Transcript PowerPoint Presentation - Osteoarthritis in the Elderly

Osteoarthritis and Total Joint
Replacement
Risk Factors, Prevention, and Treatment, and
the Effects on Sensory Mechanisms
Encountered by Osteoarthritic Total Joint
Replacement Patients
NeilV. Shah
BioNB 4210, Fall 2008
Final Project
An Introduction to Osteoarthritis
 Osteoarthritis (OA) is a slow-progressing joint inflammation that can
result from cartilage degeneration.
 OA is the most common form of arthritis, even more common as age
increases. Nearly 27 million Americans older than 25 years of age have
OA.
 By 2030, nearly 20% of Americans (approximately 72 million people)
will surpass 65 years of age and be at high risk for OA.
 Under the age of 45, male OA patients outnumber females. After that
age, it is more common in women. It is also more likely to develop in
overweight people and people with jobs that stress certain joints.
What Does OA Affect?
 OA onset at where joints occur, most commonly affecting
the hands and finger-ends, neck, lower back, knees, and hips
(Figure 1, left).
 It is painful and can negatively influence lifestyle, bringing
on depression and a sense of helplessness, and finances, as
treatment options can be expensive.
Figure 1.
(Backside BodyView)

Courtesy of NIH NAMS
It is also a very common cause for falls in the elderly. It
leads to weakened bone and muscle strength, and this can
severely worsen the effects of a fall on an elderly person.
An Osteoarthritic Joint
Figure 2.
Courtesy of Shiel 2008, MedicineNet
 Two types of OA:
 Primary OA: attributed to age, heredity, and activity-related
deterioration on joint cartilage, resulting in a total loss of cartilage cushion
between the bones of joints (Figure 2 above).
 Secondary OA: caused by other diseases/co-morbidities, such as obesity,
trauma, diabetes, etc.
Symptoms & Diagnosis of OA
 Frequently, OA patients complain of:
 Stiffness in a joint after getting out of bed or sitting for a long time
 Swelling and pain in one or more joints
 A Crunching feeling or the sound of bone rubbing on bone
**If your skin turns red or you feel hot, you may not have OA;
it could be of another cause, such as rheumatoid arthritis
 Common Ways to Diagnose OA
 Patient’s Clinical History and Physical Exam
 X-rays (Figure 3, right) or MRI images
read by an Orthopedist
Figure 3.
Courtesy of
CentraCare
Effective Treatments for OA
 Goals of Treatment
 Control Pain
 Improve Joint Function
 Treatment Options
 Exercise
 Strengthening, Aerobic, Agility
 Weight Control
 Surgery
 Complementary Methods
 Acupuncture
 Nutritional Supplements
 Restore Lifestyle
 Maintain Normal Weight
 Pain Medications
 Acetaminophen
 Corticosteroids
 Hyaluronic Acids
Surgery
 Total Joint Replacement (TJR)
 Prosthetic devices made from metal alloys (Figure 4, below), high-density plastic, or ceramic
material used to replace severely affected joints. Can be performed for degraded hips,
knees, shoulders, and ankles.
Figure 4.
Courtesy of DePuy Orthopaedics
Shoulder
Ankle
Knee
Hip
 Artificial joints have become increasingly long-lasting (up to 10-15 years). May require
revision or re-replacements after that time.
 Joint Resurfacing
 The surfaces of the bones in the joint can be surgically resurfaced, or smoothed out.
 In regular replacement, the head of the joint is removed, but in resurfacing, usually
performed in the hip, the head is resurfaced and capped with an implant that will slide into
the corresponding implanted cup.
 Often a temporary step for those who avoiding
or delaying open surgical intervention
(replacement, etc.) or arthroscopy.
Surgery Cont’d
 Arthroscopy
 Viewing scope inserted into the joint, allowing a surgeon to
view and detect the site of damage (Figure 5, below)
 Sometimes this can be can repaired through an arthroscope.
 Often a successful procedure with
recovery time quicker than
open joint surgery.
Figure 5.
Courtesy of Essex Knee Surgery
Joint Replacement
 Who Can Help You Treat your OA?
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Primary Care Physicians
Rheumatologists
Orthopaedists
Physical Therapists
Occupational Therapists
Nurse Educators

