Arthroplasty Health Dictionary

An operation for ?xating the bones in a diseased joint in a given position so that the joint cannot be moved. It is usually done if pain and deformity in a diseased joint – caused, for instance, by RHEUMATOID ARTHRITIS – are so bad that they cannot be relieved by drugs, PHYSIOTHERAPY, splinting or ARTHROPLASTY.... arthrodesis

Despite major e?orts, it has proved impossible to produce a single clear de?nition of osteoarthritis and this probably reffects the muddled nature of a concept which will need replacing. Unfortunately, there is confusion because the term is also used to cover joint pain that appears to have a mechanical basis in the absence of clinical or radiographic evidence of CARTILAGE loss.

The primary problem is seen as a change in structure of cartilage and BONE, rather than an in?ammatory SYNOVITIS. Osteoarthritis usually implies a loss of the central load-bearing area of articular hyaline cartilage, with outgrowth of cartilage at the articular margin and subsequent ossi?cation to form bony outgrowths known as OSTEOPHYTES. Osteophytes form with increasing age, whether or not there is signi?cant cartilage loss, and in the elderly may lead to local frictional symptoms, and in the spine, to nerve compression.

The condition has a wide range of causes, of which some, like dysplasia and trauma, are known and others have yet to be identi?ed. The main clinical problems occur in the hip and knee. The cartilage loss in the hip usually occurs in the sixth or seventh decade. It may affect both hips in fairly rapid succession, or only one hip; such patients often have no problems in other joints. Cartilage loss in the knee occurs from the ?fth decade onwards and is often associated with cartilage loss in small joints in the hand and elsewhere. Cartilage loss in the distal interphalangeal joints of the hand is associated with the formation of bony swellings known as Heberden’s nodes.

Treatment Management is largely directed at maintaining activity, with physical and social support as necessary. ANALGESICS may be of some value, particularly in the management of night pain. NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) may help patients with early-morning sti?ness and may also reduce pain on movement and night pain. Their bene?t, however, tends to be less marked than in RHEUMATOID ARTHRITIS and their long-term usage has considerable toxicity problems. Advanced cartilage loss is best treated by joint replacement. Hip- and knee-joint replacements – with a wide variety of arti?cial joints – are now common surgical procedures which greatly improve the mobility of affected individuals. (See ARTHROPLASTY.)

People with arthritis and their relatives can obtain help and advice from Arthritis Care.... osteoarthritis

See ARTHROPLASTY.... joint replacement

The joint formed by the FEMUR, TIBIA and patella (knee-cap). It belongs to the class of hinge-joints, although movements are much more complex than the simple motion of a hinge, the condyles of the femur partly rolling, partly sliding over the ?at surfaces on the upper end of the tibia, and the acts of straightening and of bending the limb being ?nished and begun, respectively, by a certain amount of rotation. The cavity of the joint is very intricate: it consists really of three joints fused into one, but separated in part by ligaments and folds of the synovial membrane. The ligaments which bind the bones together are extremely strong, and include the popliteal and the collateral ligaments, a very strong patellar ligament uniting the patella to the front of the tibia, two CRUCIATE LIGAMENTS in the interior of the joint, and two ?brocartilages which are interposed between the surfaces of tibia and femur at their edge. All these structures give to the knee-joint great strength, so that it is seldom dislocated. The cruciate ligaments, although strong, sometimes rupture or stretch under severe physical stress such as contact sports or athletics. Surgical repair may be required, followed by prolonged physiotherapy.

A troublesome condition often found in the knee – and common among athletes, footballers and other energetic sportspeople – consists of the loosening of one of the ?bro-cartilages lying at the head of the tibia, especially of that on the inner side of the joint. The cartilage may either be loosened from its attachment and tend to slip beyond the edges of the bones, or it may become folded on itself. In either case, it tends to cause locking of the joint when sudden movements are made. This causes temporary inability to use the joint until the cartilage is replaced by forcible straightening, and the accident is apt to be followed by an attack of synovitis, which may last some weeks, causing lameness with pain and tenderness especially felt at a point on the inner side of the knee. This condition can be relieved by an operation

– sometimes by keyhole surgery (see MINIMALLY INVASIVE SURGERY (MIS)) – to remove the loose portion of the cartilage. Patients whose knees are severely affected by osteoarthritis or rheumatoid arthritis which cause pain and sti?ness can now have the joint replaced with an arti?cial one. (See also ARTHROPLASTY; JOINTS, DISEASES OF.)... knee

Inflammation of one or more joints, with pain, swelling, and stiffness. There are several different types of arthritis, each having different characteristics. The most common form is osteoarthritis, which most often involves the knees, hips, and hands and usually affects middle-aged and older people. Cervical osteoarthritis is a form of osteoarthritis that affects the joints in the neck. Rheumatoid arthritis is a damaging

condition that causes inflammation in the joints and other body tissues such as the membranous heart covering, lungs, and eyes. The disorder has different effects in children (see juvenile chronic arthritis). Ankylosing spondylitis is another persistent form of arthritis that initially affects the spine and the joints between the base of the spine and the pelvis. Other tissues, such as the eyes, may also be affected. Eventually, the disorder may cause the vertebrae (bones of the spine) to fuse. Reactive arthritis typically develops in susceptible people following an infection, most commonly of the genital tract or intestines. Gout and pseudogout are types of arthritis in which crystals are deposited in a joint, causing swelling and pain. Septic arthritis is a relatively rare condition that can develop when infection enters a joint either through a wound or from the bloodstream.

