Adult reconstructive surgery in orthopedics has rapidly evolved
over the past 30 years. Prior to the successful development of so-called
low-friction arthroplasty of the hip in the late 1960s, reconstructive
options for the hip and the knee were limited. Reconstructive procedures
with high success rates are now available for a variety of disorders,
from marked degenerative hip disease to rotator cuff tears of the
shoulder. Research done in the last 30 years has increased the understanding
of major joint function and contributed to the success of reconstructive
surgical procedures in almost all cases, and there is now a tremendous
demand for these procedures. In 1997, total knee arthroplasty and
total hip arthroplasty procedures numbered 338,000 and 289,000,
respectively, the result of their great success in returning patients
to active lifestyles. Millions of Americans are now benefiting from
these procedures for extended periods. Because their cumulative
procedure failure rate is approximately 1% per year, 10
years after their operation, patients have approximately a 90% chance
of still having a successful, well-functioning joint replacement.
To treat arthritic conditions of the joints appropriately, an
understanding of the disease process is essential. This begins with
accurate diagnosis and a history of the progression of the disease,
so that the future progression can be predicted and appropriate
decisions regarding treatment can be made. The physician must evaluate
the possibility of traumatic, inflammatory, developmental, idiopathic,
and metabolic causes of the arthritis (Table 7–1).
Evaluation of the history, physical examination, and laboratory
data is helpful in arriving at a diagnosis.
Causes of Arthritic Conditions. |Favorite Table|Download (.pdf)
Causes of Arthritic Conditions.
|Traumatic causes||Traumatic arthritis, osteonecrosis (posttraumatic)|
|Inflammatory causes||Infectious arthritis, gout, pseudogout, rheumatoid arthritis,
systemic lupus erythematosus, ankylosing spondylitis, juvenile rheumatoid
arthritis, Reiter syndrome|
|Developmental causes||Developmental dysplasia of the hip, hemophilic arthritis,
following slipped capital fermoral epiphysis, following Legg-Calvé-Perthes
|Idiopathic causes||Osteoarthritis, osteonecrosis|
|Metabolic causes||Gout, calcium pyrophosphate deposition disease, ochronosis, Gaucher
Clearly the history is important in defining the disease process.
The time course, including duration and behavior of symptoms since
onset, is a key factor. Gradual rather than acute onset implies a
nontraumatic cause. Swelling in the joints is an important sign,
as is the distribution of joints if more than one is involved. The
degree of interference with activities indicates the seriousness
of the disorder.
The presence and extent of pain are valuable pieces of information.
Constant pain, night and day, implies infection, cancer, or a functional
disorder. Pain only with activity such as walking, standing, or
running suggests joint loading. Pain that awakens the patient is
considered severe and requires evaluation. Location helps ...