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Hip and Knee Osteoarthritis
dr n. med. Dariusz Mątewski
Joint degeneration changes are the most
frequent reason of joint diseases and affect @
15% of human population
 It is characterized by:
– Progression lesion initially mainly affected cartilage
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then another subchondral layers
in final stage also bone tissue
– Besides decayed changes quickly develop hypertrophic
ones:
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formation of new bone tissue on borders of the joint (osteophytes)
sclerosis of subchondral bone layer
– Degenerative joint disease is also described as a
disturbance of balance between cartilage degradation
process and synthesis cartilage proces
Normal cartilage structure
Normal cartilage structure
Initial degenerative joint changes
Degenerative joint changes – cont.
Advanced degenerative joint changes
Most Common Types of
Arthritis
– Primary Osteoarthritis
– Secondary Osteoarthritis
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Dysplastic Arthritis
Rheumatoid Arthritis
Post-traumatic Arthritis
Avascular Necrosis
Others
OA Symptoms
– May develop suddenly or very slowly
– Arthritis can cause pain and stiffness
– Some types of arthritis may cause swelling
– Growing deformity of joint
– Joint disfunction with limitation of motion
– Simple activities may be difficult to do
Characteristics of primary
degenerative joint disease
– The most frequently occur in patients between 45-
60 years of life.
– Frequently in women than men
– Disease is characterized by:

quite insidious, slow growing of symptoms which are
accompanying by:
– pain
– joint deformity
– joint disfunction

disease is characterized intially by:
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–
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local changes
then can affect neibourgh joints,
equal-nominal joints
whole locomotor system
Secondary Osteoarthritis
Dysplastic Arthritis

abnormal joint shape can lead to large wear
Rheumatoid Arthritis

inflamed joint tissue leading to cartilage
lesion
Post-traumatic Arthritis

irregularities of cartilage joint surface lead to
large wear
Avascular Necrosis

bone may collapse and damage cartilage
The most frequent localization of
osteoarthritis:
 Spine osteoarthritis ( intervertebral joints and deformative
and degenerative changes of vertebra’s corpuses with
intervertebral discopathy)
 Hip osteoarthritis
 Knee osteoarthritis
– (femoralopatelar compartment, femoralotibial
compartment)
 foot osteoarthitis
– MTP I joint
– ankle joint
– subtalar joint
 shoulder osteoarthritis
 elbow osteoarthritis
 hand joints osteoarthritis
The most frequent localization of osteoarthritis:
Degenerative changes of IP joints in hand –
Heberden tubercule
Degenerative changes of cervical spine
Degenerative changes of lumbar spine
Hip osteoathritis
Knee osteoarthritis
Clinical examination
we exam:
– joint contour
– joint movement
– joint conracture
– joint stability,
– limb axis,
– gait abnormalities (limping, walking distance),
– posture abnormalities,
– changing in way of doing some daily activities,
The Orthopaedic Examination
The physical examination
enables surgeon to evaluate
important aspects of joints,
including:
– Size and length
– Strength
– Range of motion
– Swelling
– Reflexes
– Skin condition
Typical posture indicates on limitation of flexion and
rotation movement in hip joint
Localization of pain in patient with hip osteoarthritis
Knee position is frequently in flexion contacture with
varisation of lower limb axis
Obciążenie współistniejące

Należy pamiętać, że choroba zwyrodnieniowa
dotyczy głównie ludzi w wieku starszym, którzy dość
często cierpią z powodu innych schorzeń:
–
–
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–

choroba wieńcowa,
nadciśnienie tętnicze,
cukrzyca,
choroby układu żylnego kończyn,
przewlekłe choroby układu oddechowego i inne
Leczenie choroby zwyrodnieniowej w wieku
podeszłym jest utrudnione i ograniczone z uwagi na
ogólną wydolność chorego.
The Orthopaedic Evaluation
X-ray Evaluation
 An
abnormal X-ray may
reveal:
– Narrowing of the joint space
– Cysts in the bone
– Spurs on the edge of the bone
– Areas of bony thickening called
sclerosis
– Deformity or incorrect alignment
Normal Knee
X-ray
Arthritic Knee
X-ray
Normal Hip
X-ray
Arthritic Hip
X-ray
The Orthopaedic Evaluation

Additional Diagnostic Tests
may include:
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Blood tests
Urine analysis
Analysis of joint fluid
Magnetic Resonance Imaging (MRI)
Bone scan
Treatment Options
– Medications
– Physical therapy
– Bracing
– Injections (steroid or joint fluid supplements)
– Arthroscopy – cleaning the joint
– Partial joint replacement
– Total joint replacement
Medications
– Aspirin-free pain relievers–acetaminophen
– Nonsteroidal anti-inflammatories (NSAIDs)
– Glucosamine / chondroitin sulfate
– Corticosteroids–injection/pill form
Quick, effective pain relief
 Max 3-4 times per year
– Viscosupplementation = Joint Fluid Replacement

Bracing and Assistive Devices

A cane in the
opposite hand
decreases joint forces
by 50% !

