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Rheumatology

Question
7 out of 13
 

What is the best treatment of a patients of Osteoarthritis Aphrolan grade II ? (AIIMS May 2010)



A High tibial osteotomy

B Conservative

C Arthroscopic washout

D Knee replacement

Ans. C Arthroscopic washout

Ref. Canale&Beaty: Campbell's Operative Orthopaedics, 11th ed page 241-300

A. Osteo arthritis - Womack grading.

Stage i there is softening of the cartilage if the surfaces of the knee. This may not show on X-ray.

Stage ii the cartilage starts to wear away and shows as a narrowed joint space.

Stage iii osteophytes are seen. Stage 2 and 3 may merge and be difficult to separate.

Stage iv is the "bone-on-bone" with very narrow joint space, lots of osteophytes, and distortion of the joint

B. Osteo arthritis - Outerbridge Classification

Grade 0: normal cartilage;
a. Grade I: cartilage with softening and swelling;
b. Grade II: a partial-thickness defect with fissures on the surface that do not reach subchondral bone or exceed 1.5 cm in diameter;
c. Grade III: fissuring to the level of subchondral bone in an area with a diameter more than 1.5 cm;
d. Grade IV, exposed subchondral bone

C. Management

i. Initial management of

1. Physical therapy

2. Bracing, orthoses, ambulatory aids

3. NSAID, glucosamine, chondroitin, intraarticular injections of steroid or hyaluronic acid, and analgesics.

ii. Arthroscopic débridement is done in active, older adults with mild-to-moderate OA of the knee after conservative treatment has been exhausted.

iii. High tibial osteotomy

It is a well-established procedure for the treatment of unicompartmental OA of the knee.

Rheumatology Flashcard List

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