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Disease Knowledge Centres

Orthopaedics - Disease Topic Overview

The specialty of orthopaedics encompasses the surgical aspects of musculoskeletal and sports medicine. This broad specialty involves the treatment of patients of all ages, although the prevalence of specific disorders changes with age.

Paediatric orthopaedic surgery includes the treatment of congenital disorders; dysplasia of the hip, foot malformations (metatarsus adductus, metatarsus varus and clubfoot) and spinal deformities (kyphosis and scoliosis).¹ However, musculoskeletal trauma is the most common reason for children to require orthopaedic treatment. Fractures are more prevalent in children due to weaknesses at the epiphysial growth plates and they perform more physical activity than adults.²

The main cause of orthopaedic treatment in adults is trauma; more specifically patients involved in transport collisions. Among this group, the most frequent orthopaedic trauma injuries occurred in males under the age of 65.³

In elderly patients, diseases such as osteoarthritis and osteoporosis are more common. Osteoarthritis is the degeneration of articular cartilage in synovial joints causing bone hypertrophy. It affects 45% of women over 65 and is a major cause of disability in these people.⁴ Osteoporosis is a disease that affects post-menopausal women and men over the age of 50, and is more common in smokers than non-smokers.^5,6 This bone demineralising disorder causes a higher proportion of fractures, of which hip fractures are the most common.⁵ The ageing worldwide population has therefore caused an increased need for total joint replacements, of which the most common are total hip and knee arthroplasty.⁷

1. Nemeth B. The Diagnosis and Management of Common Childhood Orthopedic Disorders. Current Problems in Pediatric and Adolescent Health Care. January 2011 ; 41 (1) : 2-28
2. Mencio G.A. et al. Pediatric Orthopedic Trauma. Ashcrofts Pediatric Surgery. Elsevier Inc. 2010 : 221-234
3. Urquhart D.M. et al. Characteristics of Orthopaedic Trauma Admitted to Adult Level 1 Trauma Centres. Injury. February 2006 ; 37 (2) : 120-127
4. Chasm R.M. et al. Pediatric Orthopedic Emergencies. Emergency Medical Clinics of North America. November 2010 ; 28 (4) : 907-926
5. Symmons D et al. Global Burden of Osteoarthritis in the Year 2000. Global Burden of Disease. 2006 : 1-26
6. Law M.R. et al. A Meta-Analysis of Cigarette Smoking, Bone Mineral Density and Risk of Hip Fracture: Recognition of a Major Effect. BMJ. June 1997 ; 315 (841) :
7. Wilsgaard T. et al. Lifestyle Impact on Lifetime Bone Loss in Woman and Men: The Tromso Study. Bone. May 2009 ; 44 (S1) : S38
8. Levine H.B. et al. Joint Replacement in the Geriatric Orthopaedic Patient. Operative Techniques in Orthopaedics. 2002 ; 12 (2) : 92-102

Arthritis
Arthritis is a complex disorder that comprises more than 100 distinct musculoskeletal conditions and can affect people at any stage of life. Arthritis causes joint pain, loss of movement, and inflammation.

Common forms of arthritis include osteoarthritis (OA) and rheumatoid arthritis. Both OA and RA are chronic and incurable but respond well to intervention.Osteoarthritis is the most common type of arthritis.

The prevalence increases with age, and most people over 60 years will have some radiological evidence of it. Osteoarthritis is the result of active, sometimes inflammatory but potentially reparative processes rather than the inevitable result of trauma and ageing.Rheumatoid arthritis is a chronic symmetrical polyarthritis of unexplained cause.

It is a systematic disorder characterized by chronic inflammatory synovitis of mainly peripheral joints. Its course is extremely variable and it is associated with nonarticular features.

To diagnose arthritis, there are a number of guidelines which outline the classification criteria, as well as tools to assess the patients pain.

There are a variety of treatment options available to help manage the pain and inflammation of osteo and rheumatoid arthritis, both pharmacological and non-pharmacological. It is important to balance the potential benefit against the potential side-effects.

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Arthritis is a complex disorder that comprises more than 100 distinct musculoskeletal conditions and can affect people at any stage of life. Arthritis causes joint pain, loss of movement, and inflammation. Common forms of arthritis include osteoarthritis (OA) and rheumatoid arthritis. Both OA and RA are chronic and incurable but respond well to intervention.

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Osteoarthritis Perspectives
The EULAR (European League Against Rheumatism) 2011 satellite symposium was held in London in May 2011. The symposium entitled Clinical Choices in Osteoarthritis Pain Management – Evidence Versus Practice: An Interactive Case-Based Assessment discussed the treatment regimens available for the treatment of OA.

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Osteoarthritis (OA) is a debilitating rheumatological disease that causes significant morbidity; it affects 45% of women over 65 and is a major cause of disability¹. OA is characterised by the degeneration of articular cartilage in synovial joints causing bone hypertrophy. Although this is a disease with no cure, many treatments for OA symptoms are available. Many people with OA have co-morbidities which affect which treatments are appropriate.

A satellite symposium symposium entitled Clinical Choices in Osteoarthritis Pain Management – Evidence Versus Practice: An Interactive Case-Based Assessment which was held at the EULAR Congress 2011 in London, UK, discussed the the treatment regimens available for the treatment of OA.

