by drhidayat.com

1. MANAGEMENT OF

3.  To relief pain
 Paracetemol (mild to moderate pain)
 NSAIDs e.g diclofenac, ibuprofen -if no response to PCM/inflammation
features- gastrointestinal (GI) complaints which range from gastritis to
ulceration and bleeding are common side effects -pt with GI problem, give
together with proton pump inhibitors or COX-2 inhibitors such as
celecoxib (fewer side effect)
 Tramadol- opiod analgesia ( highly resistant pain)
 Topical cream- capsaicin cream-adjunct in hand or knee OA
 Glucosamine/chondroitin sulphate- nutritional supplements-symptomatic
pain relief + slow progression of OA at early stage, c/I shellfish allergy,
caution: worsening DM (monitor blood glucose conc. before rx and
periodically thereafter)

4.  Intra-articular injection of steroids-can markedly reduce the swelling of
soft tissues and relieve pain-should be used only occasionally, particularly
in younger people-adverse side effects e.g accelerate joint degradation,
caution if infxn -single injection may be sufficient to relieve OA for
several months-the effect lasts for diff. amounts of time in diff. people.
 Hyaluronic acid therapy injection e.g Hyalgan® and Synvisc®
-viscosupplementation - once a week for three to five weeks- provide pain
relief and functional improvement for up to 6 months+ does not cause the
side effects of most oral pain relievers- suitable for people who still suffer
discomfort after being treated by pain medication, exercise, or physical
therapy- expensive

7.  Although no surgical procedure is absolutely
indicated or contraindicated for osteoarthritis (OA),
certain general aspects are important to consider
-severe pain not responding to conservative rx
-limitations in a pt's ability in ADL affecting quality
of life
-long-term functional outcome in patients.
 These factors must be integrated into an overall
evaluation in selecting the appropriate surgical
procedure.

8.  A few types of surgical procedures in relation
to OA

9.  Arthroscopy- joint debridement to remove
interfering osteophyte, cartilage tags and loose
bodies
 may provide temporary
relief from symptoms
but does not stop the
progression of OA
Arthroscopic view of the
removal of cartilaginous loose
body.

10.  Osteotomy- used in active pt younger than 60 years
who want to continue with reasonable physical activity
with mobile jt and most beneficial for significant genu
varum or bowleg deformity (mal alignment)
 Bone is osteotomized close to the affected joint, and
the fragments are then realigned so that a less damaged
part of articular surface is exposed to load stress
 Osteotomy can lessen the pain, although it can lead to
more challenging surgery later if the patient requires
arthroplasty

11. Principle: To redistribute loading forces towards less damaged parts of the joint
e.g to shift weight from the damaged cartilage on the medial aspect of the knee to
the healthy lateral aspect of the knee

12.  Arthroplasty- creation of an artificial joint to correct
advanced degenerative arthritis and restore integrity
and function of the joint.
 An excellent treatment in individuals with moderate to
severe OA, most reliable, can significantly improve the
patient's quality of life, and has results that last the
longest (15 years or more).
 Candidates are preferably older than 60 years- less
likely to need a repeat procedure (revision).
 Consists of the surgical removal of joint surface and
the insertion of a metal and plastic prosthesis which
held in place by cement or bone ingrowth into the
porous coating.

13. HEMIARTHROPLASTY

14. TOTAL REPLACEMENT

15.  Complications:
-Deep vein thrombosis
-Infection (most feared cx)
-Perforation/# femur/acetabulum esp in v.old,
osteoporotic, previous hip surgery
-Heterotropic bone formation
-Aseptic loosening
-Aggressive osteolysis

16.  Excision Arthroplasty
- Girdlestone : resection arthroplasty of the hip
-Rarely done these days but are choice after the failure of hip
replacements if there is extensive bone destruction or
persistent infection
- The femoral head and neck are excised, leaving a false
articulation btwn upper end of femur & side wall of the pelvis
- The ‘jt’ will be unstable but pt can still walk because of local
fibrosis and stabilizing effect of powerful surrounding muscle
although with marked limp as shortening of the limb ranged
from 3 to 11cm, and all patients used a support for walking
postoperatively.

18.  Arthrodesis- artificial induction of joint ossification between two
bones via surgery
 A procedure in which the surfaces of the joint are removed and the
bone ends are united- provides pain relief and stability, but the main
disadvantage will be the joint cannot bend.
 A preferred surgery for some younger individuals who have a
single involved joint as mobility in the other joints often will
compensate for the loss of movement in the fused joint.
 The joints most commonly fused are smaller joints, such as those in
the toes or fingers.

20. THANK YOU….