Lecture 5-Arthritis and Joint replacement 1

Arthritis Overview

A chronic degenerative condition affecting joints.

Can occur due to joint injuries (e.g., repetitive use, fractures).
May develop at any age due to improper joint alignment or other unknown factors.

Subchondral bone aids articular cartilage stress absorption.
Poor subchondral absorption can lead to cartilage damage.
Damage to chondrocytes (cartilage-producing cells) contributes to OA progression.

Inflammatory changes cause thickening of the synovium.
Ligament laxity and muscle weakness around the joint contribute to increased friction and pain.
This can lead to reduced movement and mobility issues.

Most commonly affected joints: Spine, Hands, Knees (most frequent in women), Hips, Feet.

Data structures incidence by age and gender, showing higher rates in knee and hip OA among women compared to men. Peak incidence generally occurs between ages 70-79.

Contact stresses from activities exceed tolerances, can lead to cartilage damage.
Running and jumping can significantly increase stress on joints.

Symptomatic: No cure exists, focus on pain management.
Strategies include:
- Weight reduction action
- Strengthening surrounding muscles.
- Nutritional supplements (e.g., glucosamine).
- Medications (e.g., NSAIDs/COX inhibitors, corticosteroids).

Indications for Surgery: Knee replacement is often recommended when conservative treatments (medications, physical therapy, lifestyle changes) fail to alleviate severe pain or functional limitations that affect quality of life.
Types of Knee Replacements:
- Total Knee Replacement (TKR): Involves replacing both the lower end of the femur and the upper end of the tibia.
- Partial Knee Replacement (PKR): Only a portion of the knee joint is replaced, which can be beneficial for patients with localized damage.
Surgical Procedure: Under general or regional anesthesia, damaged cartilage and bone are removed; metal and plastic components are then cemented into the joint space.
Postoperative Management: Includes pain control, rehabilitation focusing on restoring joint function and strength, and gradually increasing weight-bearing activities.
Outcomes: Most patients experience significant pain relief, improved function, and better quality of life. However, potential complications include infection, blood clots, and prosthesis failure.
Lifelong Considerations: Patients are advised to avoid high-impact activities to prolong the lifespan of the knee prosthesis and to maintain a healthy weight.

64-year-old female nurse presents with knee pain after prolonged standing and activity. Reports swelling and stiffness. Suggested management includes modifying sitting positions, education on expectations, and addressing pain management.

COX-1 and COX-2 Enzymes: Involved in the synthesis of prostaglandins, which influence pain and inflammation.

Study involving 1583 patients tested the efficacy of glucosamine and chondroitin compared to placebo. Celecoxib was effective across all pain groups, whereas glucosamine and chondroitin were less effective in mild cases but had some benefit for moderate-to-severe cases.

Exercise is crucial for maintaining joint function, increasing muscle strength, and improving flexibility. Recommendations promote low-impact activities tailored to individual capabilities.
Aerobic activities recommended 3-5 days/week aiming for 150 min/week. Strength training and flexibility exercises are also beneficial.

Different surgical approaches (anterior, lateral, posterior) influence rehabilitation processes and patient precautions post-surgery. Considerations include protecting joints from excessive movement, especially during recovery phases.