Lay-mans explanantion of osteoarthritis

A joint is where two bones meet to allow movement. The ends of the bone are covered with cartilage or gristle that acts as a shock absorber when the joints are loaded, e.g. when standing. In osteoarthritis, the cartilage undergoes some chemical changes that result in loss of resilience within the cartilage, leading to a tendency to fracture and fragment, with thinning of the cartilage. Sometimes the cartilage works away over part, or all, of the bones surface, causing bone to rub against bone, which is very painful. This disease is common with increasing age but in some people, because of other factors, it is far more severe. By way of contrast, Maria’s Rheumatoid Arthritis is an autoimmune disease causing inflammation of the synovial membrane and therefore it produces different symptoms. Osteoarthritis and Rheumatoid Arthritis are the two commonest of the approximately 200 different forms of arthritis.

Surgical Mx of Osteoarthritis at the Hip

Surgical Mx of Osteoarthritis at the Hip – Frank

Surgical interventions for OA include fragment removal, bone repositioning, bone fusion, and arthroplasty.

Arthroplasty



In essence, they remove all affected parts of the joint which may include the femoral head, the acetabulum and any debris. The joint is then ‘replaced’ by prosthetics which replicate your hip joint - the shaft, the head, the cartilage and the acetabulum

The shaft is replaced by stem implants, of which there are two types – cement and porous. For cement implants, they inject cement into your femoral canal and then insert the implant to allow the cement to set around and hold the implant in place. For porous, they prepare the canal to fit tightly around the implant, and the porous surface allows ingrowth from the bone into the implant to secure it in place.

The head, or the ball, is then mounted on top of the stem, which is then covered by polyethylene liner, then capped off by the acetabular shell. The parts are then put in place, and the wound is closed.

http://zimmer.com.au/z/ctl/op/global/action/1/id/528/template/PC/navid/915
http://zimmer.com.au/z/ctl/op/global/action/1/id/8140/template/PC/navid/862
http://www.bonesmart.org/hip_replacement.php?gclid=CPPKwuiZ1JUCFRIcawodTEpxhw

Arthritis - Medical Management (Reubban)

ARTHRITIS – MEDICAL MANAGEMENT
No known cure for RA, but many different types of treatment can reduce symptoms , treat pain or modify disease process.
RA can be managed pharmacologically through several drug types. These drugs are prescribed depending on initial disease presentation.
- Patients presenting with previously undiagnosed possible RA require symptomatic treatment with NSAID treatment and should be rapidly referred for definitive diagnosis and the introduction of DMARD (disease-modifying anti-rheumatic drugs) therapy (to reduce damage to joints and bones). Delay of as little as 2-3 months in DMARD initiation can lead to irreversible joint damage.
- In patients with known disease, rheumatoid flare can occur. Symptoms are increased pain, edema and loss of function. Treatment consists of NSAIDs, DMARDs, short steroid courses and possible intraarticular steroid injections. Narcotic analgesics may be used for pain relief.
- Patients can present with Felty syndrome, a triad of RA, neutropenia (a lack of white cells) and splenomegaly (enlargement of the spleen caused by hyperfunction). Patients are prone to bacterial infection, and thus require prompt diagnosis and antibiotics.
- Keratoconjunctivitis sicca occurs in ¼ patients with RA. Symptoms are ocular discharge, dry eye, and foreign body sensation. Treatment includes artificial tears, NSAIDs (local and systemic), systemic steroids and cyclophosphamide (a prodrug used to treat auto-immune diseases).

Anatomy of Hip Joint

PCL 09- Complications and Prognosis of Osteoarthritis- Alan

Complications:
Physical:
- Limits on daily activities and occupation
o Due to decreased mobility
o Can lead to disability (rare)
- Muscle inactivity
- Genu varum (bow-leggedness)
- Genu valgum (knock knees)
o Knees prone to injury
Mental
- Depression
- Anxiety
- Stress
- Feelings of helplessness
- Loss of everyday family joy and responsibilities

Prognosis
- Progressive worsening of osteoarthritis at the affected joint/s
o Though the disease can be stabilised
- No cure, different treatments can be undertaken but will only alleviate symptoms
- If positive attitude is maintained, patients tend to have better outcomes

Reference
http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm
http://www.patient.co.uk/showdoc/23068795

Complications of Hip Replacement Surgery - Eunice

Complications of Hip Replacement Surgery
- Deep vein thrombosis: most common complication. May develop into pulmonary embolism(s). Prevented by using compressive calf pumps, leg exercises or Coumadin (blood thinning drug).

- Infection: found to be higher in hip replacement surgery than any other types of surgery. Risk of infection is higher if patient has rheumatoid arthritis or diabetes, has been taking cortisone for prolonged periods of time, if the affected joint has been infected before, or if the patient has infection anywhere else in the body at the time of the infection.