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Dieticians
Physiatrists (Rehab Specialists)
Licensed Acupuncture
Therapists
Psychologists
Social Workers
 In addition to major orthopedic hospitals, many community
hospitals can now perform not only therapeutic treatment but
surgeries.
More on Joint Replacement
 This procedure is continually improving itself, and new methods
are published frequently.
 Joints can now be customized to the lifestyle and age of the
patient
 Middle-Aged (40-60) Athletes, Factory Workers, Frequent Travelers, etc.
 Orthopaedic Centers Specializing in Joint Replacement
 Hospital for Special Surgery, NewYork, NY
 NYU Hospital for Joint Diseases, NewYork, NY
 Mayo Clinic, Rochester, MN
 Cleveland Clinic, Cleveland, OH
 Duke University Medical Center, Durham, NC
Tips for Those Considering Joint
Replacement
 Take Painkillers Before Surgery
 Inform your physician
 Studies in knee replacements have documented reduced pain and other postoperative
effects
 Request Inpatient Rehabilitation Soon after the Operation
 Studies have shown that patients moved to rehab as early as three days following
surgery have had successful recoveries and reduced hospital costs.
 Don’t Sit on OA; Approach It In the Long-Term
 Don’t wait for symptoms to become debilitating to act
 Studies show that surgeries performed at later stages
of joint deterioration due to OA result in worse
postoperative functional status
Falls Can Accelerate Need for Surgery
 Common Causes of Falls
 Degraded bone density and muscle strength in the hip, knee, and ankle joints.
 Changes in Visual System

Age-related changes in sight, such as hardening, yellowing, and clouding of eye lens, decrease in
pupil diameter, clouding of intraocular fluids, weakened eye muscles all contribute to decline in sight

Among hip fracture patients, vision impairment is more frequent than in people without hip
fractures
 Changes in Perceptual and Auditory-Vestibular Systems

Declining ability to detect information combining touch and kinesthetic data (haptic perception)
hurts ability to properly grasp and manipulate objects

Vestibular system, located in the ear, is vital to maintaining and coordinating balance. Age-related
changes to these systems hurts ability to adapt to environmental changes or obstacles and greatly
increases the risk of falling
Alternatives to Operative Treatment
 Therapeutic
 Use of Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
 Aspirin, Ibuprofin (Motrin), and Naproxen (Naprosyn)
 Physical Therapy
 Treatment with food supplements (glucosamine & chondroitin)
 Hyaluronic Acid Injections – restores thickness of joint fluid for better joint lubrication
and impact capability
 Self-Managed
 Rest, Exercise, Diet Control with Weight Reduction, Adjustment of Home (Showers,
Stairwells, Chairs, etc.)
 Complementary and Alternative Methods (CAM)
 Acupuncture – by inserting fine needles into skin at specific points on body, they help
reduce pain and improve physical function.
What Can You Do To Prevent OA?
 Self-Care and Good Health Attitude are Vital
 Get Educated about OA and how it can affect your life.You should
be aware of its frequency of occurrence and thus prepare accordingly.
 If you have it, join patient education programs or selfmanagement programs to help understand and cope with OA and
reduce pain
 Stay Active with exercise and regular activity
 Eat Well and Control Your Weight
 Stay Positive – OA can be successfully managed, and research is
continuing to improve the lives of OA patients on a daily basis
Intended Audience
This presentation is primarily intended for elderly patients who
want a general overview of the risk factors, symptoms, and
treatment methods associated with osteoarthritis. It also may be
useful for:
 People wanting to gain a basic understanding of OA
 Patients younger than 60 years of age suffering from OA
 Family members of OA patients wanting to learn more about their
loved ones’ conditions and ways they can help
 This presentation is not intended to serve as a scientific review of
OA nor is it intended to provide information that would be
entirely novel to members of academia and medicine. It is merely
a resource meant primarily for patient education.
References and Resources


