Geoffrey F. Dervin, MD, MSc, FRCS(C), Associate Professor, University of Ottawa and the Ottawa Hospital, Orthopaedic Division, Department of Surgery, Ottawa, ON.
Understanding the options for treatment of osteoarthritis of the knee will allow physicians to help their patients realize the physical and social demands of healthy life. Weight loss, physical therapy and unloading braces are clinically proven strategies in the early stages of the disease. Acetaminophen remains the analgesic of choice, while COX-2 NSAIDs are reserved for flare-ups and short-term use. Oral glucosamine and chondroitin sulfate also may be helpful. Persistently swollen knees may respond to aspiration and corticosteroid injection or viscosupplementation with hyaluronic acid derivatives. Those with acute onset of mechanical symptoms may respond to arthroscopic débridement and resection of unstable meniscal tears. Osteotomy of the tibia or femur are options for isolated unicompartmental disease in younger and more active patients. Arthroplasty of one or all compartments of the knee is the definitive procedure for end-stage arthrosis with very dependable results in most clinical settings.
Key words: osteoarthritis, knee, arthroplasty, acetaminophen, older people.
Herbert P. von Schroeder, MD, MSc, FRCSC, University of Toronto Hand Program and Toronto Western Hospital, University Health Network, Toronto, ON.
Osteoarthritis is a highly prevalent and disabling condition of the hand in the geriatric population. It is commonly and effectively managed by surgical means. The interphalangeal joints and base of the thumb are most frequently involved, particularly in women, whereas post-traumatic osteoarthritis of the wrist is more common in men. Surgical procedures include simple debridement, soft tissue stabilization or osteotomies for milder cases. Joint arthroplasty, including excision procedures, and joint arthrodesis (fusion) are indicated for more severe arthritis. The type of procedure used depends on the location of the affected joint, patient age and physical demands placed on the hand. Surgery can effectively alleviate pain and improve hand function to improve an individual's quality of life.
Key words: osteoarthritis, hand, arthrodesis, arthroplasty, surgery.
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