arthritis
DESCRIPTION
TRANSCRIPT
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ARTHRITISHip and Knee
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AIMS
Types of arthritis Symptoms of arthritis Signs of arthritis Treatment of arthritis
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TYPES OF ARTHRITIS
Rheumatoid arthritis (RA) Osteoarthritis (OA)
Sero-negative arthritis Ankylosing spondylitis Reiter’s disease Crystal arthropathies
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RHEUMATOID ARTHRITIS
affects 3% population female> male (3:1) 80% RF 30% ANF HLA DR4 (chr 6)
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RHEUMATOID ARTHRITISPATHOLOGY Synovitis chronic infl, synovial hypertrophy, effusion Destruction proteolytic enzymes, pannus Deformity articular destruction, capsular stretching,
tendon rupture
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RHEUMATOID ARTHRITISEXTRA-ARTICULAR
nodules tendon sheath vasculitis myopathy and neuropathy reticulo-endothelial system visceral - lungs, heart, kidneys, brain, GI
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RHEUMATOID ARTHRITISEARLY SYMPTOMS
myopathy, tiredness, weight loss, malaise proximal finger joints wrists, feet, knees, shoulders start up pain tendon crepitus
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RHEUMATOID ARTHRITISEARLY JOINT CHANGES
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RHEUMATOID ARTHRITISLATE SYMPTOMS
joint destruction pain deformity instability
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RHEUMATOID ARTHRITISADVANCED JOINT CHANGES
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RHEUMATOID ARTHRITISX-RAY FINDINGS
joint space narrowing peri-articular osteopenia erosions
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RHEUMATOID ARTHRITISTREATMENT
stop synovitis prevent deformity reconstruct rehabilitate
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RHEUMATOID ARTHRITISPROGNOSIS
10% improve 60% intermittent, slowly worsening 20% severe joint erosion, multiple surgery 10% completely disabled
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OSTEOARTHRITIS
A chronic joint disorder in which there is
progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes) and capsular fibrosis
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OSTEOARTHRITISCLASSIFICATION
Primary or idiopathic
Secondary - infection - dysplasia - Perthes’ - SUFE - trauma - AVN
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OSTEOARTHRITISAETIOLOGY
Genetic metabolic hormonal mechanical ageing
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OSTEOARTHRITISMECHANISM 1
Disparity between:-
stress applied to articular cartilage and strength of articular cartilage
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OSTEOARTHRITISMECHANISM 2
Increased stress (F/A)
increased load eg BW or activity decreased area eg varus knee or dysplastic
hip
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OSTEOARTHRITISMECHANISM 3
Weak cartilage
age stiff eg ochronosis soft eg inflammation abnormal bony support eg AVN
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OSTEOARTHRITISX-RAY CHANGES
joint space narrowing subchondral sclerosis osteophytes cysts
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OSTEOARTHRITISX-RAY CHANGES
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ARTHRITISSYMPTOMS
pain swelling stiffness deformity instability loss of function
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ARTHRITISNON-SURGICAL TREATMENT
analgesia disease modifying drugs (RA) altered activity walking aids physiotherapy
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ARTHRITISSURGICAL TREATMENT
arthroscopy osteotomy arthrodesis excision arthroplasty replacement arthroplasty
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ARTHRITISKNEE ARTHROPLASTY
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JOINT REPLACEMENTINDICATIONS
Disabling pain
Functional limitations
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JOINT REPLACEMENTHISTORY
pain function medical expectations
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JOINT REPLACEMENTHISTORY - PAIN
Site radiation limiting activity disturbing sleep analgesics
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JOINT REPLACEMENTHISTORY - FUNCTION
Walking distance walking aids low chairs foot care stairs
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JOINT REPLACEMENTEXAMINATION
gait limb alignment range of movement stability peripheral circulation skin condition
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JOINT REPLACEMENTINVESTIGATION
X-ray - alignment - deformity - previous fractures and implants - AVN - osteophytes - bone loss CT, MRI, bone scan - rarely
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JOINT REPLACEMENTIDEAL
painless joint full range of movement stable permanent
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JOINT REPLACEMENTHIP COMPLICATIONS
dislocation - 1% loosening >90% 10y survival DVT / PE infection - 1%
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JOINT REPLACEMENTKNEE COMPLICATIONS
limited ROM patellar instability 3-5% loosening > 90% 10y survival DVT / PE infection - 2%
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ANKYLOSING SPONDYLITIS
0.2% of population mainly affects spine and SI joints male > female HLA B27 in 90% synovitis enthesopathy
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ANKYLOSING SPONDYLITISHIPS AND KNEES
flexion deformities arthritis with large osteophytes ankylosis
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ANKYLOSING SPONDYLITISDIAGNOSIS
Rome criteria
A - bilateral SI B - stiff lumbar spine - stiff thoracic spine A+ 1xB - decreased chest or 4xB expansion (<7cm) - >3/12 LBP - iritis
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ANKYLOSING SPONDYLITISX-RAY CHANGES
joint space narrowing large osteophytes heterotopic bone ankylosis