Helpful Resources

Best Hospitals: Orthopedics. 2008. America’s Best Hospitals. US News. Dec. 4, 2008.
<http://www.usnews.com/directories/hospitals/index_html/specialty+ihqorth>

Buckelew K. (2007) New technology allows joint replacement on younger patients. Daily Record. Dec. 4, 2008.
<http://findarticles.com/p/articles/mi_qn4183/is_20071119/ai_n21125849/pg_1?tag=artBody;col1>

Kulkarni S. (2006) Falls And The Elderly: An Educational Resource. Dec. 4, 2008.
<http://courses.cit.cornell.edu/psych431_nbb421/student2006/ssk34/whyfallsoccur.htm>

Osteoarthritis. 2002-2006. NIH NIAMS. Dec. 4, 2008.
<http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp>

Shiel,WC. Osteoarthritis. Sep. 2008. MedicineNet. Dec. 4, 2008.
<http://www.medicinenet.com/osteoarthritis/article.htm#Whatis>
Images

Figure 3: Thompson, EG. (2007) X-ray of osteoarthritis of the knee. CentraCare Health System. Dec. 4, 2008.
<http://64.143.176.9/library/healthguide/en-us/support/topic.asp?hwid=zm6052>

Figure 4. Joint Replacement Technology. 2002-2008. DePuy Orthopaedics. Dec. 4, 2008.
<http://www.jointreplacement.com/DePuy/index.html>
References and Resources Cont’d
 Images Cont’d
 Figure 5. Rees C. (2008) Anterior cruciate ligament (ACL) reconstruction. Essex Knee Surgery. Dec. 4, 2008.
<http://www.essexkneesurgery.co.uk/anterior-cruciate-ligament-reconstruction.php>
Relevant Studies and Publications (May Require Access to University Library Proxy; Can All be
accessed through Respective University Library through Google Scholar)
 Buvanendran A, Kroin, JS, Truman K, et. al. (2003) Effects of Perioperative Administration of a Selective Cyclooxygenase 2 Inhibitor
of Pain Management and Recovery of Function After Knee Replacement. JAMA. 290: 2411 – 2418. http://jama.amaassn.org/cgi/content/abstract/290/18/2411?ijkey=2037eae3f1d3b24c17bdf39eab0df590547a26ae&keytype2=tf_ipsecs
ha
 Fortin PR, Clarke AE, Joseph L, et. al. (2001) Outcomes of total hip and knee replacement: Preoperative functional status predicts
outcomes at six months after surgery. Arthr. and Rheum.. 42(8): 1722 – 1728.
http://www3.interscience.wiley.com.proxy.library.cornell.edu/journal/79503171/abstract?SRETRY=0
 Grue EV, Kirkevold M, Mowinchel P & Ranhoff AH. (2009) Sensory impairment in hip-fracture patients 65 years or older and
effects of hearing/vision interventions on fall frequency. J. Multidiscip. Healthcare. 2: 1-11.
http://www.dovepress.com/articles.php?article_id=2549
References and Resources Cont’d
 McCarvill S. (2005) Essay: Prosthetics for athletes. Lancet. 366(1): S10 – S11.
http://www.sciencedirect.com.proxy.library.cornell.edu/science?_ob=Article
URL&_udi=B6T1B-4HTK0YH6&_user=492137&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct
=C000022719&_version=1&_urlVersion=0&_userid=492137&md5=6fc1df7a
95e13d85b1eb14e4c39d7172
 Zuckerman JD. (1998) Inpatient Rehabilitation After Total Joint Replacement. JAMA.
279: 880. http://jama.amaassn.org.proxy.library.cornell.edu/cgi/content/full/279/11/880