osteroarthritis is a degenerative wear and tear process occurring in joints that are impaired by congenital defect and vascular insufficiency or previous disease or injury.

If a joint were never put under stress it would never become oa.Hence the relatively lightly stressed joints of the ueerlimb are in general less prone to oa than the heavily stressed joints of the lower limb.Nearly always however there is a predisposing cause that accelerates the wear and tear process.

The main predisposing factors are 1.congenital ill development 2.internal derangemnts such as a loose body or a torn meniscus 3.ireegularity of joing surfaces from previous fracture 4.previous disease, leaving a damaged articular cartilage eg.rheumatoid arthritis or haemophilia 5.malalignment of a joing from any cause like bowleg or knockknee 6.obesity 7. age alone is not the cause of oa, although it may be associated with an impaired capacity for tissue repair after injury and this may be indirect causative factor.

Pathology :

any joing may be affected the lower limb joints more often than upperlimb.The articular cartilage is slowly worn away until the underlying bone is exposed. This subchondral bone becomes hard and glossy (eburnation). Meanwhile the bone at the margins of the joing hypertrophies to form a rim of projecting spurs known as osteophytes.

Clinical Features :

most patient are past middle age. When it occurs in younger patients there is usually a predisposing cause such as previous injury or disease of joint. The onset is very gradual with pain that increases almost imperceptibly over months and years.Movements slowly becomes more and more restricted in some patients(notably in hip) deformity is a common feature in the later stages.

Course :

oa usually increases slowly year by year. In many cases the disability never reaches the stage at which treatment is required. In others pain stiffness or deformity drives the patient to demand measures for its relief.

Treatment :

The management of oa exemplifies well the three categories of treatment that should be considered in every orthopaedic problem-namely1.no treatment but advice and reassurance only 2. conservative treatment 3. operative treatment 4.few ayurvaedic oil application which had given dramtic relief in relief of pain in those patient who was taking pain killers daily.

In many cases treatment is not required,the patient may have sought advice only because of anxiety lest some grave disease be present. Reassurance with advice to restict the wear and tear on the affected joint is all that is required.

when more active treatment is called for conservative measures shoul usually be tried first, like physiotherapy analgect drug and precaution in activities of daily living.

when severe disablilty is required surgery, now a days total knee and hip replacemetn had given very good results in such type of patient.