Osteoarthritis surgery

2021-05-11 11:26 AM

Osteoarthritis surgery is usually due to the spread of bone tuberculosis. The disease occurs mainly in children, most commonly in the hip joints. The synovial membrane is very thick with tuberculosis granular tissue. The joint surface is corroded.

The movable joint is covered by a joint capsule that surrounds the articular cartilage of the two ends of the bones. The joint capsule is lined inside by the synovial membrane forming a cavity containing some lubricating fluid. Made of connective tissue, joints are an organ of support and movement, subject to damage from mechanical, circulatory, neurological and inflammatory causes. The most important joint diseases are rheumatoid arthritis and osteoarthritis causing pain, contractures, deformities and reduced function. Rheumatoid arthritis is inflammation of the joint membranes of unknown aetiology and is currently classified as an autoimmune disease. Osteoarthritis is a degenerative disease of the joint cartilage and subsequent hypertrophy of the subchondral bone. In Vietnam, arthritis caused by bacteria (tuberculosis, gonorrhoea, staphylococcus...) is still common.

Infectious arthritis

Joint infections are usually caused by blood sugar when there is bacteremia or pus in the blood. Infection can be caused by a joint injection that does not guarantee an aseptic suture or spread from an adjacent bone infection. Pathogenic bacteria are usually staphylococcus, streptococcus, gonococci, pneumococcal, meningococcal. Joint infections can occur in gonorrhea, bacterial endocarditis, meningitis, otitis media, and typhoid fever.

Purulent inflammation of the joint membrane

Swollen joints with acute inflammation. The joint cavity is filled with fluid, initially clear, then cloudy, with pus. The joint membrane is heavily congested, swollen, and soaked with inflammatory cells. Tissue is destroyed a lot, so when healed, a sticky scar is formed that causes stiffness due to fibrous tissue, sometimes it can turn into bone tissue, causing stiffness.

Example: Gonococcal arthritis is an early complication of acute gonorrhea. Often multiple joints are affected, sometimes just one.

Joint tuberculosis

Usually due to the spread of bone tuberculosis. The disease occurs mainly in children, most commonly in the hip joint. The joint membrane is very thick with tuberculous granulomatous tissue. The joint surface corroded. Cartilaginous fragments, fragments of membranes, fuse with fibrin to form small, firm, free-floating granules in the joint called melon corpuscles. The disease may stop progressing or rupture, protrude the skin or cause stiffness due to fibrosis or ossification. Microscopic, typically by tuberculous cysts.

Acute rheumatism

Especially in adolescents, the prominent disease is acute non-purulent arthritis. The joint is swollen, painful, and contains slightly cloudy fluid. Multiple joints tend to be sequential. Inflammation is predominantly in the articular membrane, but nodules may form in the subarticular and periarticular tissues.

Microscopic

These nodules resemble the Aschoff bodies of the myocardium or the rheumatic nodules of other tissues. Inflammation usually goes away completely, leaving no disability.

Rheumatoid arthritis

Manifestations are chronic arthritis, atrophy, or hyperplasia, often disabling. Women are three times more common than men, usually in their reproductive years. The disease is thought to be caused by hypersensitivity or autoimmune reactions. The disease usually starts slowly with systemic symptoms such as fever, leukocytosis, anemia... The small joints of the hands and feet are most commonly affected, later on, the larger joints. The affected joints are oval-shaped, very painful, and progress to deformity and limitation of joint movement. The disease manifests as a systemic disease with inflammatory granulomas in the heart valves, myocardium, pericardium, and pleura. The disease may be associated with conjunctivitis and swelling of the salivary glands (Sjügren's syndrome).

The primary and primary injury is a thickening of the joint membrane due to inflammatory granulomatous tissue, infiltrating polymorphonuclear leukocytes, lymphocytes, macrophages, and plasma cells; they usually gather in groups. Under the electron microscope, macrophage-like cells contain a lot of lysosomes called synovial cells type A. The joint membrane can develop into many hairy papillae with the phenomena of necrosis, hemorrhage, and fibrosis. The two sides of the joint can be joined by fibrous tissue, sometimes eventually becoming ossified. Joint cartilage and tissue around joints are also attacked. The joint cavity is filled with turbid fluid and rich in cells. Blood vessels and tissues around them become inflamed. Lysosomes released from leukocytes in synovial fluid, from type A synovial cells, and possibly from chondrocytes play an important role in arthritis and tissue destruction.

Subcutaneous nodules are seen in some cases with a microscopic appearance similar to acute rheumatic nodules.

  • Rheumatoid arthritis in children: The disease is accompanied by fever, leukocytosis, enlarged spleen, enlarged lymph nodes. T4 lymphocytes are reduced, so they are more susceptible to infections.
  • Felty syndrome: In adults, chronic arthritis is associated with leukopenia, lymphadenopathy, and spleen enlargement.

Arthritis (like rheumatoid arthritis)

These diseases do not have rheumatoid factor (R.F.)

Marie Strumpell's ankylosing spondylitis

In most men, the spine is stiffened by ossification of the ligaments and fusion of adjacent vertebrae. The patient has HLA B27.

Arthritis is associated with other diseases 

Psoriasis.

Ulcerative colitis or inflammation of the small intestine.

Reiter's syndrome (arthritis, nongonococcal urethritis, and conjunctivitis).

Osteoarthritis (degenerative joint disease)

The disease is caused by degeneration of articular cartilage with reactive hypertrophy of the underlying bone. Usually occurs in the elderly, over 40, and of large joints with local inflammation, little pain. The joint will deform and limit movement. Causes of the disease can be due to trauma, arthritis, metabolic disorders...

Initially, articular cartilage cells are degraded, broken, and peeled off. The bone under the cartilage is rubbed, stimulated, so bone growth increases. The macrophages destroy bone, destroy the subchondral bone trabeculae and the blood vessels penetrate the cartilage tissue leading to ossification to form bone shoots and bone spurs.

Other arthritis

Traumatic arthritis

Causes synovial effusion and acute inflammation.

Charcot joint disease

Seen in spinal syphilis, neuropathy (diabetes...), spinal inflammation... Joints lose sensation due to nerve fibers being destroyed, so they are prone to injury. Joints move too much, and the cartilage and bone tissue underneath is destroyed.

Gout arthritis

Usually, in middle age, the disease has a sudden, acute onset with swollen, painful joints (toes, fingers, knees). The joint is effusion with sodium urate crystals. These crystals are also present on articular membranes, articular cartilage. When the disease becomes chronic, the articular membrane becomes inflamed and hyperplastic, and the cartilage and subchondral bone is destroyed. Urate crystals destroy tissue by causing the release of lysosomal metabolites from polymorphonuclear leukocytes. Urate crystals are also deposited in the surrounding soft tissue, causing a chronic inflammatory response with polynuclear macrophages.

Arthritis in systemic diseases

Such as lupus erythematosus, dermatomyositis, polyarteritis nodule, scleroderma.

Joint tumor

Rarely.

Meningeal sarcoma (see chapter on software).