For educational purpose of MBBS, BHMS and BAMS students. Osteoarhritis is a chronic degenerative joint disorder that affects weight bearing joints (most commonly Knee, hip and lumbar spine) and fingers (DIP joints). This ppt , in brief,highligts the signs and symptoms, early diagnosis and prompt treatment of osteoarthritis in order to give a better lifestyle to patients. In case of doubts querries or feedbacks, do contact me at dr.aakashnandu@gmail.com or whatsapp 9409012212

1. Osteoarthritis
Dr Aakash Nandu
M.S. Orthopaedics
Smit Orthopaedic Hospital, Anand

3. What is OA ?
• Degenerative disease of
Synovial joints characterized
by focal loss of articular
hyaline cartilage with
proliferation of new bone and
remodeling of bone contour.

4. Epidemiology
• Weight bearing joints ( knee and hip)
• Age > 60 yrs
• More common in women
• Familial Tendency

5. Etiology
• When there no obvious pre-
disposing factor
• Common form of OA
Primary
• Occurs in response to a
recognizable local or systemic
factor
Secondary

6. Traumatic
Inflammation
Neuropathies Developmental
Aseptic
necrosis
Endocine

7. Risk factors
Constitutional
1. Hereditary
2. Gender
3. Obesity
4. High BMD
Mechanical
1.Trauma
2. Joint shape
3. Alignment
4. Usage

8. Pathogenesis
Progressive destruction & loss of articular
cartilage and peri articular bone loss
Loss of subchondral bone which
becomes sclerotic
Increased Vascularity and cyst formation

9. Clinical features
• Increases with activity, relieved by rest
Pain
• For a brief period of time, usually <30 min
Morning stiffness
• Due to capsular thickening and blocking by osteophytes.
Restricted movements

10. Clinical features in Nodal Generalised OA
• Women 40-50 yrs of age
• Pain
• Stiffness
• Swelling on 1/1+ DIP joints
• Heberden’s nodes
• Involvement of 1st MCP joint
• Predisposition to OA at other joints (esp Knee)

11. Clinical features in knee OA
• Medial Tibio-femoral and patella
femoral joint involvement
• Pain localized to anterio-medial
aspect of knee and upper tibia
• Varus deformity
• Lurching / waddling gait

12. • Joint-line tenderness
• Restricted Movement
• Wasting of Quads
• Bony swelling around the joint

13. Clinical features in OA hip
• Superior > Anterior aspect of hip
• Pain is deep in groin area
• Antalgic gait
• Wasting of Quads and Gluteal muscles
• Restriction of internal rotation.

14. Comparison – Differential diagnosis
Osteoarthritis Rheumatoid
Arthritis
Gout
Age of onset 50 20 35 (men) 45
(women)
Morning stiffness Less than 30 min Longer than 1 hour Not seen
Pain with movement Increases Decreases -
Nodules Heberden’s Bouchard’s -
Systemic symptoms Absent Fatigue, Malaise Chills, Malaise,
Fever
Lab Findings Normal to mildly
+ve ESR, CRP
RA and Anti-CCP +ve Uric acid raised
Gouty crystals on
microscopy

15. Investigations
• 1 Xrays
• Joint space narrowing
• Subchondral sclerosis
• Osteophytes
• Subchondral cysts

16. 2. Blood tests
• ESR – Normal
• CRP – Normal
• CBC – Normal
• RA factor – Normal
• Uric Acid - Normal

17. 3. Synovial fluid analysis
• Straw coloured fluid
• Viscous with low turbidity
• CPPD and Calcium phosphate
• Negative for uric acid crystals

18. Treatment
Non
pharmacological
Pharmacological Surgery

19. Non Pharmacological
1. Lose weight
2. Exercise
3. Avoid sitting on floor / sitting
cross-legged / squatting
4. Avoid / reduce climbing stairs

20. 5. Avoid standing for >30min or walking >1km at a
stretch
6. Regular Physiotherapy
7. Identify other mechanical issues eg. Flat foot and
correct it

21. Pharmaco-
logical
PCM
Opioids
I.A. Inj
NSAIDS

22. Surgery
•1. HTO (high tibial osteotomy)

23. • 2. Medial Hemireplacement (UKR)

24. • 3. Total Knee Replacement (TKR)

25. Complications of OA
1. Deformities
2. Stiffness
3. Stress fractures
4. Neuropathies
5. Degenerative spine diseases
6. Indirect (lack of exercise leads to obesity, high blood pressure,
diabetes, cholesterol, heart diseases)

26. Thank you !!