Coupon Accepted Successfully!


Osteoarthritis (O.A)

Also called Advance degenerative joint disease.


The central event is destruction of articular cartilage.


It is a chronic non inflammatory joint disorder in there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytosis) and capsular fibrosis, Its asymmetrical distribution, often localization to only one part of a joint and its association to abnormal loading rather than frictional wear differentiates OA from simple wear and tear.


  1. Etiopathogenesis, & Risk Factors
    1. OA is the most common joint disease. It develops in either of two settings
      1. Excessive loading inspite of normal articular cartilage and subchondral bone.
      2. The applied load is normal but material properties of cartilage or bone is inferior
    2. Risk factors for OA are
      Age is the most powerful risk factor

  1. In majority of cases the precipitating cause of OA is increased mechanical stress in some part of articular surface. This may be due to increased load (eg in deformities around joint) or to a reduction of articular contact area (eg. with joint incongruity or instability), Both factors operate in varus deformity of knee and in acetabular dysplasia.
  2. Quadriceps (vastus medialis) is mostly involved muscle in OA
  1. Classification
    1. Idiopathic (Primary) OA
      1. Localized (Monoarticular and Pauciarticular) OA involving
        1. Hands: DIP (heberden’s node), PIP (Bouchard’s node), 1st carpometacarpal joint
        2. Feet hallux valgus, hallux rigidus, talonavicuiar, contracted toes (hammer / cock up toes)
        3. Knee (Most common)
        4. Hip (Rare in India)
        5. Spine (apophyseal joint, inter vertebral joint)
        6. Other less common single sites are glenohumeral, acrornioclavicular, tibiotalar, sacroiliac, temporomandibular,
      2. Generalized (Polyarticular) includes 3 or more of the above listed area
    2. Secondary OA
      1. Trauma
      2. Congenital / Developmental disorders eg Perthe’s ds, SCFE, CDH, Varus/ valgus deformity, bone dysplasias
      3. Metabolic disease eg. ochronosis (alkaptonuria), hemochromatosis, Wilson’s disease, Gaucher’s disease.
      4. Endocrine disorders eg. Acromegaly, hyperparathyroidism diabetes mellitus, obesity, hypothyroidism
      5. Calcium deposition diseases eg. CPPD, apatite arthropathy
      6. Other joint disease eg fracture, AVN, gout, infection, osteopetrosis, osteochondritis, paget’s disease etc.
    3. Pattern of Joint Involvement
      1. In <55 years joint distribution in men & women are similar; in older hip OA is more common in men, while OA of interphalangeal joints and thumb base is more common in women.
      2. Classical monoarticular or pauciarticular OA involves one or two of large weight bearing joints knee> hip. Symptomatic OA knee is more common in men than in women.
      3. Polyarticular (generalized) OA is the most common form, and it most commonly involves distal interphalangeal joint
    4. Sparing of metacarpophalangeal and wrist joint

Extra Edge: Osteoarthritis characterstically involves distal interphalangeal joint (Heberden’s node), proximal interphalangeal joint (Bouchard’s node) 1st carpometacarpal joint (base of thumb) of hand with sparing of metacarpophalangeal joint and wrist joint.


  1. Radiological Feature
    X-ray are so characteristic that other forms of imaging are seldom necessary. The cardinal signs are

  1. Asymmetrical loss of cartilage causing narrowing of joint space (earliest feature)
  2. Sclerosis of subchondral bone under the area of cartilage loss
  3. Cystic lesion close to articular surface
  4. Osteophytes at the margins of joint
  5. Lose bodies & deformities.

  1. Hand
    1. DIP -Heberden’s node (m.c)
    2. PIP Bouchard’s node
    3. Non nodal erosive interphalangeal arthritis
    4. CMC joint (carpometacarpal joint of base of thumb)
  2. Not Involved
    1. MP joint
    2. Wrist joint
  3. Treatment
    1. Maintain movement & muscle strength by physiotherapy & graded muscle exercise
    2. Protects the joint from overload by giving rest and weight reduction
    3. Correction of deformities if present
    4. Irrespective of Radiological grade (Most commonly used is Ahlback’s grade): treatment starts with Medications that include
      1. Analgesics
      2. Glucosamine (Increases lubrication)
      3. Chondrotin sulfate (Increases lubrication)
      4. Diacerin (Reduces IL-1 induced cartilage damage)
      5. S-Adenosyl Methionine (SAM): Reduces pain and cartilage damage
      6. Tetracycline (Inhibits metalloproteinase) not recommended for routine therapy.
    5. In addition physical therapy is given like Thermal modalities, analgesic medication, wedged insoles, arthoses
    6. Intra articular injections like steroid or viscoelastic supplementation like Hyaluronic acid can be used but they give temporary relief.
    7. Indication for surgery is severe disabling pain. Pain that is affecting activity of daily life and there is radiological evidence of osteoarthritis (Grade 2 to 5, any grade)
    8. Arthroscopic debridement & lavage only in presence of mechanical symptom like locking/loose bodies in x-ray.
    9. Progressive joint destruction require joint replacement.
Treatment algorithm can be considered for Osteoarthritis:


Unicompartmental (Medial or lateral)

More than one compartment

Young/High activity/Laboures

High tibial osteotomy


Old/Less active

Unicompartmental knee arthroplasty

Total knee arthroplasty

Ndications for Arthroplasty

  1. Total Knee Replacement (TKR)
    1. The primary indication is to relieve pain caused by severe arthritis with or without significant deformity.
    2. Deformity can become the principal indication in patients with moderate arthritis.
    3. Severe pain from chondrocalcinosis & pseudogout and severe patello femoral arthritis in an elderly is an occasional indication for TKR.
  2. Total Hip Replacement (THR)
    1. Originally the primary indication for THR was the alleviation of incapacitating pain in patients older than 65 years of age who could not be relieved, sufficiently by non-surgical means & for whom the only surgical alternative was resection of hip joint (Girdle stone resection arthroplasty)
    2. Of secondary importance was improved function of hip.
    3. So it is mostly used for hip arthritis (rheumatoid, akylosing, OA), AVN of femoral head and non-union of femoral head and nonunion of femoral neck. Its indication are:-
      1. Arthritis Rheumatoid, JRA (Still’s disease), ankylosing spondylitis
      2. Secondary degenerative joint diseases (osteoarthritis): due to traumatic dislocation, fracture acetabulum, hemophilia, Paget’s disease, slipped capital femoral epiphysis, congenital dislocation of hip, coxa plana (leggp erthes disease)
      3. Avascular necrosis d/t cortisone induced, alcoholism, caisson’s disease, lupus, Gaucher’s disease, non-union femoral neck and trochanteric fractures with head involvement, post traumatic, post dislocation, SCFE, hemoglobinopathies (sickle cell disease), idiopathic.
      4. Bone tumor involving proximal femur or acetabulum
      5. Pyogenic arthritis or osteomyelitis & tuberculosis of hip joint (Head cases), But active infection is absolute contraindication.
      6. Failed reconstruction eg hemi-replacement, girdle stone arthroplasty etc.
      7. Hereditary disorder (eg achondroplasia)

Test Your Skills Now!
Take a Quiz now
Reviewer Name