“Unloader” braces
can take pressure off
the painful side of the
knee and stabilize the
joint
Physical Therapy

Passive range-of-motion exercises may help:
– Reduce stiffness
– Keep joints flexible

4-5 times bodyweight through knee climbing
stairs!
 Quadriceps strengthening
 Transition from high to low-impact exercises
– Cycling, elliptical, swimming
– Avoid deep knee bends against resistance
What is Arthroscopy?

Arthroscopy is a surgical
procedure used to visualize,
diagnose and treat problems
inside a joint.
• A small incision is made in the patient's skin and then
pencil-sized instruments are inserted that contain a small
lens and lighting system to magnify and illuminate the
structures inside the joint.
Partial Joint Replacement

Surgical procedure in which only the
damaged or diseased surfaces of the joint
are replaced, leaving much of the natural
bone and soft tissue in place.
– Post-operative pain may be reduced
– Recovery period may be shorter than total
knee replacement
Total Joint Replacement

Surgical procedure in which certain parts of
an arthritic or damaged joint are removed
and replaced with an artificial joint.

The artificial joint is designed to move just
like a healthy joint.
Joint Replacement
 Joint
replacement is a treatment
option when pain:
– Is severe
– Interferes with daily activities
– Interferes with work
Joint Surgery

May be suitable for patients who:
– Have a painful, disabling joint disease of the joint
resulting from a severe form of arthritis
– Are not likely to achieve satisfactory results from
less invasive procedures, medication, physical
therapy, or joint fluid supplements
– Have bone stock that is of poor quality or
inadequate or other reconstructive techniques
Total Joint Replacement
Goals of total joint
replacement
are to help:
Relieve pain
Restore motion and
function
Hip Joint

The hip must bear the
full force of body
weight and consists of
two main parts:
– A ball (femoral head)
at the top of your thigh
bone (femur)
– A rounded socket
(acetabulum) in your
pelvis
How’s this for an endorsement?
“The Operation of the Century:
Total Hip Replacement”
The Lancet, October 2007
Total Hip Replacement
Replaced Hip X-ray
Knee Joint
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Femur – thigh bone
Cartilage – tissue between bones
that provides cushioning
Patella – knee cap
Tibia – shin bone
Synovium – tissue surrounding
the joint that provides lubricating
fluid
Ligament – flexible tissue that
holds knee joint together
Total Knee Replacement
– End surface of femur
replaced with metal
– End surface of tibia
replaced with metal
– Plastic liner is inserted
between femur and
tibia
– Patella is resurfaced
with plastic
Replaced Knee X-ray
Anterior (front) View
Lateral (side) View
Knee Replacement:
Total versus
Unicompartmental

Majority of patients
predominantly affected in one
compartment only
 Relatively easier recovery
 Less surgery
 Maintain cruciate ligaments
– “feels more natural”
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Does not preclude TKA later
– Most do not need to be converted
Computer Navigation

No benefit in skilled hands for the average patient
 May help surgeon who do less joint replacements, but
need to know when not to trust it…
 Definitely helpful in outliers:
– Significant deformity or malalignment
– Old hardware

Total knee replacement is primarily a Soft Tissue
Procedure.
Recovery
Recovery
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Every individual is different and every treatment
plan is different.

“You’ll be mad at me for two weeks”
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Estimated Recovery Schedule:
– In-hospital: 2 – 5 days
– Significant Functional Improvement: 2 wks – 3 mos
– Maximal Improvement: 6 – 12 months
Recovery
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Directed exercise program
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The physical therapist or another
member of the staff works with
you to help you:
– Regain muscle strength
– Increase range of motion
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Start with home PT and progress
to outpatient therapy
General Guidelines to get back
to your Routine
– You'll practice stair-climbing in the hospital and should
be able to do this by the time you leave
– You should have no restrictions on leaving your home
as long as your safety and comfort are assured. A good
balance of exercise, rest, and relaxation is best for
helping your body heal and gain strength
– When to resume driving a car, going to work, and/or
participating in sports activities are all highly
individualized decisions.
Limitations After Surgery

Athletic activities that place
excessive stress on the joint
replacement should be avoided.
 Examples include:
– Difficult Skiing (snow or water)
– Contact sports
– Regular running
– Frequent jumping

Patients don’t listen to me…