- Loosening of the prosthesis from the bone: will happen over time, in a process called osteolysis. Revision surgery may be needed if this happens. How long the bond will last depends on:
a. How well the surgery is done
b. The quality of the patient’s bones: The harder the bones are, the better the bond will be, and the longer the replacement will last. Osteoporosis is a factor of age, as well as the type of arthritis you have. People with rheumatoid arthritis have especially soft bones.
c. How active the patient is: Excessive force on the implant can cause the bond to loosen. Activities such as running and heavy lifting should be avoided.
d. Weight: Every pound of weight the patient adds three pounds to the force and stress on the hip so he/she should try to maintain an ideal weight.
e. Whether or not the implant is cemented: At present it is believed that uncemented implants will last longer than cemented ones.
f. The design of the implant: Small abrasion particles from the implant may play a role in implant loosening. Plastic surfaces shed more particles than metal or ceramic ones.
g. People with osteoporosis and rheumatoid arthritis are also more at risk.

- Wear of the plastic polyethylene socket

- Dislocation of the hip replacement: where the metal ball slips out of the plastic socket. In the first six weeks after surgery, the ball is only held in place by muscle tension. During this time, before scar tissue forms around the ball and before muscle strength returns, the hip is more likely to dislocate.

- Extra bone formation (ectopic bone) around the artificial hip: causes the hip to be stiffer than desired. More likely to occur in younger males with severe osteoarthritis. Can be treated by surgical removal of the bone when it matures.

- Fracture of the femur: can occur during hip replacement, and can either be a small crack or deep fracture.

- Residual pain and stiffness: in the thigh, groin or knee, but usually transient. Chronic pain may remain in 2-5% patients.

- Change in the length of the leg: sometimes the surgeon will deliberately lengthen the affected leg to stabilise the hip or improve muscle function. In the first few weeks after surgery, most patients complain that the operated leg feels too long even when the legs are perfectly equal in length, which is an artificial sensation which will resolve itself after a few months.

- Injury to the arteries or nerves in the leg: may cause pins and needles, foot and leg nerve pain or weakness and numbness

- Excessive bleeding: can occur into the wound, forming haematomas. This may distend the hip and cause a dislocation. May require surgery to remove the haematoma if serious. Blood thinners may also cause bleeding into the urine, but this is usually temporary and not serious.

- Anaesthetic complications: include nausea and vomiting, cardiac problems (e.g. heart attack) and cerebral complications (e.g. stroke).

- Allergy to the metal parts

- Complications from blood transfusions

- Fat embolisms: fat from the bone marrow can get into the circulation, causing lung or neurological symptoms. Is very rare though.

- Trochanteric problems: the greater trochanter is detached during surgery to access the hip joint and is then reattached. If the trochanter does not heal back on the femur, it remains as a separate piece, and may result in pain, weakness and loss of hip function since many large muscles attach to the greater trochanter.

- Bowel complications: constipation frequently occurs for the first week or so after surgery, and can be caused by medication, immobility, loss of appetite, not drinking enough fluids.

- Urinary problems: a catheter may be inserted during surgery, which poses an increased risk of urinary tract infection.

- Pressure sores: patients will most probably be spending more time in bed in recovery. Spending a lot time in one position can lead to pressure sores. The heels, especially that of the surgery leg, are especially susceptible. The elderly are especially prone to pressure sores, so more attention should be paid to such patients.


http://www.hipsandknees.com/hip/hipsurgerycomplications.htm
http://ezinearticles.com/?Hip-Replacement-Complications&id=430604
http://orthopedics.about.com/od/replacementcomplications/Information_About_Joint_Replacement_Complications.htm

CAM - Bryn

CAM is being sought more frequently now for relief is osteoarthritis. These are some common treatments that have shown some promise for osteoarthritis:

Acupuncture
-tiny needles are inserted into your skin at precise spots
-believed that the needles free or redirect your body's energy in order to relieve pain.
-Studies of acupuncture for knee osteoarthritis have been mixed. Most haven't found a benefit, though some have found some short-term relief of pain.
-Acupuncture can be safe if with a reputable practitioner.
-Risks include infection, bruising and some pain where needles are inserted into your skin.

Ginger
-Some research has found ginger extract may be helpful in reducing osteoarthritis pain.
-Limited studies have been conducted with ginger in people with osteoarthritis, and results have been mixed.
-Side effects of ginger supplements can include heartburn and diarrhea.
-they can interfere with prescription medications such as warfarin.

Glucosamine and chondroitin.
-Studies have been mixed on these nutritional supplements.
-Some have found benefits for people with osteoarthritis, others haven't.
-Don't use glucosamine if allergic to shellfish.
-Chondroitin sulfate may affect blood levels of warfarin if you're taking that medication.

