Osteoarthritis

• What is Osteoarthritis
• Statistics on Osteoarthritis
• Risk Factors for Osteoarthritis
• Progression of Osteoarthritis
• Symptoms of Osteoarthritis
• Clinical Examination of Osteoarthritis
• How is Osteoarthritis Diagnosed?
• Prognosis of Osteoarthritis
• How is Osteoarthritis Treated?
• Osteoarthritis References

What is Osteoarthritis

Osteoarthritis (OA) is the leading cause of pain and disability in the community, and the most common condition leading to joint replacement surgery of the hip and knee.
It may be thought of as a degenerative joint disorder characterised by the breakdown of articular cartilage (cartilage from in between the joint surfaces which is smooth and helps absorb shock),as well as the formation of new bone. Traditionally it has been divided into primary osteoarthritis (no apparent cause), or secondary osteoarthritis (due to an underlying condition or abnormality), however, this classification is probably irrelevant as new underlying causes of primary osteoarthritis are presently being discovered.

Statistics on Osteoarthritis

Osteoarthritis (OA) is the most common joint disorder in the world. Most people aged over 75 years show signs of OA on x-rays. Males and females are both affected, but the pattern of joints affected may vary. In women, OA more commonly affects the hands and knees, whilst in men OA commonly affects the hip joints. Severe disease is more commonly present in women.

Risk Factors for Osteoarthritis

Osteoarthritis is thought to develop as a result of joint wear and tear. As this joint damage takes many years to develop, age is the main risk factor. A family history of OA increases risk as well.
Risk factors which may be changed or prevented include joint injury (especially meniscal or cruciate ligament tears), obesity and occupational overuse of a joint.

Progression of Osteoarthritis

Symptoms tend to increase slowly over a period of time, sometimes disappearing for months at a time. There is stiffness and reduced movement of the joint. In long standing cases of osteoarthritis the patient may feel instability in the affected joint.

How is Osteoarthritis Diagnosed?

• Full blood count and ESR – normal, but important to rule out inflammatory conditions.
• Radiology – May show narrowing of the joint space (from cartilage loss), osteophytes (bony outgrowths), subchondral sclerosis (thickening of the bone under the cartilage) and cyst formation.
• MRI demonstrates early cartilage changes.

Prognosis of Osteoarthritis

Joint replacement tends to have an excellent prognosis in suitable patients who are motivated to do rehabilitation. For other procedures, such as joint injections, outcome is much harder to predict.

How is Osteoarthritis Treated?

Joint mobility can be improved with a tailored exercise program to improve range of motion, muscle strength and overall well-being. Losing weight may be of benefit as it helps to reduce load on the joint.
Devices such as supportive shoes, a walking cane and raised toilet seat may make life easier for people with osteoarthritis. Pain can be controlled with medications, or steroid injections into the affected joint. In patients with severe symptoms or very limited use of the joint, surgery may be an option.
An osteotomy may be performed to realign the hip or knee joints if that is the cause of the problem. In patients aged over 60 years, joint replacement is the treatment of choice and provides an excellent outcome and improved quality of life.

Osteoarthritis References

1. Apley A, Solomon L. Apley’s System of Orthopaedics and Fractures, 8th Edition. Butterworth Beinemann, 2001.
2. Collier, Longmore, Scally. Oxford handbook of clinical specialties, 6th ed. Oxford University Press, 2003.
3. Grainger, Cicuttini. Clinical Update: Medical management of osteoarthritis of the knee and hip joints. MJA 2004; 180 (5): 232-236.
4. Hakim A, Clunie G. Oxford Handbook of Rheumatology. Oxford University Press, 2002.
5. Kumar and Clark. Clinical Medicine 5th ed. 2002. WB Saunders
6. Manek, Lane. Osteoarthritis: Current Concepts in Diagnosis and Management. Am F Phys. 2000 (online) http://www.aafp.org/afp/20000315/1795.html
7. March, Bagga. Epidemiology of osteoarthritis in Australia. Bone and Joint Disorders: Prevention and Control. MJA 2004; 180 (5 Suppl): S6-S10.