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Osteoarthritis of Hip
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Osteoarthritis
- degenerative condition of joints characterised by progressive loss of
articular cartilage in association with pain and stiffness
- 10x more common than Rheumatoid
arthritis
- primary OA
- middle aged woman
- familial history
- secondary OA
- wear & tear
- trauma
- disabled patients
- inflammatory arthritides
- neuropathic (Charcot) joints
Pathology
- loss of proteoglycans from cartilage matrix leads to cracking of cartilage
- cartilage loss leads to bone-bone contact and pain
Macroscopic
- loss of cartilage leads to eburnation
- cartilage loses white appearance
Risk factors
- trauma to joint
- unusual load distribution
- e.g. compensating for deformity / injury elsewhere
- repeated heavy loading of joint
General symptoms
- pain
- worse with exercise / towards end of day
- varies day to day
Examination
- Hands
- Nails
- Skin
- Joints
- Heberden's nodes
- Bouchards nodes
- squaring of hands
- 1st carpometacarpal joint
- Nerves
- Function
- Knees
- Genu varum
- may be effusion
- movement limited
- crepitus
- joints stable
Investigation
- X-rays
- loss of joint space
- local sclerosis
- (fibrous) cysts
- osteophytes
Specific joints
Treatment
- conservative
- weight loss
- change of job
- walking aids
- physiotherapy / mobility
- simple analgesics
- medical
- NSAIDs
- joint injections of steroid / anaesthetic
- Surgery
- joint replacement
- osteotomy
- arthrodesis
- excision arthroplasty
Risks of surgery
- death (1:400)
- infection
- dislocation
- nerve damage
- premature loosening
- DVT / PE
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