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Review the known and potential causes of osteoarthritis of the limb joint(s) and treatments available now or in the future to impede its progress.

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Introduction

Review the known and potential causes of osteoarthritis of the limb joint(s) and treatments available now or in the future to impede its progress. Bones are joined together by joints, which allow varying degrees of movement between the adjacent bone ends; some joints permit considerable movement, others allowing only limited movement. The most important type of joint that permits considerable movement is the synovial joint. A strong joint capsule and an enclosing ligament, assisted by attached muscles and tendons, limit excessive movement at the joint. In joints in which there is only limited movement the bones are joined by a fibrous or cartilaginous tissue. This is the typical joint that will be damaged in osteoarthritis in the limb. Osteoarthritis is also called degenerative joint disease. It is the most common type of joint disease and millions of dollars are spent each year for its treatment. It is characterized by the progressive erosion of articular cartilage. The term osteoarthritis implies a role of inflammation in its pathogenesis, considered to be a disease of cartilage. It is the narrowing of the joint space, which represent the loss of articular cartilage. This in return will increase the thickness of the subchondral bone which forms bone cysts. ...read more.

Middle

(b) The early changes in osteoarthrisis is destruction of articular cartilage, which splits, become eroded and leads to narrowing of the joint space on radiography. There is inflammation and thickening of the joint capule and synovium. (c) With time, there is thickening of subarticular bone caused by constant friction of the two naked bone surfaces, leading to a highly polished bony articular surface. Small cysts develop in the bone beneath the abnormal articular surface causing irregular outgrowths of bone. ( From Stevens and Lowe Pathology 2nd edition) Osteoarthrisis of the limb progresses slowly. Initially people feel discomfort in the limb joint. Usually this symptom would be felt for several years, which gradually gets worse with time, limiting the persons movement of the leg considerably. The onset is graduals with pain, limitations of movement and loss of function. The pain is greatest when the knee joint is used, or immediately after use, and is relieved by rest. Stiffness is less severe than in rheumatoid arthritis, and morning stiffness may not be as severe. As disorganization of the joint progresses crepitus may be felt or heard and joint effusions occur. As movement becomes more limited muscle wasting develops. Sometimes the lead into osteoarthrisis of the limb is due to osteoarthrisis in the hips. ...read more.

Conclusion

In the limb arthrodesis causes significant disability, but even in this site the operation may be indicated in a young patient, with advanced disease in one of these joints, whose occupation is physically heavy. Arthrodesis puts greater stress upon neighboring joints and should rarely be used when multiple joint involvements is present. Hence, two stiff knees would be a major handicap. 3. Replacement arthroplasty is the substitution of an artificial joint for the diseased joint. This is a rapidly developing field of orthopedic surgery which hold great promise. Even the best of artificial joints, however, differ in one important respect from natural ones, in that they have no capacity for repair. For this reason wearing out or mechanical failure is a very real threat which dictates a certain caution in the use of replacement arthroplasty. So far it has been mostly used for management of chronic arthritis, particularly in the elderly and in patients with multiple limb joint disease. In pure reality, there are still no satisfactory means of preventing osteoarthrisis in the limb nor are there any methods of halting its progression. This disease may stabilize for years at any stage but more often is slowly progressive over the remaining years of life. Although there are many attempts to find a possible cure for this increasing disease it has yet been found and so prevention is the best cure to osteoarthrisis of the limb today. ...read more.

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