Orthopaedics - Osteoarthritis (Ny!)

Front 1

Osteoarthritis can be characterized as:
- degenerative joint disease
- disease of articular cartilage in synovial joints
- inflammatory arthropathy
- one of the autoimmune disease of joints

Back 1

Osteoarthritis can be characterized as:
- degenerative joint disease+
- disease of articular cartilage in synovial joints+

Front 2

Exacerbation of osteoarthritis is characterized by:
- constant background rest pain and activity related pain
- soft tissue irritation (swollen and stiff joints, with effusion)
- redness of affected joints
- increase in serum inflammatory parameters – ESR, CRP

Back 2

Exacerbation of osteoarthritis is characterized by:
- constant background rest pain and activity related pain+
- soft tissue irritation (swollen and stiff joints, with effusion)+

Front 3

X-ray investigation most often use:
- plain radiographs, preferably in two planes
- CT and MRI
- arthrography with contrast medium
- scintigraphy

Back 3

X-ray investigation most often use:
- plain radiographs, preferably in two planes+
- CT and MRI+

Front 4

The first stage of osteoarthritis is characterized by:
- usually being clinically asymptomatic
- X-ray with a discrete subchondral sclerosis, joint space is normal
- only small osteophytes on X-ray film
- patient has start-up pain

Back 4

The first stage of osteoarthritis is characterized by:
- usually being clinically asymptomatic+
- X-ray with a discrete subchondral sclerosis, joint space is normal+

Front 5

Most frequently are performed:
- hip arthroplasties
- knee arthroplasty
- shoulder arthroplasty
- ankle arthroplasty

Back 5

Most frequently are performed:
- hip arthroplasties+
- knee arthroplasty+

Front 6

Inflammatory degenerative joint diseases include:
- rheumatoid arthritis, JRA – juvenile rheumatoid arthritis, Still's disease, ankylosing spondylitis (M. Bechtěrev)
- here Reiter's syndrome, Felty´s syndrome, Sjögren's syndrome, psoriatic arthropathy, metabolic arthropathy
- septic arthritis, such as coxitis, gonitis
- neuropathic joint disability – Charcot arthropathy

Back 6

Inflammatory degenerative joint diseases include:
- rheumatoid arthritis, JRA – juvenile rheumatoid arthritis, Still's disease, ankylosing spondylitis (M. Bechtěrev)+
- here Reiter's syndrome, Felty´s syndrome, Sjögren's syndrome, psoriatic arthropathy, metabolic arthropathy+

Front 7

Diagnosis of rheumatoid arthritis is based on:
- clinical symptoms – small joints swelling, deformities, joint effusion, rheumatoid nodules, tendo-vaginitis, vasculitis, skin changes
- laboratory: high ESR, anaemia, positive RhF, CRP, ANA (antinuclear antibody)
- increased skin temperature of the joints
- impossibility of movement in affected joints

Back 7

Diagnosis of rheumatoid arthritis is based on:
- clinical symptoms – small joints swelling, deformities, joint effusion, rheumatoid nodules, tendo-vaginitis, vasculitis, skin changes+
- laboratory: high ESR, anaemia, positive RhF, CRP, ANA (antinuclear antibody)+

Front 8

For the secondary osteoarthritis is typical:
- is more common in the weight-bearing joints of the lower limb than upper limb joints
- conditions after septic diseases, metabolic diseases (ochronosis, gout), the structural changes (Perthes disease, CVA, DDH, intra-articular fractures)
- occurs on the basis of primary (idiopathic) osteoarthritis progression
- can be cured conservatively targeted medication (chondroprotection drugs)

Back 8

For the secondary osteoarthritis is typical:
- is more common in the weight-bearing joints of the lower limb than upper limb joints+
- conditions after septic diseases, metabolic diseases (ochronosis, gout), the structural changes (Perthes disease, CVA, DDH, intra-articular fractures)+

Front 9

When osteotomy is performed:
- we cut the bone to change the axis of the limb or joint
- most often performed osteotomy in varus knee is valgus OT
- we remove surgically the damaged part of the joint
- corticectomy of a bone with chisel to improve blood circulation

Back 9

When osteotomy is performed:
- we cut the bone to change the axis of the limb or joint+
- most often performed osteotomy in varus knee is valgus OT+

Front 10

Between joint preserving operations belong in osteoarthritis of hip and knee:
- arthroscopic wash-out, cartilage transplantation, synovectomy
- varus and valgus osteotomy, shelf procedures (Bosworth)
- total replacement arthroplasty, hemiarthroplasty, unicompartemal replacement
- joint resection (Girdlestone arthroplasty), arthrodesis

Back 10

Between joint preserving operations belong in osteoarthritis of hip and knee:
- arthroscopic wash-out, cartilage transplantation, synovectomy+
- varus and valgus osteotomy, shelf procedures (Bosworth)+

Front 11

The conservative treatment of osteoarthritis sustain from:
- treatment with chondroprotectives, analgesics, compound analgesics, NSAIDs
- intra-articular application of corticosteroids, viscosupplementation
- antibiotics, inhibitors of tumor necrosis factor alpha (anti-TNF-alpha)
- series of methotrexate, sulfasalazine, hydrochloroquine

Back 11

The conservative treatment of osteoarthritis sustain from:
- treatment with chondroprotectives, analgesics, compound analgesics, NSAIDs+
- intra-articular application of corticosteroids, viscosupplementation+

