Osteoarthritis

Background

  • Alternatively called arthrosis[1]

Risk Factors

  • Age
  • Female versus male sex
  • Obesity
  • Lack of osteoporosis
  • Occupation
  • Previous injury
  • Muscle weakness
  • Genetic elements

Clinical Features

  • Commonly affected joints
    • Cervical and lumbar spine
    • First carpometacarpal joint
    • Proximal interphalangeal joint
    • Distal interphalangeal joint
    • Hip
    • Knee
    • Subtalar joint
    • First metatarsophalangeal joint
  • Uncommonly affected joints
    • Shoulder
    • Wrist
    • Elbow
    • Metacarpophalangeal joint

Differential Diagnosis

Monoarticular arthritis

Polyarthritis

Evaluation

  • Greater than 50 years of age
  • Morning stiffness for less than 30 minutes
  • Crepitus on active motion of the knee
  • Bony tenderness
  • Bony enlargement
  • No palpable warmth

Management

Nonpharmacological

  • Weight loss
  • Ice/warm packs
  • Physical therapy
  • Occupational therapy
  • Exercise

Pharmacological [2]

AAOS Decision Tool for Knee OA

Surgical

  • Arthroscopy for removal of meniscal tears or loose foreign bodies
    • No additional benefit compared to PT and medical therapy in routine OA [3]
  • Osteotomy in young patients with misalignment of knee or hip joint
  • Arthroplasty
    • If all other modalities are ineffective
    • Prothetic knee/hip/shoulder usually has 10-15 year viability
    • Infection, Pulmonary embolism are biggest risks
  • Joint fusion
    • Relieves pain but prevents motion
    • May be used in small foot/ankle bones or after failed arthroplasties

Disposition

  • Discharge with PCP follow-up

See Also


References

  1. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi:10.1136/ard.16.4.494
  2. Jordan JM, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007 Jan. 34(1):172-80.
  3. Kirkley A, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11. 359(11):1097-107
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