This interactive webcast contains three multimedia presentations delivered by Michael Doherty MA MD FRCP FHEA, Marc C. Hochberg MD MPH and Francis Berenbaum MD PhD.The first presentation, presented by Michael Doherty, explains how evidence-based guidelines provide the tools for effective, individualised treatment for patients with OA. Marc C. Hochberg discusses the importance of identifying patients with gastrointestinal risk (GI) factors and specific treatments available for these people. Francis Berenbaum completes the webcast with a presentation on treatment of patients with both cardiovascular and GI risk factors.

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References

1. Chasm R.M. et al. Pediatric Orthopedic Emergencies. Emergency Medical Clinics of North America. November 2010 ; 28 (4) : 907-926

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Latest Multi Media

Discussion of Clinical Approach to Lower Back Pain

Orthopaedics Drug Data - A-Z English

Latest Drug News

Cimzia (UCB) Phase III success in Psoriatic Arthritis - 16-02-2012

Top-line results were reported from the RAPID-PsA phase III study evaluating the efficacy and safety of Cimzia (certolizumab pegol) from UCB, in patients with adult onset active Psoriatic Arthritis and demonstrated a clinically relevant and statistically significant improvement at week 12 in the signs and symptoms of Psoriatic Arthritis. Initial analyses suggest that no new safety signals were observed in this study and adverse events were consistent with those seen in other trials of certolizumab pegol. In this 48 week, multicenter, double-blind, parallel-group, phase III study, 409 patients were randomized to receive certolizumab pegol (200 mg every two weeks or 400 mg every four weeks) or placebo. UCB plan to file Cimzia for treatment of Psoriatic Arthritis by the end of 2012

Latest Social Media

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Surgical cockup or error?
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Surgical cockup or error?
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... DGHs have such experienced surgeons capable of performing this type of surgery. The catalogue of failures including preoperative imaging ...

Latest Clinical Trials

VIDEO: Vitamin D evaluation in osteoarthritis

Does vitamin D help people with knee osteoarthritis?

Conjoint Analysis of Treatment Preferences for Osteoarthritis

The purpose of this study is to develop a conjoint analysis-based questionnaire and decision aid for patients with osteoarthritis of the knee and to compare the responses of two groups of subjects, one receiving only printed information about knee osteoarthritis, the other participating in a computer-based adaptive conjoint analysis program.

Latest Journal Publications

Heart

Background: Resistance to the insulin-sensitising adipocytokine, adiponectin, has been described at the level of the skeletal muscle in patients with chronic heart failure (CHF). Objective: To investigate whether exercise training (ET) would improve skeletal muscle energy metabolism and adiponectin signalling. Methods: In a prospective cohort study, patients with CHF were recruited from the Cardiac Rehabilitation Centre, Antwerp University Hospital. They underwent 4 months' combined endurance–resistance ET. Skeletal muscle mRNA and protein expression of adiponectin, AdipoR1 and downstream metabolic genes were measured. Results: Adiponectin mRNA expression in the nine CHF patients was higher than that in 10 matched healthy subjects (p=0.007), whereas AdipoR1 and downstream-located genes involved in lipid (PPAR-α, ACADM) and glucose metabolism (AMPK, hexokinase2) were down-regulated. Skeletal muscle AdipoR1 correlated with VO2 peak (r=0.900; p=0.001), maximal workload (r=0.753; p=0.019) and steady state workload (r=0.928; p<0.001). ET increased maximal workload and muscle strength. In addition, ET lowered adiponectin mRNA expression (p=0.017), whereas the expression of AdipoR1 (p=0.011) and downstream metabolic genes was increased to levels comparable to those in healthy subjects. ELISA confirmed the normalisation of skeletal muscle adiponectin expression at the protein level (p=0.047). Conclusion: At the level of the skeletal muscle, CHF patients are characterised by increased adiponectin expression and decreased expression of AdipoR1 and downstream metabolic genes. ET normalises the mRNA expression of adiponectin and AdipoR1 and reverses disorders in lipid and glucose metabolism in skeletal muscle. These alterations in metabolic gene expression may help to understand the beneficial effects of ET in CHF.

Calcified Tissue International

Little is known about bone mineral density (BMD) in patients with heroin addiction and subsequent methadone substitution. The goal of this study was to compare bone mass density of young HIV-negative women on long-term methadone treatment to a local group of young healthy women. Eleven women (aged 20–29) with previous heroin dependence and current methadone substitution (20–140 mg, median 60, daily) for 1.5–9 (median 3) years were compared to 30 healthy women (aged 20–28). Participants were examined with dual-energy X-ray absorptiometry of the lumbar spine (L2–L4), of the total proximal hip area, and of the femoral neck. Patients and controls had neither current nor lifetime underweight condition, had comparable ages at menarche, and did not differ significantly in current body mass index (21.9 ± 4.0, respectively, 20.5 ± 1.5 kg/m2) in spite of a largely unhealthy lifestyle (cigarette, alcohol, and cocaine consumption in patients). Patients’ total-hip parameters were marginally lower than those of controls (BMD P = 0.054, T score P = 0.049), whereas the femoral neck and lumbar spine parameters did not differ significantly between the two groups. Long-term methadone substitution in HIV-negative women seems to slightly affect bone mass density.