Osteoarthritis (OA)

Dr.Maulik Jhaveri is experienced orthopedic with a long history of serving patients by successfully diagnosing, treating their conditions. Dr Maulik Jhaveri Best Orthopedic In Bharuch & Ankleshwar Gujarat

Osteoarthritis (OA) is one of most common diseases

Osteoarthritis, sometimes abbreviated to “OA”, is the most common form of arthritis, a very common disease. It is a chronic, slowly progressing disease that involves the breakdown of articular cartilage, the normally smooth, slippery covering that allows the bones of your joints to slide over each other.
The wear and tear on joints accumulated over the years is the only identifiable factor for many people. Trauma (for injury) is another contributing factor. Overuse or occupational injuries, as well as sport injuries, are commonly associated with OA.  Obesity plays a part, too, as extra weight puts added stress on weight bearing joints, like the hip and knee; but even light weight ballerinas are at greater risk of developing OA of the big toe and hip, due to great stresses put on these joints.  OA tends to affect weight bearing, hard working joints. As you’d expect, the hardest working and weight-bearing joints are the ones usually affected by OA. These include the hips, knees, feet, spine, and hands. Except, as a result of injury or un-usual stress, ankles, wrists, and elbows are not common sites for OA, although other types of arthritis can affect these areas. People with OA in one joint often have OA in other joints. This so-called generalized arthritis is more common in women than in men and may be inherited. With OA, articular cartilage breaks down and wears away. The rest of our discussion will focus on the knee joint, a common site of OA. The knee is a complex joint, composed of bone, cartilage, membranes, and joint fluid all working together for easy, comfortable motion.  In OA, the joint breaks down in stages, over a time; smooth cartilage becomes pitted and frayed. Damaged cartilage is less elastic, and more readily affected by overuse or injury. Synovial fluid may also lose its cushioning and lubricating properties. The ends of the bone can thicken and form spurs where the ligaments and synovial lining attach. Finally, bits of bone or cartilage (sometimes called ‘joint mice’) float in the joint space, causing further damage and pain. Eventually, large areas of cartilage may wear away completely, so bones scrape over each other painfully. The joint may lose its proper alignment, and much of its function.

Diagnosis

Diagnosis

Diagnosis is based on a wide range of evidence.

There is no specific test for OA. A complete clinical assessment will include a discussion of any family history of OA, and a physical examination to identify misalignment, deformities, mechanical problems and which joints are affected.

OA is often visible on X-ray, and that can confirm that the pain and stiffness is indeed due to OA. X-ray can be useful in uncovering subtitle joint abnormalities and other joint and bone diseases, like osteoporosis. However, X-ray may not pick up early arthritic changes, even if there are symptoms.

Common Symptoms

Common Symptoms

If you have OA of the knee, you’re probably familiar with some of these symptoms:-

1.PAIN
2.SWELLING
3.TENDERNESS
4.GRATING SENSATION
5.STIFFNESS

Management

Management

OA of the knee cannot be cured, but in most cases it can be effectively managed, resulting in less pain and stiffness, and better joint function.

Physical therapy and exercise and, if appropriate, weight loss can be helpful in alleviating symptoms at any stage of OA.

Assistance devices like canes, knee braces, and insoles can also help. For OA with mild pain and few or no functional problems, nonprescription pain relievers like acetaminophen may be tried.

If this therapy does not suffice, a prescription strength anti-inflammatory drug, such as naproxen or cortisone injections, or stronger pain relievers, such as narcotic analgesics may be needed. Finally, a variety of surgical procedures are available for the management of severe OA.

Physical Therapy & Exercise

Physical therapists can determine what the most suitable conditioning exercises are for a given patient, then show the patient how to perform them correctly.

Simple analgesics

Lornoxicam and paracetamol and other products are recognized as an effective medication for OA of the knee. It is generally well-tolerated, without the side effects of prescription arthritis drugs like naproxen and ibuprofen, which we’ll talk about shortly.

Topical Treatments

Topical treatments include rubs, hot and cold packs, and TENS, which uses electricity applied to the skin to stimulate nerve endings. These are valid methods that give many people significant pain relief.

Hyaluronate Preparations

The newest class of injected products for the pain of OA of the knee are the hyaluronate preparations that are injected directly into the knee. Hyaluronate is a natural substance that acts like an “Oil” and is believed to help cushion and lubricate joints such as the knee.

Corticosteroid injections

Corticosteriod, like cortisone, or prednisone, are powerful drugs that relieve pain and inflammation. Special formulations are available for injection into the knee so that they remain in the knee and maintain their effect.

 

Surgery

Surgery

If OA becomes impossible to live with, surgery may be the answer. There are many types of surgical procedures, from arthroscopy to total knee replacement. However, there are limits to what surgery can achieve. Strenuous exercise such as downhill skiing after total knee replacement may not be possible. Pain relief and greater freedom of motion are likely outcomes. A strict treatment and rehabilitation program after surgery is in large part dependent upon active participation by the patient. Now let’s look at the various surgical options available today.

Arthroscopic surgery

– For repair of damaged cartilage

– For removal of loose bits of cartilage and bone

– To drain infected or excess synovial fluid

– May be performed in the office or in the hospital, depending upon nature of the surgery.

The arthroscope is inserted through a very small incision, which leaves little scarring. Arthroscopic surgery can, in many cases, be done in the office.

 

Osteotomy

May be an option when OA involves a single, weight bearing compartment of the knee joint. – To correct deformities by selective trimming away of bone. – Improves joint alignment – Generally preferred for young and active patients.

Osteotomy literally means “bone cutting”. Even slight bone deformities can put pressure and strain on joints, and contribute to OA. The deformity is corrected by removing or adding triangular wedges of bone. Osteotomy can be useful in preventing the deterioration of joints with OA due to a preexisting deformity such as bowleggedness. Osteotomy is generally preferred for young, active patients.

 

Arthrodesis (Fusion)

Reserved for patients who cannot undergo total knee replacement. – Relieves pain – Leg is left permanently rigid – Interferes with walking, sitting, driving, and other movement

The word arthrodesis means ‘fusion of a joint’. When this surgery is performed on the knee, the thigh and shin bones are fused to become one bone. Pain is relieved, but the leg is left permanently rigid, which interferes with walking, sitting, driving, or moving in a narrow space. For these reasons, arthrodesis is used only when certain infections or ligaments loss make it unsafe to implant a prosthesis.

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