Osteoarthritis (OA)

Check the neck before you plan the airway - Cervical spine OA is present in over 80% of individuals over the age of 55. Document flexion, extension, and rotation to the point where pain stops the patient, and pull prior anesthetic records for what actually worked.

Rule out myelopathy - Upper motor neuron signs on exam — spasticity, ataxic gait, hyperreflexia, a positive Babinski — mean cord involvement rather than a merely stiff neck. Spurling test and straight leg raise sort out radiculopathy.

Red flags that change the plan - Numbness, loss of grip strength, loss of bowel or bladder continence, saddle anesthesia, or fever and chills alongside back pain point away from simple OA and toward infection, neoplasm, or cord compression.

Position within the joint's own arc - Limited range of motion in OA comes from pain, swelling, and fixed deformity, alongside bony enlargement, crepitus, effusions, and joint line tenderness. Move each joint with the patient awake, note where it stops, and reproduce only that on the table — arms that won't abduct, hips that won't flex, a neck that won't extend.

Account for chronic NSAIDs - Oral NSAIDs are first-line for OA and carry gastrointestinal, renal, and cardiovascular toxicity. They're used cautiously in patients with cardiovascular disease or stroke, peptic ulcer disease, the elderly, and anyone also taking corticosteroids. Get a creatinine and a hemoglobin.

Chronic opioids raise the baseline - Opioids give more pain relief than NSAIDs in chronic pain but carry addictive potential and a real side-effect profile. Reconcile the home dose, expect tolerance, and lean on multimodal and regional technique rather than escalating opioid alone.

Cement is the hemodynamic event - OA is the leading indication for hip and knee arthroplasty. Systolic pressure falls after cement insertion for femoral head replacement, with significant risk of intraoperative hypotension, intravascular embolization, and rarely cardiac arrest; the proposed mechanism is right ventricular failure from a rise in pulmonary artery pressure. Risk climbs with hypertension, obesity, and a previously uninstrumented femoral canal — have vasopressor drawn up and ask the surgeon to call the cement.

Recovery depends on a working leg - After knee arthroplasty, bed mobility and full weight-bearing with a walker start the day of surgery, and active range of motion and straight leg raises start on day one; discharge requires safe ambulation and adequate pain control. Build an analgesic plan that controls pain without leaving the leg too weak to stand on.

Expect the comorbidities that come with it - Central obesity, diabetes, high blood pressure, and hyperlipidemia are independently associated with OA. A baseline ECG, glucose, and renal panel are usually worth having.

Osteoarthritis (OA) is the most common form of arthritis: progressive loss of articular cartilage, either primary (degeneration with no apparent underlying reason) or secondary to another process. As cartilage thins, subchondral bone density rises and osteophytes form, driving synovial hypertrophy, cartilage ulceration and eburnation, joint instability, and bony overgrowth; in the spine that overgrowth contributes to spinal stenosis. Synovial fluid loses its viscoelasticity as hyaluronic acid declines, and leukotrienes and prostaglandins keep the facet joints inflamed.

What reaches the anesthesia provider is a patient with stiff, painful, fixed-range joints, a cervical spine that is degenerative in over 80% of people past 55, a long list of NSAIDs and opioids, and often the metabolic syndrome comorbidities — central obesity, diabetes, hypertension, hyperlipidemia — that travel with OA.