Osteoarthritis
Pathophysiology/Etiology
- Most common degenerative joint disease, mostly affecting middle-aged and older persons
- Progressive loss of articular cartilage, appositional new bone formation in the subchondral trabeculae, formation of new bone at the joint margins (osteophytes)
- Joints of the lower extremities are most commonly affected (knees and hips)
- OA of a single joint is a local problem in the articular structure and function, causing activity and participation limitations
- Pain leads to higher tonus of the surrounding muscles
Signs/Symptoms
- Morning stiffness, joint pain, loss of ROM, activity limitations
- localized tenderness/pain with AROM and PROM, crepitus
- muscle atrophy is seen secondary to disuse
- OA of the hip: pain the area of the groin and along inner aspect of thigh, dec ROM (mainly IR)
- restrictions in ADLs, social isolation, depressive mood, sleep disturbances, fear avoidance strategies, fear of falling
Diagnostic Tools
- Radiographs
- MRI
- Hip (sensitivity 86%, specificity 75%):
- Hip pain, plus: hip IR <15 deg, OR ESR </= 45 mm/h
- OR Hip pain, plus: hip IR >/= 15 deg, OR pain with hip IR, OR morning stiffness of hip for </= 60 min
- Hip (sensitivity 89%, specificity 91%):
- Hip pain, plus at least 2 of the following:
- ESR < 20 mm/h
- Femoral or acetabular osteophytes on radiographs
- Joint space narrowing on radiographs
Prognosis
- Can be measured using progression in range of motion and outcome measures such as the hip disability and osteoarthritis outcome scores (HOOS), Harris Hip Score (HHS), Oxford hip score (OHS), hip and knee questionnaire and Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH)
- Influenced by several factors such as comorbidities, bone adaptation and diet
Treatment:
- Goals: pain control, maximizing functional independence, improving quality of life
- First line management: exercise
-- Resistance exercise program
-- Aerobic exercise
-- Flexibility exercise
- Nonpharmacological: exercise, therapeutic ultrasound, electrostimulation, low-level laser therapy, acupuncture, thermal agents, pulsed magnetic field therapy, assistive devices, weight reduction
Prevention
- Weight loss
- Exercise-resistance training
- Aerobic exercise
- Flexibility for increased ROM
- Education on joint protection
- Avoid repetitive stress
Differential Diagnosis
- Bursitis
- tendonitis
- chondral damage or loose bodies
- femoral neck or pubic ramus stress fracture
- labral tear
- muscle strain
- neoplasm
- osteonecrosis of femoral head
- paget's disease
- piriformis syndrome
- psoriatic arthritis
- rheumatoid arthrits
- L2-3 radiculopathy