4. Osteoarthritis is a degenerative disorder
that results from the biochemical
breakdown of articular (hyaline) cartilage
in the synovial joints.
However, the current concept holds
that osteoarthritis involves not just the
articular cartilage but the entire joint
organ, including the subchondral bone
and synovium.
4
5. Osteoarthritis predominantly involves
the weight-bearing joints, including the
knees, hips, cervical and lumbosacral
spine, and feet. Other commonly
affected joints include the distal
interphalangeal (DIP) and proximal
interphalangeal (PIP) joints of the hands.
5
6. Clinical Presentation
Joint soreness after inactivity or periods of overuse of a
joint.
Stiffness after rest and disappears quickly as activity
begins again.
Morning stiffness lasting no longer than 30 minutes.
Joint pain which is less in the morning and stronger at the
end of the day following activity.
Muscle atrophy around joints caused by inactivity can
increase pain.
Pain and stiffness can affect posture, coordination and
ability to walk. 6
7. Signs of Knee Osteoarthritis may include :
pain exacerbated by moving the knee
knee locking or catching
pain when standing up from a chair
pain when going up and down stairs
weakening thigh muscles.
7
12. The goals of osteoarthritis treatment
Pain alleviation and improvement of functional status
Non-pharmacologic interventions are the cornerstones of
osteoarthritis therapy
Patient education
Temperature modalities
Weight loss
Exercise
Physical therapy
Occupational therapy
Joint unloading in certain joints (e.g., knee, hip).
12
13. Acetaminophen has clearly been demonstrated
to be effective in the treatment of pain of OA
when c/w placebo for 50% pain reduction
when using 1000mg.
Acetaminophen has been demonstrated to be
safe up to 4 gm/day.
As OA is principally non-inflammatory NSAIDs
should clearly be titrated for clinical effect.
13
16. Glucosamine Sulfate
Glucosamine sulfate has measured its
effectiveness on Osteoarthritis of the knee.
However, there is some evidence that it might
also help Osteoarthritis of the hip or spine.
In addition to relieving pain, glucosamine
sulfate might also slow the breakdown of
joints in people with osteoarthritis who take it
long-term.
16
17. Side Effects of Glucosamine Sulfate
Glucosamine appears to be safe for most people
with diabetes, but blood sugar should be
monitored closely.
People with asthma should be cautious about
taking products that contain glucosamine.
17
18. There is not enough reliable scientific
information available to know if glucosamine
sulfate is safe to take during pregnancy or while
breast-feeding.
Until more is known, do not take
glucosamine sulfate while pregnant or breast-
feeding.
18
19. What about the role of Steroid Injections ?
Steroid injections can be used as an adjunct therapy
along with systemic therapy.
This is an effective way to knock down inflammation.
Mechanism of Action
Inhibit accumulation of inflammatory cell lines
Reduction of prostaglandin synthesis
Inhibit leukocyte secretion from synovial cells
Decrease interleukin secretion by the synovium
Increase viscosity of synovial fluid
19
20. HYLURINIDASE
Hyalgan® is indicated for the treatment of
pain in osteoarthritis (OA) of the knee in
patients who have failed to respond
adequately to conservative non-
pharmacologic therapy, and to simple
analgesics, e.g., acetaminophen.
20
22. 22
NEW DRUGS
Protelosa, contain the chemical Strontium
Ranelate which is thought to encourage the
body to produce cartilage and is already used
to treat osteoporosis.
Celecoxib : 100 to 200 mg once or twice a day.
38. Indications for Total Knee
Joint Replacement
The main indication for Total Knee
Arthroplasty is for relief of pain associated
with arthritis of the knee in patients who
have failed non operative treatments.
(American Academy of Orthopedics)
38
42. 42
22 Jul 2011
(Ex- Sub) Gurmukh Singh, 65 Yrs
Old case of Hypertension with Type
2 DM on medication for past 15 Yrs
Diagnosed with Osteoarthritis Both
Knees with Varus Deformity.
65. Medication Strength/dose Amount
First injection
Bupivacaine 0.5% (200-400 mg) 24 cc
Morphine sulphate 8 mg 0.8 cc
Epinephrine (1:1000) 300 μg 0.3 cc
Methylprednisolone
acetate
40 mg 1 cc
Cefuroxime 750 mg 10cc (reconstituted in
normal saline)
Sodium chloride 0.9% 22 cc
Second injection
Bupivacaine 0.5% 20 cc
Sodium chloride 0.9% 20 cc
Ranawat Orthopedic Center (ROC) cocktail
65
