Page 93 - ASOP ROT Study Guide

2 . 1 . 2 Secondary Osteoarthritis

In this minority group we see obvious causative factors .which quite reasonably may be assumed responsible for
secondary osteoarthritis. These are conveniently listed below with examples as they have been, or will be,
discussed elsewhere.

♦ Congenital - congenital dislocation of the hip
♦ Childhood - Perthe's disease, infection
♦ Trauma - fracture into a joint
♦ Metabolic - gout, crystal arthroplasty
♦ Infection - TB (tuberculosis)
♦ Chronic inflammatory - rheumatoid

2 . 2 Clinical Picture

Osteoarthritis can appear at any age but becomes increasingly common later in life. In the younger patient there
is usually a recognizable predisposing cause as indicated in secondary arthritis above, but not always so.

2 . 2 . 1 History (what the patient tells the doctor)

The patient complains of pain and associated loss of function of the affected joint and limb. Stiffness of the
joint is also a feature but nearly always is secondary to pain. In other words it is unusual for arthritis to cause
stiffness alone.

Usually the onset of arthritis is associated with pain during activity. If a lower limb joint is affected the patient
is often left with a general feeling of tiredness because of the effort required to move about. Help is sought from
the General Practitioner when simple pain relief (analgesia) no longer adequately controls the pain. Specialist
help from an orthopedic surgeon or a rheumatologist (a physician specializing in joint diseases) is usually
sought by the general practitioner when the patient's sleep is disturbed. The threshold for referral varies from
patient to patient but in general younger patients tend to request help earlier than the elderly, who expect a
degree of arthritis as they get older. Management of the problem is heavily dependent on the clinician's ability
to distinguish between the degrees of severity of arthritis amongst a very diverse population, and to treat and
refer the patient for surgery appropriately.

2 .2 . 2 Examination

The symptoms of osteoarthritis are pain and an associated limitation of movement. It is important to appreciate
that the limitation of movement during a routine examination will be less than any limitation observed during
an examination under anesthetic. Once this is appreciated then the clinician will soon come to realize that
successful results of surgery are related to adequacy of pain relief rather than to improvements in mobility of
the joint.

2 . 3 Management (how a doctor treats a patient)

All management is aimed at pain relief and, through this, return of function. The ultimate way of relieving pain is
surgery although there are general measures which will alleviate symptoms and postpone the need for
operation.

2 . 3 . 1 Non surgical (conservative) options

These include:

♦ weight loss

♦ use of a cane