Diagnosis of particular types of arthritis is made from blood tests and, in some cases, microscopic examination of fluid from the affected joint. X-rays or MRI can indicate the type and extent of joint damage.

Physiotherapy and exercises can help to minimize the effects of arthritis, and there are specific treatments for some types, such as antibiotic drugs for septic arthritis.

In severe cases, one or more joints may need arthroplasty (replacement with an artificial substitute) or arthrodesis (fusion of the bones).... arthritis

See ARTHROPLASTY.... artificial joints

Outward displacement of the great toe – always associated with a bunion (see CORNS AND BUNIONS). It is due to the pressure of footwear on an unduly broad foot. In adolescents, this broad foot is inherited; in adults it is due to splaying of the foot as a result of loss of muscle tone. The bunion is produced by pressure of the footwear on the protruding base of the toe. In mild cases the wearing of comfortable shoes may be all that is needed. In more severe cases the bunion may need to be removed, while in the most severe the operation of ARTHROPLASTY may be needed.... hallux valgus

‘Rheumatism’ is the colloquial term for nonspeci?c musculoskeletal symptoms arising in the joints, ligaments, tendons and muscles. ‘Arthritis’ describes a pathological musculoskeletal disorder. Most common are sprains of ligaments, strains of tendons and muscles,

BURSITIS, TENDINITIS and non-speci?c back pain (see BACKACHE).

Osteoarthritis (OA) rarely starts before 40, but by the age of 80 affects 80 per cent of the population. There are structural and functional changes in the articular cartilage, as well as changes in the collagenous matrix of tendons and ligaments. OA is not purely ‘wear and tear’; various sub-groups have a genetic component. Early OA may be precipitated by localised alteration in anatomy, such as a fracture or infection of a joint. Reactive new bone growth typically occurs, causing sclerosis (hardening) beneath the joint, and osteophytes – outgrowths of bone – are characteristic at the margins of the joint. The most common sites are the ?rst metatarsal (great toe), spinal facet joints, the knee, the base of the thumb and the terminal ?nger joints (Heberden’s nodes).

OA has a slow but variable course, with periods of pain and low-grade in?ammation. Acute in?ammation, common in the knee, may result from release of pyrophosphate crystals, causing pseudo-gout.

Urate gout results from crystallisation of URIC ACID in joints, against a background of hyperuricaemia. This high concentration of uric acid in the blood may result from genetic and environmental factors, such as excess dietary purines, alcohol or diuretic drugs.

In?ammatory arthritis is less common than OA, but potentially much more serious. Several types exist, including: SPONDYLARTHRITIS This affects younger men, chie?y involving spinal and leg joints. This may lead to in?ammation and eventual ossi?cation of the enthesis – that is, where the ligaments and tendons are inserted into the bone around joints. This may be associated with disorders in other parts of the body: skin in?ammation (PSORIASIS), bowel and genito-urinary in?ammation, sometimes resulting in infection of the organs (such as dysentery). The syndromes most clearly delineated are ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF), psoriatic or colitic spondylitis, and REITER’S SYNDROME. The diagnosis is made clinically and radiologically; no association has been found with autoantibodies (see AUTOANTIBODY). A particularly clear gene locus, HLA B27, has been identi?ed in ankylosing spondylitis. Psoriasis can be associated with a characteristic peripheral arthritis.

Systemic autoimmune rheumatic diseases (see AUTOIMMUNE DISORDERS). RHEUMATOID ARTHRITIS (RA) – see also main entry. The most common of these diseases. Acute in?ammation causes lymphoid synovitis, leading to erosion of the cartilage, associated joints and soft tissues. Fibrosis follows, causing deformity. Autoantibodies are common, particularly Rheumatoid Factor. A common complication of RA is Sjögren’s syndrome, when in?ammation of the mucosal glands may result in a dry mouth and eyes. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) and various overlap syndromes occur, such as systemic sclerosis and dermatomyositis. Autoantibodies against nuclear proteins such as DNA lead to deposits of immune complexes and VASCULITIS in various tissues, such as kidney, brain, skin and lungs. This may lead to various symptoms, and sometimes even to organ failure.

Infective arthritis includes: SEPTIC ARTHRITIS An uncommon but potentially fatal disease if not diagnosed and treated early with approriate antibiotics. Common causes are TUBERCLE bacilli and staphylococci (see STAPHYLOCOCCUS). Particularly at risk are the elderly and the immunologically vulnerable, such as those under treatment for cancer, or on CORTICOSTEROIDS or IMMUNOSUPPRESSANT drugs. RHEUMATIC FEVER Now rare in western countries. Resulting from an immunological reaction to a streptococcal infection, it is characterised by migratory arthritis, rash and cardiac involvement.

