NSAID
 Topical NSAID
 Tramadol
 Steroid intraarticular injection
 Conditionally recommend  SHOULD NOT:
 Chondroitin sulfate
 Glucosamine
 Topical capsaicin
KNEE OA:
HYALURONIC ACID INTRAARTICULAR INJECTION

Mechanisms:
Ideal indication :
moderate femorotibial OA Chondroprotection
w/o effusion Proteoglycan &
Possible indication : glycosaminoglycan synthesis
condropathy Antiinflammatory
femoropatellar OA Mechanical
Subchondral
Analgesic effect
OA HIP
HIP OA: SIGN & SYMPTOM

Pain on ROM
Pain in buttock
Limitation of ROM, esp
internal rotation
HIP OA: PLAIN RADIOGRAPH

Anteroposterior view
1. Joint space narrowing
2. Osteophyte formation
HIP OA:
NON-PHARMACOLOGIC MANAGEMENT

 Strongly recommend:
 Aerobic &/or resistance land-
based exercise
 Aquatic exercise
 Lose weight
 No recommendation regarding:
 Conditionally recommend:
 Balance exercise
 Self-management program
 Manual therapy w/o supervision
 Manual therapy + supervised
exercise  Tai chi
 Psychosos intervention
 Use of thermal agents
 Receive walking aids, as needed
HIP OA:
PHARMACOLOGIC MANAGEMENT

 Conditionally recommend:
 Acetaminophen
 Oral NSAID  NO recommendation
 Tramadol regarding:
 Steroid intraarticular injection  Topical NSAID
 Conditionally recommend   Duloxetine
SHOULD NOT:  Opioid analgesics
 Chondroitin sulfate
 Glucosamine
HIP OA:
HYALURONIC ACID INTRAARTICULAR INJECTION

Ideal indication :
moderate hip OA w/o
effusion, not hip
NO indication:
replacement candidate
Advanced hip OA
Possible indication :
Rapidly destructive hip OA
dysplasia (impingement)
TERIMA KASIH