Arthritis- Hip and Knee

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bchkanth bchkanth on Mar 28, 2012 Says :

arthritis can be cured. by doing yoga & pranayam following proper diet prescibed in ayurveda.highily realiable.

peterson on Sep 27, 2011 Says :

thanks for the presentation

Musaab on Jun 20, 2010 Says :

ttanks for this wonderful slides

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Slide 1 :

Arthritis Hip and Knee Nigel Brewster 1998

Slide 2 :

Aims Types of arthritis Symptoms of arthritis Signs of arthritis Treatment of arthritis

Slide 3 :

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

Slide 4 :

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

Slide 5 :

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

Slide 6 :

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

Slide 7 :

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

Slide 8 :

Rheumatoid Arthritis early joint changes

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Rheumatoid Arthritis late symptoms joint destruction pain deformity instability

Slide 10 :

Rheumatoid Arthritis advanced joint changes

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

Slide 12 :

stop synovitis prevent deformity reconstruct rehabilitate Rheumatoid Arthritis treatment

Slide 13 :

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

Slide 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

Slide 15 :

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

Slide 16 :

Osteoarthritis aetiology Genetic metabolic hormonal mechanical ageing

Slide 17 :

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

Slide 18 :

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

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

Slide 20 :

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

Slide 21 :

Osteoarthritis X-ray changes

Slide 22 :

Arthritis symptoms pain swelling stiffness deformity instability loss of function

Slide 23 :

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

Slide 24 :

Arthritis surgical treatment arthroscopy osteotomy arthrodesis excision arthroplasty replacement arthroplasty

Slide 25 :

Arthritis knee arthroplasty

Slide 26 :

Joint Replacement indications Disabling pain Functional limitations

Slide 27 :

Joint Replacement history pain function medical expectations

Slide 28 :

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

Slide 29 :

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

Slide 30 :

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

Slide 31 :

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

Slide 32 :

Joint Replacement ideal painless joint full range of movement stable permanent

Slide 33 :

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

Slide 34 :

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

Slide 35 :

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

Slide 36 :

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

Slide 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

Slide 38 :

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

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