Magnets.
-believed tthat placing magnets near affected joints can relieve osteoarthritis pain.
-Some small studies have found magnets can provide temporary pain relief, though others haven't found any benefit from magnets.
-Magnets appear to be safe.

Tai chi and yoga.
-movement therapies involve gentle exercises and stretches combined with deep breathing. -small studies have found that tai chi and yoga may reduce osteoarthritis pain. More study is needed to understand whether tai chi and yoga can relieve osteoarthritis pain.
-When led by a knowledgeable instructor, these therapies are safe.

sources:
http://www.mayoclinic.com/health/osteoarthritis/DS00019/DSECTION=alternative-medicine

http://osteoarthritis.about.com/od/alternativetreatmen/Natural_Remedies_Alternative_Medicine_Complementary_Treatments.htm

http://www.mayoclinic.com/health/osteoarthritis/DS00019/DSECTION=alternative-medicine

Osteoarthritis of hip -- Symptoms and Signs

The pain of osteoarthritis almost always begins gradually, progressing slowly over many years. People under 40 may have the condition with no symptoms at all.
Pain usually characterizes Osteoarthritis and is localised to the particular joint.
Osteoarthritis is commonly identified by the following symptoms:
·The most common symptom of osteoarthritis in any joint is pain that worsens during activity and that gets better during rest. Stiffness also tends to follow periods of inactivity, such as sleep or sitting, which can last for more than an hour or it can be eased by stretching and exercise. As the disease advances, the pain may occur even when the joint is at rest and can keep a sufferer awake at night.
·Pain is generally described as aching, stiffness, and loss of mobility.
·The pain may behave like a roller coaster, with bad spells followed by periods of relative relief.
·Pain seems to increase in humid weather.
·Some people experience muscle spasm and contractions in the tendons.
Fatigue and general weakness are not signs of osteoarthritis.

For the Hips: Osteoarthritis frequently strikes the weight-bearing joints in one or both hips.
- Pain develops slowly, usually in the groin and on the outside of the hips or sometimes in the buttocks.
- The pain may also radiate to the knee, confusing the diagnosis.
- Restricted range of motion (particularly when trying to rotate the hip) and walk with a limp, because they slightly turn the affected leg to avoid pain.

Symptoms of osteoarthritis vary greatly from patient to patient. Some patients can be debilitated by their symptoms. On the other hand, others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on X-rays.

Symptoms also can be intermittent. It is not unusual for patients with osteoarthritis to have years of pain-free intervals between symptoms

http://osteoarthritis.about.com/od/osteoarthritissymptoms/a/signs_symptoms.htm
http://www.medicinenet.com/osteoarthritis/page2.htm

PCL09 Risk Factors Myat

Factors that increase your risk of osteoarthritis include:

Older age
Osteoarthritis typically occurs in older adults. People under 40 rarely experience osteoarthritis.

Sex
Women are more likely to develop osteoarthritis, though it isn't clear why.

Bone deformities
Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.

Joint injuries
Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.

Obesity
Carrying more body weight places more stress on your weight-bearing joints, such as your knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.

Other diseases that affect the bones and joints
Bone and joint diseases that increase the risk of osteoarthritis include gout, rheumatoid arthritis, Paget's disease of bone and septic arthritis.

http://www.mayoclinic.com/health/osteoarthritis/DS00019/DSECTION=risk-factors

The Use Of MRI

An MRI is an imaging or radiology technique which uses magnetism, radio waves and a computer to produce images of body structures. The resolution produced by an MRI is quite detailed and can detect tiny changes of structure within the body.

MRI is used for a variety of diagnostic purposes, often when the information needed hasn't been provided by other imaging techniques such as ultrasound, conventional xray or CT.

The MRI can:
-determine what the problem is inside the body.
-show the exact location of the problem.
-rule out certain diseases.
-produce detailed images of joints and soft tissues, particularly of cartilage, ligaments and tendons within joints.
-identify a wide range of internal organ disorders, infections, inflammatory conditions, trauma and other injury.

Aside from those who suffer from claustrophobia or who have implanted medical devices, the MRI poses no medical risks. One disdvantge of using the MRI is the cost which is much higher than a regular Xray or CT scan.

The cost of MRIs varies widely. As a private individual paying full price, you will have to fork out somewhere between $200-500 or more. If you can get a referral from a specialist such as an orthopaedic surgeon, you can claim Medicare rebate. GPs and sports physicians can't order an MRI under Medicare.

Xray - Fern

http://www.totaljoints.info/diagnosis_hipdisease.htm

http://www.kneeandhip.co.uk/arthritis/default.aspx