pamhong3-Ankle Osteoarthritis
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42 terms
Terms | Definitions |
|---|---|
 What does OA affect? | bone, joint, cartilage causing destruction synovial tissue are also affected |
| What are the 3 main categories of OA? | Primary secondary posttraumatic |
| What is primary OA caused by? | natural phenomenon of wear & tear process of aging, weight, biomechanical dysfunction |
| What is secondary OA due to? | RA or other disease processes leading to joint damage |
| What is posttraumatic OA due to? | trauma such as ankle fracture with joint involvement or talar fracture |
| What are the main causes of posttraumatic arthritis? | 1. posterior malleolar fractures 39% 2. ankle ligamentous injuries 16% 3. talar fractures 2% 4. pilon fractures 14% |
| What is the purpose of cartilage? | serves as protective barrier for underlying bone & provides protection from mechanical stresses |
| What % of ECM is water volume? | 65-70% |
| What type of environment is ankle joint? | anoxic & undergoes anaerobic metabolic pathways |
| WHy does OA occur in the joint? | imbalance between mechanical & catabolic processes that act upon joint & interferes with tissues ability to withhold strain & undergo repair |
| Which joint has higher concentration of glycosaminoglycan sulfate & much lower water concentration? | ankle joint |
| What is greater yet lower in the ankle joint compared to the knee? | greater dynamic stiffness of ankle cartilage & gerater stiffness & protection from destructive compressive mechanical stresses BUT Less hydraulic permeability |
| What is upregulated in presence of damaged cartilage? (immunohistochem) | -upreg of mRNA for type III B collagen in chondrocytes in articular cartilage -high levels of glycosaminoglycan (GAG) also found in damaged cartilage |
| In OA cartilage, >90% of synovial membrane cells are positive for what CDs? | CD 44, CD37, CD90 |
| What areseen in high numbers of damged carilage? | -interleukins -TNF-alpha -matrix metalloproteases -GAG -mRNA for type III B collagen |
| What are the 3 stages of OA disease progression? | Stage I: proteolytic breakdown of cartilage matrix StageII: fibrillation & erosion of cartilage surface & release of breakdown products into synovial fluid Stage III: demonstrates synovial inflammation secondary to phagocytosis & exhibits proteases & pro-inflammatory cytokines |
| Known OA risk factors? | Age Weight systemic diseases, HIV, drug use, biomech joint malalignments, |
| Clinical presentation of OA? | -joint stiffness -unilateral or b/l & can affect multiple or single joint |
| What are inflammatory monoarticular dzs? | -gout -infection -psoriatic arthritis -reactive arthritis |
| What are inflammatory polyarticular infetion? | -IBD sarcoidosis -SLE psoriatic arthris -ankylosing spondylosis Sjogren's syndrom -poliomyositis malignancy -Behcet dz -post infection |
| Noninlammatory/polyarticular dzs | -hemochromatosis -sick ell dz -hemophilia amyloidosis |
| Dx testing for OA? | SERUM TESTING ESR -absent CRP-absent/weakly present RF-absent ANA -absent ANTI-CCP-absent |
| Synovial fluid characteristics of OA? | straw yellow high viscosity transparent NO crystals 200-2000/ul WBC neg gram stain & bacteria |
| Synovial fluid characteristics of RA? | yellow-opalescent low viscosity opaque fluid NO crystals 2000-10,000/ul Neg gram stain & bacteria |
| Synovial fluid characteristics of SEPTIC ARTHRITIS? | yellow-green variable viscoity opaque fluid NO CRYSTALS 2,000-100,000/ul POS GRAM STAIN & POS BACTERIA |
| Synovial fluid characteristics of GOUT | yellow-opalescent LOW viscoity translucent-opaque fluid CRYSTALS PRESENT 2000-40,000/ul NEG GRAM STAIN & BACTERIA |
| Synovial fluid characteristics of HEMORRHAGIC | Red-deep brown color variable viscosity sanguinous fluid NO CRYSTALS 200-2,000/ul NEG gram stain & bacteria |
| What can be seen on MRI? | -decreased subchondral bone thickness -joint space narrowing -subchondral bone cysts -signal change within cartilage & BM |
| What are radiographic changes of OA? | -bone spurs (osteophytes) -joint space narrowing or obliteration -subchondral sclerosis -joint deformation |
| Conservative tx of OA? | -topical meds -exercise -bracing -orthotics -ankle injections -mesenchymal stem cells for chondrogenesis -ankle injections to increase synovial fluid viscity & lubrication |
| ORAL MEDS For OA? | -analgesics, -corticosteroids -COX-2 inhibiotrs -NSAIDS |
| What are surgical options for OA? | -ankle joint fusion -ankle joint arthrodiasis -debridement -allograft transplantation -osteotomies -total ankle replacement |
| What is arthrodiastasis? | -ankle joint distraction -- joint sparing procedure -joint repair can be facilitated when mechanical stresses are removed -distraction positively impacts metabolic activity & maintains intermittent fluid pressure within joint --> collagen repair is encouraged in low-pressure environment that can be down via distraction -external fixators can be used to achieve distraction -device remain in place for about 3 months -- maintained at 5 mm (1 mm/day) |
| What is supramalleolar osteotomy? | -joint sparing surgery that corrects deformity at or above level of ankle & restores normal alignment --> slows down progression of arthritis |
| indications for supramalleolar osteotomy? | -pediatric deformities -malunions -varus/valgus deformity |
| What is a JOINT DESTRUCTIVE procedure for OA? | arthrodeiss |
| When are arthroscopic fusions contraindicated? | -presence of significant varus/valgus malalignment |
| What is the Tayler Spacial Frame used for? | -compression across ankle fusion site |
| What is the Charnley method? | -external fixation ankle arthrodesis requiring intact Achilles tendon to achieve compression across the arthrodesis site via a tension band effect |
| What is the Calandruccio external device & technique? | -external fixation ankle arthrodesis that does not require Achilles to be intact -device relies upon triangular config to impart compression & buttress the fusion site with medial & lateral malleolar onlay grafts |
| What is the unilateral frame application? | -external fixation ankle arthrodesis in which compression device is added directly to fixator |
| What is the ideal positioning of the ankle joint? | -5-10 degrees of external foot rotation -ankle joint in neutral or 0 degrees flexion -5 degrees of hindfoot valgus |
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