Front 12

The true osteoarthritic changes on x-ray include:
- subchondral sclerosis, joint space narrowing, joint incongruity
- irregular trabecular spongiosa, subchondral cysts, osteophytes on the borders of the articular surface
- abnormal alignment of the joint axis, swelling of the soft tissue around the joint
- spotted osteoporosis (of multiple small brightening)

Back 12

The true osteoarthritic changes on x-ray include:
- subchondral sclerosis, joint space narrowing, joint incongruity+
- irregular trabecular spongiosa, subchondral cysts, osteophytes on the borders of the articular surface+

Front 13

Characteristics of osteoarthritis:
- non-inflammatory joint disease, with regressive changes in cartilage, with changes of bone and soft tissues of joints
- can affect any joint, but most often weight-bearing joints of the lower limb (hip and knee)
- mainly is a manifestation of age
- if early diagnosed, can be cured pharmacologically well

Back 13

Characteristics of osteoarthritis:
- non-inflammatory joint disease, with regressive changes in cartilage, with changes of bone and soft tissues of joints+
- can affect any joint, but most often weight-bearing joints of the lower limb (hip and knee)+

Front 14

For the diagnosis of osteoarthritis is characterized by:
- most present with pain, stiffness and functional loss, joint crepitus
- swelling joints, deformity, moderate effusion, abbreviated legs
- fever with increased warmth of overlying skin of joint
- in the lab examination high levels of inflammatory parameters - ESR, CRP, RF

Back 14

For the diagnosis of osteoarthritis is characterized by:
- most present with pain, stiffness and functional loss, joint crepitus+
- swelling joints, deformity, moderate effusion, abbreviated legs+

Front 15

Surgical treatment of osteoarthritis:
- reduce the overload of the joint, correct deformity and restore ROM
- alleviate pain and improve joint function
- nowadays has been replaced by therapeutic drugs
- performed only in elderly patients

Back 15

Surgical treatment of osteoarthritis:
- reduce the overload of the joint, correct deformity and restore ROM+
- alleviate pain and improve joint function+

Front 16

For the early changes in osteoarthritis is typical:
- located in the superficial layer of cartilage, leads to the necrosis and reduction in the number of chondrocytes
- cracks in the cartilage, may extend to the subchondral bone
- generated deep ulcerations to the subchondral bone necrosis and pseudocysts
- collapse of the pseudocyst, deformation of congruence of the articular surface, formation of osteophytes

Back 16

For the early changes in osteoarthritis is typical:
- located in the superficial layer of cartilage, leads to the necrosis and reduction in the number of chondrocytes+
- cracks in the cartilage, may extend to the subchondral bone+

Front 17

The aims of osteotomy are:
- to improve alignment of the joint, bring a different area of joint cartilage into function
- biological effect – increase blood circulation around the osteotomy, improve healing
- improve cosmetics around the affected joint
- to remove the effusion in the joint

Back 17

The aims of osteotomy are:
- to improve alignment of the joint, bring a different area of joint cartilage into function+
- biological effect – increase blood circulation around the osteotomy, improve healing+

Front 18

Among typical features for ageing joints include:
- joint space narrowing (loss of elasticity)
- loss of bone mass (osteoporosis)
- formation of osteophytes
- formation of bone cysts

Back 18

Among typical features for ageing joints include:
- joint space narrowing (loss of elasticity)+
- loss of bone mass (osteoporosis)+

Front 19

Typical features of total hip replacements are:
- replace the cup and the head, prosthesis are modular
- can be cemented and cementless
- are reserved for elderly patients, due to low survival rate
- cannot be implanted in cases of secondary osteoarthritis

Back 19

Typical features of total hip replacements are:
- replace the cup and the head, prosthesis are modular+
- can be cemented and cementless+

Front 20

Indications for implantation of joint replacement are:
- after exhausting conservative treatment
- for primary and secondary coxarthrosis, rheumatoid arthritis, fractures, tumors
- if patient has severe pain, also without x-ray changes
- if health instance company pay expenses with surgery

Back 20

Indications for implantation of joint replacement are:
- after exhausting conservative treatment+
- for primary and secondary coxarthrosis, rheumatoid arthritis, fractures, tumors+

Front 21

Hemiarthroplasty of the hip is characterized as:
- replaces only the head and neck of femur, correspond to the size of the original head
- usually indicated for fractures of the neck biologically older patients
- we perform in young patients with good quality of the acetabulum
- is advantageous for economic reasons

Back 21

Hemiarthroplasty of the hip is characterized as:
- replaces only the head and neck of femur, correspond to the size of the original head+
- usually indicated for fractures of the neck biologically older patients+

Front 22

Which is/are true of a total knee replacement:
- it is an anatomical condylar replacement, modular type
- components are usually cemented
- usually implanted arthroscopically
- indication only in young patients

Back 22

Which is/are true of a total knee replacement:
- it is an anatomical condylar replacement, modular type+
- components are usually cemented+

Front 23

Contraindications of the knee replacement are:
- peripheral arterial disease (PAD), infection around the joint, leg ulcers
- infection anywhere in the body, age, obesity (BMI > 40)
- age more than 75 years
- movement restrictions greater than ½ the range of flexion

Back 23

Contraindications of the knee replacement are:
- peripheral arterial disease (PAD), infection around the joint, leg ulcers+
- infection anywhere in the body, age, obesity (BMI > 40)+