Other infections which may be associated with arthritis include rubella (German measles), parvovirus and LYME DISEASE.

Treatment Septic arthritis is the only type that can be cured using antibiotics, while the principles of treatment for the others are similar: to reduce risk factors (such as hyperuricaemia); to suppress in?ammation; to improve function with physiotherapy; and, in the event of joint failure, to perform surgical arthroplasty. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) include aspirin, paracetamol and many recently developed ones, such as the proprionic acid derivatives IBUPROFEN and naproxen, along with other drugs that have similar properties such as PIROXICAM. They all carry a risk of toxicity, such as renal dysfunction, or gastrointestinal irritation with haemorrhage. Stronger suppression of in?ammation requires corticosteroids and CYTOTOXIC drugs such as azathioprine or cyclophosphamide. Recent research promises more speci?c and less toxic anti-in?ammatory drugs, such as the monoclonal antibodies like in?iximab. An important treatment for some osteoarthritic joints is surgical replacement of the joints.... joints, diseases of

Originally the general measures, both surgical and mechanical, for the correction or prevention of deformities in children. Now, that branch of medical science dealing with skeletal deformity (congenital or acquired), fractures and infections of bones, replacement of arthritic joints (hips, knees and ?ngers – see

ARTHROPLASTY) and the treatment of bone tumours. (See BONE, DISORDERS OF; JOINTS, DISEASES OF.)... orthopaedics

n. surgical excision of a joint. It is usually performed on a painful joint that has ceased to function, as may result from intractable infection, or after a failed joint replacement. See also arthroplasty.... arthrectomy

painful stiffness and enlargement of the metatarsophalangeal joint, at the base of the big toe, resulting from osteoarthritis. Unlike *hallux valgus, men are more commonly affected than women. Conservative treatment is often successful, but in some cases surgery (e.g. *cheilectomy, *arthrodesis, or *arthroplasty) is required.... hallux rigidus

n. see arthroplasty.... hemiarthroplasty

a surgical procedure developed for replacing a diseased hip joint with a prosthesis. A plastic or metal cup forms the socket, and the head of the femur is replaced by a metal ball on a stem placed inside the femur. There are many types of prosthesis, which can be fixed to the bone with or without cement. See also arthroplasty.... hip replacement

an operation for *hallux valgus (see also bunion) or *hallux rigidus that involves an excision *arthroplasty of the metatarsophalangeal joint, at the base of the big toe. The toe will be slightly shorter and floppy, but usually this improves alignment and range of movement. [W. L. Keller (1874–1959), US surgeon]... keller’s operation

A type of arthritis in which the joints in the fingers, wrists, toes, or elsewhere in the body become painful, swollen, stiff, and, in severe cases, deformed. Tissues outside the joints, such as the heart, can also be affected. Rheumatoid arthritis is an autoimmune disorder that usually starts in early adulthood or middle age but can also develop in children (see juvenile chronic arthritis) or elderly people. Women are affected more often than men. There are usually recurrent attacks.

Symptoms are mild fever and aches followed by swelling, redness, pain, and stiffness in the joints. Ligaments, tendons, and muscles around the joint may also become inflamed. Raynaud’s phenomenon may occur in the fingers, and swelling of the wrist may cause carpal tunnel syndrome and tenosynovitis. Complications caused by severe rheumatoid arthritis include pericarditis, ulcers on the hands and feet, pleural effusion, pulmonary fibrosis, and Sjögren’s syndrome.

A diagnosis can be confirmed through X-rays and blood tests. Treatments include non-steroidal anti-inflammatory drugs (NSAIDs); antirheumatic drugs, such as gold, penicillamine, or sulfasalazine; and immunosuppressants, such as azathioprine or corticosteroids. Corticosteroid drugs may also be injected into the joints.

Physiotherapy is needed to prevent or limit deformity or to help relieve symptoms and maintain mobility. People who are disabled by arthritis can be helped to cope with everyday tasks through occupational therapy.

In severe cases, surgery may be performed to replace damaged joints with artificial ones (see arthroplasty).

Most sufferers must take drugs for life, but many can achieve a near-normal level of activity with effective control of symptoms.... rheumatoid arthritis

n. inflammation of the synovial joints of the backbone. Ankylosing spondylitis is a *sero-negative arthritis; 90% of cases carry the tissue-type antigen HLA-B27 (see HLA system). Ankylosing spondylitis predominantly affects young adult Caucasian males and the inflammation affects the joint capsules and their attached ligaments and tendons, principally the intervertebral joints and sacroiliac joints (see sacroiliitis). The resultant pain and stiffness are treated by analgesics (including *NSAIDs), physiotherapy, and biological *disease-modifying antirheumatic drugs. The disorder can lead to severe deformities of the spine (see kyphosis; ankylosis) and the hip joint, in which case surgical correction or *arthroplasty may be required.... spondylitis