OSTEOARTHRITIS: The Curse of the Athlete

SEYI IDOWU. FWACS FMCS

OUTLINE

– Introduction

– Epidemiology of OA from sports

– Pathogenesis

– Clinical features

– Diagnosis

– Management

INTRODUCTION

– OA is the most common joint disease.

– Affects up to 10% of some populations.

– Failed attempt to repair damaged cartilage by chondrocytes.

– A full disease of the joint apparatus (synovium, subchondral bone).

– Sports-related OA usually secondary.

– OA mainly affects weight-bearing joints: knees, hips, spine, feet.

OSTEOARTHRITIS AND FOOTBALL

– Klünder et al: Hip OA significantly more common in retired footballers.

– Lindberg et al: 5.6% in former footballers vs 2.8% in controls.

– Shepard et al: 13% prevalence vs 1.5% in age-matched controls.

FURTHER EPIDEMIOLOGICAL FINDINGS

– UK survey: About 50% reported OA, knee most affected.

– Drawer & Fuller: 32% OA in lower limb joints.

– Nearly 50% retired due to injury.

– Knee OA more common than ankle or hip OA.

RELEVANT ANATOMY

– Articular cartilage

– Subchondral bone

– Synovial membrane

– Synovial fluid

– Joint capsule

FUNCTIONAL OVERVIEW OF JOINT STRUCTURES

– Articular cartilage contains chondrocytes, proteoglycans, collagen.

– Joints reduce friction and distribute load.

– Synovial fluid provides nutrients, viscosity, elasticity.

– Synoviocytes produce hyaluronic acid.

PATHOGENESIS OF OSTEOARTHRITIS

– Inflammation occurs via cytokines and metalloproteinases.

– Early OA: cartilage swelling from increased proteoglycans.

– Later: proteoglycan loss → cartilage softening.

– Microscopic fissures develop.

– Loss of cartilage → joint space narrowing → exposed bone.

– Subchondral bone thickens (eburnation).

– Cystic degeneration (subchondral cysts).

CLINICAL FEATURES

– Pain

– Deformities

– Restricted range of movement

DIAGNOSIS

– Plain radiographs

– MRI/CT (to exclude specific conditions)

– Arthrocentesis (to exclude inflammatory arthritis)

– Other ancillary investigations

NON-PHARMACOLOGIC MANAGEMENT

– Patient education

– Heat and cold therapy

– Weight loss

– Exercise

– Physical therapy

– Occupational therapy

– Joint unloading (knee, hip)

PHARMACOLOGY — ACR GUIDELINES

– Use: topical capsaicin, topical NSAIDs, oral NSAIDs, tramadol, intra-articular corticosteroids.

– Not recommended: chondroitin sulfate, glucosamine, topical capsaicin (for knee OA).

– No recommendation: hyaluronates, duloxetine, opioids.

PHARMACOLOGY — AAOS GUIDELINES

– Recommended: oral NSAIDs, topical NSAIDs, tramadol.

– Insufficient evidence: acetaminophen, opioids, pain patches, steroid injections, PRP.

– Not recommended: hyaluronic acid, glucosamine, chondroitin.

SURGICAL INTERVENTION

– Arthroscopy

– Osteotomies

– Arthroplasty

– Arthrodesis

PROGNOSIS

– Rapid progression risk factors: older age, higher BMI, varus deformity, multiple joint involvement.

– Hip/knee arthroplasty success >90%.

– Prosthesis may need revision after 10–15 years depending on activity level.

Thank You

End of document.