OA vs. Aging
Table 1.0 Main difference between osteoarthritis and aging |
Osteoarthritis |
Aging |
Highly anabolic and synthetic process |
Normal metabolism |
Enzymatic destruction of hard tissue |
Normal enzymatic remodeling |
Remodeling all tissues about joint, articular and particular |
Cartilage changes only |
Chondrocyte mitosis |
No mitosis |
Intense increased sysnthesis, collagen and proteoglycan |
Normal rates synthesis, collagen and proteoglycan |
Increased water content cartilage |
No change |
Fibrillation, focal and progressive at weightbearing sites |
Fibrillation nonprogressive, nonweightbearing sites |
Eburnation, ivory-like |
No eburnation |
Osteophytes occur with other changes |
Osteophytes only with excessive use |
No increased collagen X link |
Increased collagen X link |
Inflammation |
No inflammation |
No pigment-cartilage |
Pigment-cartilage |
Unlike aging, OA is progressive and a significantly more active process
OA –Overall Changes

Osteoarthritis with osteophyte, loss of articular cartilage and some subchondral bony sclerosis.
OA –Radiographic Diagnosis
Asymmetrical joint space narrowingfrom loss of articular cartilage
- Medial (inside) part of knee most commonly affected by OA.
- Asymmetrical joint space narrowing
- Subchondralsclerosis and cysts
- Osteophytes

OA –Arthroscopic Diagnosis
Arthroscopy allows earlier diagnosis by demonstrating the more subtle cartilage changes that are not visible on x-ray
Normal Articular Cartilage

Ostearthritic cartilage with exposed subchondral bone

OA –Arthroscopic Treatment
- Most accurate way of determining stage of OA
- Debridementof the knee joint:
- Cleaning out the joint of all debris and loose bodies.
- Loose bodies of cartilage removed
- Saline solution.
- Micro-fracture techniques
- Badly worn areas may be treated with sub-chondralholes (fracture) to promote growth of new cartilage
- Fibro-cartilage that is scar tissue.
- Usually offer temporary relief of symptoms
- Graft-transplantation
OA –Management
- Slow progression over many years
- Treatment directed at symptoms and slowing progress of the condition
Goals:
- Decreasing pain
- Increase range of motion
- Increase muscle strength
OA –Non-operative Treatments
- Pain medications
- Physical therapy
- Walking aids
- Re-alignment

Physical Therapy
- Accomplishes all 3 goals : reduce pain, increase range of motion and strength
- Heat, electrical stimulation, & ultrasound decrease pain
- Manipulate muscles & tendons surrounding joint
- Better strength means better weight support
- Low impact (especially aquatic) exercises is both safe & effective
- Improves balance and coordination of bones & muscles
Physical Therapy 2
- Increased activity decreases overall body weight
- Decreases load & pain on joints
- Improves physical function due to increased strength
- Also lowers forces and stress on joints
- Improves quality of life due to pain relief & wider range of movement
- Slows progression of OA
Pain Management
- Non-Steroidal Anti-Inflammatory Drugs (NSAID)
- Drugs that reduce pain, inflammation and fever
- Inhibit prostaglandins which play role in inflammation
- Are not made from steroids or narcotics
- No sedation, depression, addiction/dependence
Examples:
- Ibuprofen (Motrin/Aleve), Naproxen, Diclofenac(Voltaren)
- Asprin
*Note: Acetamenophen(Tylenol) is NOT an NSAID because has no anti inflammatory use
COX-2 Inhibitors
- Some NSAIDsInhibit COX-1 enzyme which acts as messenger molecule during inflammation
- Results in gastrointestinal side effects
- COX-2 is secondary enzyme that selectively inhibit without disrupting GI system
- Examples: Meloxicam(Mobic), Celecoxib(Celebrex), Rofecoxib(Vioxx)
Pain Management
- Steroid Injections: 2 types
- Reduce inflammation response around joints
- Tend to have more rapid effect than NSAIDs
- Viscous supplement
- Replace modified synovial fluid in joints
- Increase viscosity & elasticity of fluid
- Various Corticosteroids
- Visco-Supplements
- Hyalgan
- Euflexxa
- Orthovisc
- Synvisc
Realignment Surgery: Proximal Tibial Osteotomy
Osteoarthritis usually affects the inside half (medial compartment) of the knee more often than the outside (lateral compartment).
This can lead to the lower extremity becoming slightly bowleggedor a genuvarumdeformity

The problem:
- The weight bearing line passes more medially (towards the medial compartment of the knee).
- Increased pressures are transferred through the medial joint surfaces, which leads to more pain and deformity.
The aim:
- re-aligning the angles in the lower extremity by shifting the weight-bearing line towards the midline or lateral compartment of the knee. This places more of the weight-bearing force into a healthier compartment.
The result is pain reduction and delay in the progression of the degeneration of the medial compartment.
In the procedure to realign the leg, a wedge of bone is removed or added to the upper tibia.
A staple or plate and screws are used to hold the bone in place until it heals.

The Proximal Tibial Osteotomy buys some time before needing to perform a total knee replacement. Pain relief usually lasts for 5-7 years.
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