Classification of Osteoarthrosis
Primary
Osteoarthritis without a clear history of trauma is triggered by joint degeneration due to the joint’s own degeneration, heredity, body fat, and increased age. It is most often seen in post-middle-aged patients with extensive lesion involvement.
Secondary
There is usually a clear history of trauma resulting in cartilage damage, joint inflammation and ligament or capsule damage, secondary to early traumatic arthritis into osteoarthritis. It is most often seen in young and middle-aged patients with limited cartilage damage.
Common causes of secondary osteoarthrosis
1) After joint trauma, after traumatic osteoarthritis joint infection, infectious osteoarthritis.
2) Congenital dysplasia, secondary osteoarthritis. Such as acetabular dysplasia and other osteonecrosis caused by, such as primary femoral head necrosis caused by hip arthritis.
(3) Metabolic immune diseases, psoriatic arthritis. Gout, etc.
4) Neurological diseases, Charcot’s joint.
(5) Other, such as endemic diseases, large bone joint disease, etc.
Diagnosis of osteoarthrosis
Diagnosis
The main clinical symptoms of osteoarthritis are recurrent pain in the affected joints, such as pain in the knee joint in the early stage of going up and down stairs, squatting pain, walking pain, joint swelling, joint stiffness, bone rubbing sound when moving, joint effusion and bony hypertrophy in the later stage, and functional impairment or deformity.
Physical examination
In the early stage, there is pressure pain in the infrapatellar region, grinding pain in the patella, pain from pushing or lifting the patella, pressure pain in the medial or lateral patellar crease, pressure pain in the medial condyle of the knee, medial tibial plateau, and posterior knee as the disease progresses, limited extension and flexion, and inversion deformity.
Morning stiffness usually lasts from a few minutes to ten minutes (unlike rheumatoid arthritis, morning stiffness does not necessarily occur in the morning after waking up, but can occur after the joint has been stationary for a period of time, so it is often referred to as a “gluing sensation”).
Early joint swelling is limited by a small amount of joint fluid, and as the disease progresses, there may be diffuse swelling and bursal thickening arthrogryposis.
X-ray examination
The radiographic features of osteoarthritis are: asymmetric joint space narrowing; subchondral osteosclerosis and cystic changes; osteophytes and osteophyte formation at the joint edges; intra-articular free bodies; and joint deformity.
Kellgren and Lawrecne’s imaging criteria
Grade 0 Normal
Grade I Suspicious narrowing of the joint space; possible osteophytes
Grade II Mild narrowing of the articular space; apparent bone fragment formation.
Grade III Significant narrowing of the joint space; moderate bone formation; mild sclerosis of the subchondral bone.
Grade IV Possible disappearance of joint space; large amount of bone redundancy; significant subchondral bone sclerosis; joint enlargement or deformation.
Diagnostic criteria
The Osteoarthritis Subcommittee of the American University Committee on Standards for the Diagnosis and Treatment of Rheumatic Diseases has developed criteria for the diagnosis and treatment of osteoarthritis of the knee, hip and hand.
Diagnostic criteria for osteoarthrosis of the knee (clinical presentation)
1. pain in the knee joint mostly in the past few months.
2. babbling sounds during joint movement.
3, stiffness of the joint for ≤ 30 minutes in the morning during the onset of the disease.
4, age ≥ 38 years.
5, bony enlargement of the knee joint seen on examination
Having 1, 2, 3, and 4, or 1, 2, and 5, or 1 and 5 above diagnoses osteoarthritis of the knee. It has a sensitivity of 89% and a specificity of 88%.
Diagnostic criteria for osteoarthrosis of the knee (clinical manifestations, laboratory tests and radiological criteria)
1. pain in the knee joint mostly in the past few months.
2, osteophytes at the joint edges.
3, synovial fluid analysis for typical OA manifestations.
4, age ≥ 40 years.
5, joint stiffness ≤ 30 minutes in the morning during onset.
6, joint movement with babbling sound
Having 1 and 2 above, or 1, 3, 5 and 6, or 1, 4, 5 and 6, can be diagnosed as knee osteoarthritis. Its sensitivity is 94% and specificity is 88%.
Diagnostic criteria for hip osteoarthritis (clinical manifestations, laboratory tests and radiological criteria)
1. Most pain in the hip joint in the past few months.
2, the presence of femoral-side and/or acetabular-side bony bulge on x-ray.
3, blood sedimentation ≤ 20 mm/h.
4. age ≥ 40 years.
With 1 and 2 above, or 1, 3 and 4, osteoarthritis of the hip can be diagnosed. Its sensitivity is 91% and specificity is 89%.
Diagnostic criteria for osteoarthritis of the hand joint (clinical manifestations)
1, pain or stiffness in the hand most of the time in the past few months.
2, bony enlargement in 2 or more of the 10 designated joints.
3, swelling of no more than 3 metacarpophalangeal joints.
4, severe swelling of 2 or more distal interphalangeal joints.
5. 2 or more deformities in 10 designated joints
Having 1, 2, 3 and 4 above, or 1, 2, 3 and 5, can diagnose osteoarthritis of the hand joint. Its sensitivity is 92% and specificity is 98%. The 10 designated joints included the 2nd, 3rd distal and proximal interphalangeal joints, and the 1st carpometacarpal joint.
A particularly important diagnostic criterion in all of these criteria was the patient’s complaint of persistent joint pain for a prolonged period of time during the past few months of onset. This is particularly important because many patients with radiographic findings do not necessarily have joint pain. If the radiological manifestations of the joint are the only criteria, the diagnosis of osteoarthritis is broadened. Therefore, in clinical work, we must combine the clinical manifestations and signs of osteoarthritis with the radiographic manifestations of the affected joint to make an appropriate diagnosis.