Oa

1. Treatment And
Management of
Osteoarthritis​

2. Investigations
• Laboratory investigations are usually within normal limits .​
• Radiological examination of the affected joint is the most
important diagnostic tool.​

3. X-ray

5. Synovial fluid analysis
• Clear fluid WBC <2000 cubic mm
• Normal viscosity

6. Arthroscopic Examination
• Arthroscopy allows earlier diagnosis by demonstrating the
more subtle cartilage changes that are not visible in x-rays.
• Reveals loose bodies and frayed meniscus.

7. CT and MRI
For early detection of osteocartilagenous fracture ,bone edema
or avascular necrosis.
For determination of severity of disease.

8. TREATMENT
Aims of treatment of OA
It can be illustrated by 4R”s
• Relieve pain
• Restore function
• Reduce disability if any
• Rehabilitation

9. Conservative Treatment
• Educate patient about disease and management.
• Weight loss- to prevent the progress.
• Physiotherapy – to prevent muscle atrophy
application of superficial heat(hot packs,heating pads,hot
water bottles) or cold(ice packs)

10. • Therapeutic exercises
Muscle strengthening- quadriceps exercise
Strengthening quadriceps musculatures with either isometric or
isotonic ,resisitve exercises.
• Walking with support (crutches held in opposite side)
• Braces to support joint.

12. Pharmacological measures

13. • Possible structure/disease modifying stuff
• Glucosamine
• Diacerein
• Cytokine inhibitors
• Cartilage repair
• Bisphosphonates
• Degradative enzyme inhibitors
• Tetracyclines, metalloproteinase inhibitors

14. Surgical Options

15. Proximal Tibial Osteotomy
• Osteoarthritis usually
affects the inside half (medial
compartment) of the knee
more often than the outside
(lateral compartment).
• This can lead to the lower
extremity becoming slightly
bowlegged, or in medical
terms, a genu varum
deformity

16. • The result is that the weight bearing line of the lower extremity
moves more medially (towards the medial compartment of the
knee).
• The end result is that there is more pressure on the medial joint
surfaces, which leads to more pain and faster degeneration.
• In some cases, re-aligning the angles in the lower extremity can
result in shifting the weight-bearing line to the lateral
compartment of the knee. This, presumably, places the majority of
the weight-bearing force into a healthier compartment. The result
is to reduce the pain and delay the progression of the degeneration
of the medial compartment.

17. • In the procedure to realign the angles,
a wedge of bone is removed from the
lateral side of the upper tibia.
• A staple or plate and screws are used
to hold the bone in place until it heals.
• This converts the extremity from
being bow-legged to knock-kneed.

18. Total Knee Replacement
• The ultimate solution for osteoarthritis of the knee is to
replace the joint surfaces with an artificial knee joint:
•Usually only considered in people over the age of 60
•Artificial knee joints last about 12 years in an elderly population
•Not recommended in younger patients because:
•The younger the patient, the more likely the artificial joint will fail
• Replacing the knee the second and third time is much harder and much less
likely to succeed.
• Younger patients are more active and place more stress on the artificial joint,
that can lead to loosening and failure earlier
• Younger patients are also more likely to outlive their artificial joint, and will
almost surely require a revision at some point down the road.
• Younger patients sometimes require the surgery (simply because
no other acceptable solution is available to treat their condition)

19. • The ends of the femur, tibia, and patella are shaped to
accept the artificial surfaces.
• The end result is that all moving surfaces of the knee are
metal against plastic

21. Arthrodesis
• Most suitable in OA of small joints
• If patient is young and involved in heavy occupation, it is
indicated to give him strong and stable klnee.
• Results in stiff knee.

22. Arthroscopic Debridement
• Palliative, temporizing treatment of OA knee.
• Removal of loose bodies, cartilage tags, thickened synovium,
osteophytes.

23. References
• Textbook of orthopedics John Abnezar
• Essential Orthopedics Maheshwori and Mhasker

24. THANK YOU