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The term ‘osteoarthritis’ applies particularly to the degeneration and excessive wear of articular cartilage, although gradual changes in underlying bone tissue (subchondral bone) also occur. The condition is one which develops and progresses with increasing age. It may be ‘primary’ or ‘secondary’.
– Primary osteoarthritis, the cause of which is unknown, occurs most frequently in women and in people with diabetes. Obesity is probably of no significance so far as onset of the disease is concerned, but it does accelerate the degenerative process once it has begun.

– Secondary osteoarthritis may follow either injury or joint disease. Fractures of articular surfaces, including damaged cartilage, ligament injuries, and dislocations are all possible causes, as are infections
and rheumatoid arthritis. Persistent inappropriate loading of joints, for example in joggers who run on a camber, may in rare cases also result in osteoarthritis.

Pathological changes

Whether osteoarthritis is primary or secondary, the changes that occur in the joints are similar. Initially the articular cartilage softens. Subsequently the surface becomes uneven, and the cartilage ‘frays’ and develops cracks which may extend down to the bone beneath. Ultimately the cartilage is worn away to reveal the bone which then has to serve as the loadbearing surface of the joint. Simultaneously the bone hardens (sclerosis) and areas of low density (cysts) begin to form. New cartilage cells laid down around theworn cartilage become ossified, and bony projections (osteophytes) are formed as a result of thickening of the joint capsule. The changes are seen most frequently in the hip and knee joints, and less frequently in the ankle, and are clearly visible on X-ray examination carried out with the joint under load.

Symptoms and diagnosis

pain. Some pain is usually present. Even when it is absent during normal daily activities, it can often be precipitated by increasing the load on the affected joint. Initially pain develops gradually, and in athletes it may disappear during warm-up only to return once training or competition is over. Pain at rest occurs when osteoarthritis has reached an advanced stage and at this point sleep may be disturbed.

Joint abnormalities.A variety of changes may be found around an osteoarthritic joint on clinical examination. They include swelling, impaired range of movement, muscle hypotrophy (loss of mass), tenderness, crepitus, local increased temperature, and instability and/or abnormal joint movements resulting from ligament laxity.

Stiffness. Stiffness typically occurs after a period of inactivity, and a limp may also be present. It is most common in the morning.

X-ray changes. These include narrowing of the joint space, cysts, osteophytes, and sclerosis. There may also be evidence of increased production of synovial fluid.


The changes of osteoarthritis cannot be reversed, but a variety of approaches may be adopted to relieve symptoms and to delay further degeneration.

– The load on the affected joint should be reduced. It may be necessary to discontinue pounding and weightbearing sporting activity if a hip or knee is affected, in which case physical fitness can be maintained by cycling or swimming.
– Active mobility and muscle-strengthening exercises should be carried out under the direction of a physical therapist (and possibly in a pool). Passive exercises—those that involve no effort on the part of the patient, whose joints are manipulated—should be avoided.
– Ultrasound, shortwave therapy and hot packs can have a beneficial psychological effect, and a heat retainer may be used.
– A walking-stick, used on the healthy side when one hip or knee is affected, or lightweight shockabsorbing hiking poles, can be used.
– Bandages or braces of various sorts may be used to relieve the load on joints.
– Anti-inflammatory and pain-relieving medication may be prescribed.
– Surgery may be necessary when the degenerative changes are severe.

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