1. OSTEOARTHRITIS Dr Sami Abdallah

2. Anatomy of synovial joints:

3. MECHANISMS FOR MAINTAININGJOINT STABILITY Alignment of joint components Shape and fit of articular surfaces Adhesive property of synovial fluid Integrity of capsule and ligaments Muscle tone and power Neurological control of balance

4. THREATS TO CARTILAGE INTEGRITY Loss of joint stability Localized increase in loading stress Increased stiffness of the cartilage Inflammatory (enzymatic) degradation Restriction of free joint movement Sclerosis in the subchondral bone

5. Osteoarthritis (OA) is a slowly progressive chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage The commonest of all joints diseases

6. Asymmetrical affection No systemic manifestations Degenerative disease with some inflammatory process

7. New growth of cartilage and bone at the joint margins(osteophytes) Cyst formation and sclerosis in the subchondral bone Mild synovitis and capsular fibrosis

8. Prevalence Universal disorder Males = females All people > 65 years 40 % of people reaching 40 years Racial distribution Hips, knees and spine are commonly affected

9. Prevalence Risk factors Joint dysplasia Obesity Bone density Trauma Family history Occupation

10. Pathology The cardinal features are:  Progressive cartilage destruction  Subarticular cyst formation  Sclerosis of the surrounding bone  Osteophyte formation  Capsular fibrosis

11. Clinical features Symptoms Pain Swelling Deformity Stifness Loss of function

12. Signs Swelling Muscle wasting Tenderness Instability Crepitus

13. Clinical types: Monoarticular The classic form of OA

14. Clinical types: Monoarticular Pauciarticular

15. Clinical types: Monoarticular Pauciarticular Generalized The commenest type of OA Affects middle aged women Small joints

16. Complications Capsular herniation Loose bodies Rotator cuff dysfunction Spinal canal stenosis

17. Imaging X rays

19. Radioisotope scanning

20. CT and MRI

21. Arthroscopy

22. EARLY TREATMENT PRINCIPLES To maintain movement and muscle strength To protect the joint from overload To modify the daily activities

23. Physeotherapy

24. Load reduction

25. Physeotherapy Load reduction Analgesia

26. INTERMEDIATE TREATMENT Joint debridement Corrective osteotomy

27. LATE TREATMENT Re-alignment osteotomy Joint replacement Arthrodesis

29. THANK YOU