Osteoarthrosis-the orthopedic surgeon's perspective

The clinically useful definition of osteoarthrosis (OA) is symptomatic loss of significant articular cartilage in a habitual load bearing area of a joint associated with subchondral sclerosis and osteophyte formation. In the large joints, significant articular cartilage loss means full thickness loss of articular cartilage in an area greater than about 1 cm2. The presence of fibrillated articular cartilage, by itself, is not necessarily progressive. Cartilage fibrillation and softening, with significant proteoglycan loss and markedly increased water content, i.e. chondromalacia, can persist indefinitely (Byers 1974, Meachim 1963). Chondromalacia is a pathologic rather than a clinical diagnosis, since it is asymptomatic, and is not necessarily pre-arthrotic (Abernathy et al. 1978). Trueta and his colleagues describe such changes, particularly in the usually unloaded areas of joints, believing that these changes were the signs of the earliest arthrotic involvement of the joints (Trueta 1963). They are not!