 Hello, I am Dr. S.D.I. Ranjit, I am a practicing orthopedic surgeon in Manipal Hospital, Malaysia. I am here to talk about osteoarthritis, how it occurs, in whom it occurs, what are the aggravating factors, what are the relieving factors and briefly touch upon the treatment aspects. We will be talking in detail about the further treatment aspects at later talks. So what is osteoarthritis? Osteoarthritis is a progressive disorder affecting the cartilage in the joints. So in addition to damage to the joint and the cartilage, there is also damage to the subarticular area with cyst formation, osteophyte formation, ligamentous laxity and other damages. This is basically due to an imbalance between the repair and the damage of the joint. The common joints which are affected are joints of the hand, the PIP, DIP, MCP joints, the weight bearing joints like the hip, the knee and the vertebral joints. Articular cartilage is a slippery tissue which occurs at the end of the joints. Healthy cartilage allows the bones to glide over each other and also help in absorbing the shock of movement. In osteoarthritis, the top layer of the cartilage gets damaged and broken off. This exposes the underlying subcontrail bone which when they rub together is called osteoarthritis. This leads to pain, swelling, fluid collection, deformity and other issues which are characteristic of osteoarthritis. Over time the joint loses its shape and also bits of bone and cartilage break off into the joint which form loose bodies and this leads to further damage of the articular cartilage. To classify osteoarthritis, we can classify them as primary and secondary osteoarthritis. Now primary osteoarthritis occurs with age and can affect a lot of joints. Secondary arthritis is when there is a definite cause of arthritis. It may be associated with post-injury, it may be associated with certain skin diseases like psoriasis, certain other immune diseases like rheumatoid arthritis, SLE, other diseases could cause arthritis. Now these are the secondary causes of osteoarthritis. Osteoarthritis is one of the core reasons for disability. It affects about 15% of the total population but as a person grows older his chances of developing osteoarthritis are higher. Nearly 30% of people above 50 years have osteoarthritis and about 85% of the people above 70 have osteoarthritis. Osteoarthritis varies with age, gender, race, activity level, weight and a few other parameters. In general men are more affected than women but practically what we notice is that men tend to come at a later age, they are generally in their 70s by the time the arthritis is severe enough for them to seek medical help. Women on the other hand though less commonly affected by osteoarthritis tend to attend to a doctor at a younger age usually in their 50s or in the early 60s. Osteoarthritis affects all races but it's generally more common in the Asian and Indian population when compared to the Caucasian or the Afro-African population. There is a direct correlation between obesity and osteoarthritis. The impact that a joint takes because of the weight of a person tends to directly increase the wear and tear in the joint causing osteoarthritis. As a patient gains a few kilos his arthritis worsens and likewise any weight reduction definitely contributes to the improvement in the symptoms of osteoarthritis. You must have heard of something called the metabolic syndrome where there is diabetes, hypertension, cholesterol, obesity, joint together and nowadays a lot of doctors are associating osteoarthritis also as part of this metabolic syndrome because there is a direct correlation between these and osteoarthritis. Often occupations do predispose to osteoarthritis occupations where there is prolonged standing there are a lot of impact activities occupations where person has to squat or sit for a long duration these are occupations where a patient tends to develop osteoarthritis at an earlier age. Sports activities can cause osteoarthritis not directly by the effect of the sport but more due to the impact activities and more commonly due to any associated injury. The age of injury at which the injury occurred during the sport is another very important factor and usually arthritis develops about 15 to 20 years post any kind of an injury. There are a few genes which have been isolated which do show increased propensity to osteoarthritis especially your vitamin D receptor insulin like growth factor and a few other genes but then they have not been definitively conclusively associated with osteoarthritis. The characteristics of healthy cartilage the articular cartilage can depress up to 40 percent of its height during impact activities. Now when it compresses the surface area of contact increases and thereby helps in shock absorption and load sharing also articular cartilage is virtually frictionless there is almost no coefficient of friction between two articular cartilage surfaces which is separated by a thin layer of synovial fluid so coming to the differential diagnosis of knee pain though a lot of patients I see in my clinic with knee pain tend to have osteoarthritis there are a few things which we need to rule out the commonest would be injury to the ligaments or to the meniscus there are other inflammatory causes there are certain auto immune causes for osteoarthritis and sometimes it's just a strain causing an acute exacerbation of the pain so these are a few