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  • The most prevalent form of arthritis
  • May occur in virtually any joint of the body
  • Has no cure and leads to pain and joint dysfunction
  • The end result is loss of articular cartilage with secondary bone changes, including osteophytes, subchondral sclerosis, and subchondral cysts.
  • Classification is by single or multiple joint involvement.
  • Synonyms: Degenerative joint disease; Wear-and-tear arthritis
  • The knee is the most commonly affected joint, followed by the hand and hip.
  • In a study of 697 females >65 years old, knee arthritis occurred in 30%, hand arthritis in 15%, and hip arthritis in 8%.
  • Osteoarthritis, the most common form of arthritis, affects females more often than males.
  • In contrast to inflammatory arthritis, osteoarthritis occurs principally in individuals >60 years old.
  • In 1 study:
    • Hand osteoarthritis occurred in 23% of females >65 years old.
    • The most commonly affected joints were the DIP and 1st CMC joints.
Risk Factors
  • Obesity
  • AVN
  • Septic arthritis
  • Advancing age
  • Female gender
A genetic predisposition is thought to exist, but genes have not yet been identified.
  • No known cause of osteoarthritis (idiopathic osteoarthritis):
    • The common pathway is loss of the articular cartilage with progressive overloading of the joint.
  • Many conditions that injure the joint may lead to secondary arthritis.
    • Trauma: Posttraumatic arthritis
    • Infection: Postinfectious arthritis
    • AVN: Arthritis associated with the condition
Associated Conditions
No conditions are associated with osteoarthritis.
Signs and Symptoms
  • Discomfort with weightbearing and joint motion
  • Stiffness
  • Loss of function:
    • Inability to do heavy work
    • Inability to tie or put on shoes
    • Limitation to short distance walking
Pain and swelling that increase with activity or prolonged inactivity
Physical Exam
  • The principal features are:
    • Stiffness and loss of ROM
    • Joint effusion
    • Limb deformity
    • Painful joint motion
    • Gait disorder
No specific laboratory features
  • Radiography:
    • AP and lateral radiographs are the main imaging modalities.
    • In the knee, foot, and ankle, weightbearing radiographs are obtained.
  • MRI can be used to exclude other diagnoses such as AVN, stress fractures, and neoplasms.
Pathological Findings
Loss of the thickness and organization of the articular cartilage
Differential Diagnosis
  • The diagnosis of osteoarthritis is not difficult when the disease is in the moderate or advanced stage.
  • Early arthritis can be confused with the following conditions:
    • Tendinitis or bursitis
    • Stress fractures
    • Synovial proliferative disorders
General Measures
Rest, activity modification, weight loss, and NSAIDs
Special Therapy
Physical Therapy
  • Patients should begin a program to preserve muscle strength and ROM and to avoid contractures.
  • Heavy-impact activity (such as running, contact sports, and heavy work) exacerbates symptoms.
  • A cane used in the opposite hand substantially reduces the forces across the hip joint and will relieve discomfort and improve gait.
Complementary and Alternative Therapies
  • Acupuncture may provide pain relief for knee arthritis in the short term.
  • Many herbal medicines are used for the treatment of osteoarthritis.
    • Evidence to support their use is limited.
First Line
  • NSAIDs, including COX-2 inhibitors, are mainstays in the nonoperative treatment of arthritis.
    • Meta-analysis shows these medications to be slightly more effective than a placebo in the short term.
    • NSAIDs have a high rate of side effects, including gastrointestinal bleeding.
  • Acetaminophen is widely used for pain relief.
Second Line
  • The use of nutraceuticals, such as glucosamine and chondroitin sulfate, is controversial, with a recent study showing no benefit.
  • Intra-articular injection:
    • With corticosteroids, decreases pain for short periods
    • With hyaluronic acid, may have a small effect on knee pain
  • Opioid pain medicine may be used for severe pain in patients who are not operative candidates.
  • 2 main types of surgery: Realignment osteotomy and joint replacement
    • Realignment osteotomy:
      • The joint surfaces are repositioned by cutting the bone and changing the axis of weightbearing.
      • Purpose: Allows the healthiest articular cartilage to bear the most weight
      • May be combined with ligament or meniscal repair
    • Arthroplasty:
      • The arthritic joint surfaces are removed, and a new joint surface is implanted.
      • The bearing surface is typically metal on high-density polyethylene.
      • Examples are total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty.
Issues for Referral
Patients with end-stage arthritis or severe pain from arthritis should be referred to an orthopaedic surgeon for consideration of surgical treatment.
  • Osteoarthritis progressively worsens with time.
  • No cure exists.
  • Modern methods of joint replacement provide excellent function and pain relief.
  • Progressive arthritis leads to worsening deformity and stiffness.
    • In the lower extremity, patients may stop walking and rely on wheelchairs
    • In the upper extremity, prevents activities and leads to lack of function
  • Treatment also may lead to complications.
    • The side effects of NSAIDs include gastritis and gastrointestinal bleeding.
    • Surgical intervention may lead to infection, DVT, or failure of the replacement mechanical joint.
Patient Monitoring
  • Patients are followed at 3-12-month intervals, depending on the severity of their symptoms.
  • Plain radiographs are taken every 6-12 months.
715.9 Osteoarthritis, unspecified whether generalized or localized
Patient Teaching
  • Patients are:
    • Taught to avoid activities that worsen the pain
    • Shown how to prevent contractures
    • Encouraged to lose weight
  • Patients should be encouraged to maintain muscle strength and joint mobility.
  • Exercises that do not cause pain are best.
  • Activities with little or no impact include elliptical trainers, bicycling, swimming, and water aerobics or running.
Weight loss may help prevent joint degeneration.
Q: What can be done to prevent osteoarthritis?
A: In general, interventions have not been found to prevent osteoarthritis. However, osteoarthritis is associated with obesity, and weight loss may help prevent joint degeneration.
Q: When is surgery indicated for the treatment of osteoarthritis?
A: Surgery is the final treatment after nonoperative measures (such as muscle strengthening, ambulatory aids, and medications) have been tried. The most commonly performed surgery is total knee replacement.

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