Osteoarthritis

OSTEOARTHRITIS
DR.FAIZAN IQBAL
ASSISTANT PROFESSOR ORTHOPEDICS

BAQAI MEDICAL UNIVERSITY
LEARNING OBJECTIVES:
At the end of this session you will be able to:
•Definition of osteoarthritis?
•Distinguish normal and abnormal knee radiograph.
•What is Outerbridge grading?
•What are the Clinical features of osteoarthritis?
•What are the radiographic findings in advanced osteoarthritis?
•Management of osteoarthritis?
DEFINITION
• Osteoarthritis OA is a degenerative disease of synovial
joint, characterized by
 Breakdown of articular cartilage

 Proliferative changes of surrounding bones
 Progressive softening and disintegration of articular
cartilage
 New growth of cartilage and bone at the joint margins
( osteophytes)
NORMAL KNEE RADIOGRAPH
EPIDEMIOLOGY
• Osteoarthritis(OA) is the most common joint disease.
• OA of the knee joint is found in 70% of the population over

60 years of age.
• Radiological evidence of OA can be found in over 90 % of the

population
OUTERBRIDGE GRADING:
Etiology :
• Disparity between mechanical stress and
ability to withstand stress
• PRIMARY : cause not known

• SECONDARY : follows demonstrable
abnormality-
Inflammatory/post-traumatic/septic arthritis.
RISK FACTORS FOR OA
• Advancing Age
• Female Gender
• Obesity
• Genetics/family history
PATHOLOGY-CARDINAL FEATURES
• Progressive cartilage destruction
• Narrowing of joint spaces
• Subarticular cyst formation
• Sclerosis of subchondral bone
• Osteophyte formation
CLINICAL FEATURES OF OA
• Joint pain - degenerative
• Stiffness following inactivity – 30 min
• Limitation of ROM – later stages
• Deformity (Varus/Valgus)
• Loss of function
• Instability
DEFORMITY
INVESTIGATIONS:
• RADIOGRAPHIC VIEWS:
1. Rosenberg view/Tunnel view.
- 45 Degree flexion weight bearing view.
2. Standing Scannogram-
- Deformity assessment
Standing Scannogram Lower Limb
• RATIONALE OF TUNNEL VIEW:
- Most early cartilage loss is seen in 30-60

degree flexion.
- Can be missed in extension.
OA OF HIP JOINT
• More common in males over 40 years of age
• Joint stiffness
• Pain of hip, gluteal and groin areas radiating to
the knee
• Mechanical pain- Nature
• Limited walking function
LABORATORY FINDINGS OF OA
• There are no pathognomonic laboratory

findings for OA
• Laboratory analysis is performed to rule

out differential diagnosis
DIAGNOSIS OF OA
CLINICAL FINDINGS
Joint pain
+
RADIOLOGIC FINDINGS
Osteophytes
DIFFERENTIAL DIGANOSIS
• Rheumatoid arthritis
• Septic arthritis
• Gouty arthritis
• Psoriatic arthritis
• Tuberculosis arthritis
SYNOVIAL FLUID ANALYSIS
TREATMENT OF OA
• NON-PHARMACOLOGICAL THERAPY:
(ELM POPI)
Education
Lifestyle Management
- weight loss
- reduce sport
Physiotherapy- Straight leg raise/Quadripceps/Hamstring
Orthotics
- walking stick
- braces
Pharmaceuticals
- NSAIDS
- acetominophen
- glucosamine
Injections joint
- cortisone
- hyaluronic acid
TREATMENT-LATE OA
• Arthroplasty- Total knee replacement.
INDICATIONS:
- Intractable pain despite conservative
treatment is the only indication of surgery.
MCQ 1:
Which part of joint does osteoarthritis usually
affect?
1.Bone
2.Cartilage
3.Tendon
4.All of above
ANSWER
• B
In osteoarthritis, the cartilage wears away,

leaving the bones beneath it to rub together.
MCQ 2
• Which of these makes it more likely to get
osteoarthritis?
• Young age
• Excessive body weight
• Too little body weight
• Back pain
• None of above
ANSWER
B
Researchers think that osteoarthritis is caused
by a combination of advancing age, excess body
weight, past joint injury, and family history
MCQ 3
• When a person gets osteoarthritis of the hip,
where else might the pain show up?
1.Arm
2.Groin
3.Feet
4.Shoulders
5.All of above
ANSWER
B
Osteoarthritis of the hip can cause severe

disability. The pain can also appear in the groin,
knees, inner thigh, and buttocks
• How can xray help a healthcare provider to
diagnose osteoarthritis?
1.It can show cartilage loss

2.It can show bone damage
3.It can show bone spurs
4.All of above
ANSWER
• D
An X-ray may not show joint damage early on in
the condition. To help diagnose osteoarthritis,
the healthcare provider will also note
symptoms and when they appeared. They will
also look at the affected joints. The provider
will also do a physical exam and take a health
history that describes the symptoms, and
when and how they started
• Which of these medicines used to treat
osteoarthritis?
1.Aspirin
2.Acetaminophen
3.Corticosteroid injections
4.All of above
ANSWER
D
All of these medicines are used for pain relief in

osteoarthritis.
THANKYOU!

Osteoarthritis

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OSTEOARTHRITIS

ASSISTANT PROFESSOR ORTHOPEDICS

 Breakdown of articular cartilage

• OA of the knee joint is found in 70% of the population over

• Radiological evidence of OA can be found in over 90 % of the

• PRIMARY : cause not known

1. Rosenberg view/Tunnel view.

- 45 Degree flexion weight bearing view.

- Most early cartilage loss is seen in 30-60

• There are no pathognomonic laboratory

• Laboratory analysis is performed to rule

In osteoarthritis, the cartilage wears away,

Osteoarthritis of the hip can cause severe

1.It can show cartilage loss

All of these medicines are used for pain relief in

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