things that I look at ruling out before coming to a diagnosis of osteoarthritis the American College recommends that at least three of six criteria should be there for knee osteoarthritis one age above 50 knee tenderness knee enlargement morning stiffness crepitus and no palpable warmth apart from these clinical symptoms a synovial fluid analysis would reveal that the cell count is less than 2000 proteins and the glucose are normal and X-ray would show a reduced joint space subcontral sclerosis formation of cysts formation of osteophytes loss of alignment of the joint. These are the findings which help cement the diagnosis of osteoarthritis the gold standard for diagnosis of osteoarthritis is an arthroscopic examination but since that is a surgical procedure it is rarely resorted to for the diagnosis of osteoarthritis. Now we shall move on to the management of osteoarthritis the primary aspect of management is going to be lifestyle changes a weight loss program exercise program for strengthening the muscles around the knee general exercises to improve the tone and strength of muscles good range of movement exercises for the knee all these things go a long way to alleviate the symptoms of osteoarthritis reduce the pain. We can use certain devices like canes, walkers, offloading braces these are few things to temporarily tide over the pain of osteoarthritis and offloader brace works very well in taking pain off the arthritic compartment and transferring it to the opposite compartment and thereby reducing the pain the medical management of arthritis is mainly the pain management now these can be your regular painkillers like paracetamol or dichlofenac and other NSAIDs also we have your non-NSAID medicines like your tremidol or flupatin and few other medications which help in control of the pain. There are a few so called joint vitamins like collagen, chondroitin, glucosamine which have showed variable success in the pain management and the reduction of the symptoms of osteoarthritis. We also have various injections which are given into the joint these are called intraarticular joints and provide a variable period of relief. The intraarticular injections are mainly glucocorticoid in the injections gently 40 or 80 milligrams of Triumph's loan is what I prefer for my patients and it's generally mixed with a small dose of local anesthetic which helps numb the pain and ensure accuracy of drug delivery. It provides a variable period of pain relief and alleviation of the symptoms especially the ones which are chemically mediated. It can theoretically be given every three months for up to two years but a word of warning there is a risk of infection and also a worsening of the arthritis once the effect of the glucocorticoid has worn off. There are a few other commercially available formulations containing hyaluronic acid sorbitol and a few other drugs which may also be given intraarticulary giving a variable pain relief for the patient. When all these medical management options have been exhausted then it's time to start thinking of surgical options. When it comes to surgical options we have an arthroscopic washout or an arthroscopic debrivedment. We have certain joint preserving procedures like high tibial osteotomy or various corrective osteotomies to improve upon the alignment of the joint and to transfer the load to the normal part of the joint. We also have various joint replacement procedures like a unicorn dollar or a total knee replacement. Arthroscopic debrivedment or an arthroscopic washout is basically when we use a key hole technique and make two holes in the knee joint a camera is passed through one and instruments are passed through the other and we visualize the joint in its entirety and clear away all the damaged and the necrotic tissue. Any loose bodies or any foreign bodies which are in the joint are also removed at the same time. It gives a variable period of relief depending on the significance and the of the damage which has occurred in the joint. Then it is a temporary procedure and will help us delay the any definitive procedure. Coming to joint realignment procedures like a high tibial osteotomy or other osteotomies around the knee to correct the alignment. Here we first do an arthroscopy and check the level of damage. Then we cut the bone and align it in such a way that the healthy cartilage is where the most of the weight transfers through. This is again preferred in younger patients for whom it gives excellent results and corrects alignment and delays the formation of osteoarthritis. The joint replacement procedures are mainly a unicorn dollar knee replacement or a total condom knee replacement. A unicorn dollar knee replacement is where the part of the joint which is damaged is removed and replaced with an artificial knee and it helps in younger patients and also in elderly patients where only one of the compartments is significantly damaged and the other is quite healthy. But in most of our patients the whole joint is completely damaged in which case a total knee replacement where all three compartments are replaced is the best option which gives a long lasting pain free comfortable life and helps the patient resume their normal lifestyle. We shall be talking in detail about the various surgical options especially concentrating on total knee replacement in the upcoming sessions. Thank you very much. Please feel free to address any questions in the chat box.