1. Arthritis
Hip and Knee
Nigel Brewster 1998

2. Aims Types of arthritis Symptoms of arthritis Signs of arthritis
Treatment of arthritis

3. Types of Arthritis Rheumatoid arthritis (RA) Osteoarthritis (OA)
Sero-negative arthritis
Ankylosing spondylitis
Reiter’s disease
Crystal arthropathies

4. Rheumatoid Arthritis affects 3% population female> male (3:1)
80% RF
30% ANF
HLA DR4 (chr 6)

5. Rheumatoid Arthritis Pathology
Synovitis
chronic infl, synovial hypertrophy, effusion
Destruction
proteolytic enzymes, pannus
Deformity
articular destruction, capsular stretching, tendon rupture

6. Rheumatoid Arthritis extra-articular
nodules
tendon sheath
vasculitis
myopathy and neuropathy
reticulo-endothelial system
visceral - lungs, heart, kidneys, brain, GI

7. Rheumatoid Arthritis early symptoms
myopathy, tiredness, weight loss, malaise
proximal finger joints
wrists, feet, knees, shoulders
start up pain
tendon crepitus

8. Rheumatoid Arthritis early joint changes

9. Rheumatoid Arthritis late symptoms
joint destruction
pain
deformity
instability

10. Rheumatoid Arthritis advanced joint changes

11. Rheumatoid Arthritis X-ray findings
joint space narrowing
peri-articular osteopenia
erosions

12. Rheumatoid Arthritis treatment
stop synovitis
prevent deformity
reconstruct
rehabilitate

13. Rheumatoid Arthritis prognosis
10% improve
60% intermittent, slowly worsening
20% severe joint erosion, multiple surgery
10% completely disabled

14. Osteoarthritis
A chronic joint disorder in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes) and capsular fibrosis

15. Osteoarthritis classification
Primary or idiopathic
Secondary - infection
- dysplasia
- Perthes’
- SUFE
- trauma
- AVN

16. Osteoarthritis aetiology
Genetic
metabolic
hormonal
mechanical
ageing

17. Osteoarthritis mechanism 1
Disparity between:-
stress applied to articular cartilage
and
strength of articular cartilage

18. Osteoarthritis mechanism 2
Increased stress (F/A)
increased load eg BW or activity
decreased area eg varus knee or dysplastic hip

19. Osteoarthritis mechanism 3
Weak cartilage
age
stiff eg ochronosis
soft eg inflammation
abnormal bony support eg AVN

20. Osteoarthritis X-ray changes
joint space narrowing
subchondral sclerosis
osteophytes
cysts

21. Osteoarthritis X-ray changes

22. Arthritis symptoms pain swelling stiffness deformity instability
loss of function

23. Arthritis non-surgical treatment
analgesia
disease modifying drugs (RA)
altered activity
walking aids
physiotherapy

24. Arthritis surgical treatment
arthroscopy
osteotomy
arthrodesis
excision arthroplasty
replacement arthroplasty

25. Arthritis knee arthroplasty

26. Joint Replacement indications
Disabling pain
Functional limitations

27. Joint Replacement history
pain
function
medical
expectations

28. Joint Replacement history - pain
Site
radiation
limiting activity
disturbing sleep
analgesics

29. Joint Replacement history - function
Walking distance
walking aids
low chairs
foot care
stairs

30. Joint Replacement examination
gait
limb alignment
range of movement
stability
peripheral circulation
skin condition

31. Joint Replacement investigation
X-ray - alignment
- deformity
- previous fractures and implants
- AVN
- osteophytes
- bone loss
CT, MRI, bone scan - rarely

32. Joint Replacement ideal
painless joint
full range of movement
stable
permanent

33. Joint Replacement hip complications
dislocation - 1%
loosening >90% 10y survival
DVT / PE
infection - 1%

34. Joint Replacement knee complications
limited ROM
patellar instability 3-5%
loosening > 90% 10y survival
DVT / PE
infection - 2%

35. Ankylosing Spondylitis
0.2% of population
mainly affects spine and SI joints
male > female
HLA B27 in 90%
synovitis
enthesopathy

36. Ankylosing Spondylitis hips and knees
flexion deformities
arthritis with large osteophytes
ankylosis

37. Ankylosing Spondylitis diagnosis
Rome criteria
A - bilateral SI B - stiff lumbar spine
- stiff thoracic spine
A+ 1xB decreased chest
or 4xB expansion (<7cm)
- >3/12 LBP
- iritis

38. Ankylosing Spondylitis X-ray changes
joint space narrowing
large osteophytes
heterotopic bone
ankylosis