Osteoarthritis is a chronic disorder characterized by cartilage loss. It occurs when the protective cartilage cushions the ends of bones down over time. The joints may be impaired by congenital defect, vascular insufficiency, previous disease or injury. Pain is relieved during resting position. Morning stiffness and cracking or grinding are the major symptomatic of Osteoarthritis. It commonly affects our knee joints, hips and spine.

Causes :

1. Primary cause : Aging.
2. Secondary cause :

• Obesity
• Repeated trauma
• Surgery to the joint structures
• Congenial abnormalities
• Gout
• Rheumatoid arthritis
• Diabetes

Pathology : The main changes are in the articular cartilage and underlying bone. The bone at the margins of the joints hypertrophies to form a rim of projecting spur is known as Osteophytes. There is no primary affect in the capsule or synovial membrane but the recurrent strains on osteoarthritic joint. It leads to slight thickening and fibrosis.

Clinical features :

• Morning stiffness
• Pain
• Crepitus with movement
• Gel like feeling in the joints
• Deforming varus and valgus.

Diagnosis :

1. Physical Examination  : Joints appear large due to bony hypertrophy, fluid or soft tissue swelling. Effusion  may be painless but crepitus is felt during movement.

2. Radiological Examination :

1. X-ray :

• Diminution of cartilage space
• Subchondral scterosis
• Subchondral cysts
• Spurring or lipping of the joint margins from the formation of osteophytes.

1. MRI
2. CT
3. Joint aspiration

3. Blood test :

• CBC
• ESR

Treatment :

1. Medication :

• Acetaminophen
• Nonsteroid anti inflamatory drugs
• Glucosamine chondrotin sulfate
• Interarticular injection of corticosteroid
• Interarticular injection of hyaluronic acid

2. Physiotherapy :

• SWD
• UST
• MWD
• Quadriceps strengthening exercise
• Ice therapy
• Aerobic exercise example bicycling
• Stretching exercise
• Orthosis
• ADL

3. Operative treatment :

• Osteotomy is useful mainly at the joint  to correct deformity.
• Arthroplasty (Construction of a new joint).
• Arthrodesis (Elimination of the joint by fusion)

Complications of Osteoarthritis :

• Rapidly or completely breakdown of cartilage.
• Bone death (Osteonecrosis)
• Stress fracture
• Bleeding inside the joint

Foods which are prohibited during affected Osteoarthritis :

• Salt
• Fried food
• White flour
• Omega six fatty acids
• Dairy

Advice :

• Patient must reduce body weight.
• Adequate water, fruit and green vegetables must be eaten.
• Patient must make the habit of regular exercise such as walking, swimming, yoga etc.
• Stick or cane can be used during severe condition.

Md.Ruhul Amin
BSPT (DU)
Clinical Physiotherapist
Department of Physiotherapy
National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR).