Transcript Slide 1

Boomeritis
Arthritis of the hip and knee joint
Hardy Singh, M.D.
Welcome….
Hardy Singh, M.D.
3404 Wake Forest Road
Suite 201
Raleigh, NC 27609
(919) 256-1511
www.seortho.net
Background…
Hardy Singh, M.D.
Medical School, Punjab, India
Orthopaedic Training, India
Research, Duke University Medical Center
Residency Duke University Medical Center
6 month Fellowship, Joint replacement
Joint Efforts
• Putting the spring
back in your steps….
• Or..
• Charting your course
to a more normal
lifestyle….
Choosing an orthopaedic surgeon…
• How are orthopaedic
surgeons trained?
• What is Board
Certification?
• What is a fellowship?
Topics..
• Arthritis
• Joint Anatomy
• Treatment options
The Arthritis Foundation
“Half of Americans diagnosed with
arthritis don’t think anything can
be done to help them.”
The Arthritis Foundation
• Arthritis is the number one cause of
disability in the U.S.*
• Over 16 million adults say that arthritis
limits their usual activities in some way.*
• 8.2 million working aged U.S. adults
(about 1 in 20) report work limitations due
to arthritis or joint symptoms.
Anatomy
• Ligaments
– Connect bone to bone
• Tendons
– Connect muscle to bone
• Cartilage
– Lubricates and cushions
movement
Cartilage = Tires
• Covers bone ends in
every joint
• White, slippery tissue
• One-quarter inch thick
• Can be damaged
What is Arthritis..?
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Defined as inflammation of the joint
More than 100 different types
Affects 43 million Americans each year
Pain, swelling, and loss of motion
Most common cause of disability in US—
1 in 6 affected
• Two primary types
– Osteoarthritis
– Rheumatoid arthritis
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Source—Centers for Disease Control and Prevention
Rheumatoid Arthritis
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Inflammatory arthritis
Often affects many joints at once
Can occur at any age, even children
Excess synovial fluid
Osteoarthritis
• Most common type of arthritis
• 23 million Americans affected annually*
• Degenerative disease affecting joint
cartilage
– “wear and tear”
• May result from overuse or injury
• Knees, hips, back and hands most often
affected
Osteoarthritis (continued)
• Begins as small area
• Eventually results in bone-on-bone contact
• Results in swollen, painful and stiff joints
Osteoarthritis
Healthy knee x-ray
Arthritic knee x-ray
Osteoarthritis
Normal
hip
Xray
Arthritic
Hip
X-ray
Symptoms of Arthritis
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Joints warm to the touch
Joints swelling
Joint pain and immobility
Joint stiffness
Joint weakness (buckling)
Decreased activity
Impaired lifestyle
Joint deformities
Osteoarthritis vs. Normal
Aging
• Osteoarthritis causes
changes in the bone below
cartilage
• Osteoarthritis occurs
primarily in weight-bearing
joints
• With osteoarthritis, the
water content increases
early in the disease
process
Exercise Nourishes Cartilage
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Extremely beneficial.
Keeps bones strong.
Keeps joints limber.
Strengthens muscles.
– Good muscle tone decreases
stress to the articular surface of
the joint.
• Helps prolong life of joints.
Types of Exercise
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Walking
Swimming
Bicycling
Water aerobics
Work with physical
therapist.
• Posture
– Lift correctly
– Rest
– ADL’s
Modifying Activities of Daily
Living
• Posture
• Lift correctly
• Rest
Weight Control
(Being Overweight…)
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Places extra stress on your joints1
– 3 pounds of pressure for every 1 pound of
body weight
– 150 pound person can place up to 450
pounds of pressure across each joint
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Accelerates rate of cartilage destruction2
Makes it harder to exercise properly
before and after surgery2.
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Harrington, I. J. (1976): A bioengineering analysis of force actions at the knee in normal and pathological gait.
Biomed. Eng., 11:167–172.
Felson, D. T.: “Weight and osteoarthritis.” J. Reumatol, 43: 7–9, 1995.
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Too much to handle..
Ice….is nice
• Decreases local
circulation
• Decreases swelling
• Acts as a local antiinflammatory
• Decreases pain
• Improves exercise
tolerance
Heat… is nice
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Increases local circulation
Promotes relaxation
Helps muscles and joints stretch
Decreases joint and muscle aches
Braces and Self-Help
Devices
• Back/Hip/Knee
– Abdominal supports to reduce stress
on the back
– Long-handled reachers and
grabbers to reduce bending
– Sock sliders
• Knee
– Bracing the knee reduces painful
instability
– Unloader braces are special knee
braces to reduce stress on the knee
joint.
Orthotics
• Properly fitting footwear is essential to
align legs
• Heel wedges or orthotics help align the
legs, relieving pressure on knees
• Rubber shoe inserts may reduce some of
the impact loading that your knees or hips
experience.
• Canes (in opposite hand).
• Walkers
Glucosamine/Chondroitin
sulfate
• Building block of cartilage
• May be useful in strengthening
cartilage, preventing breakdown.
• Can be extracted from shells of
crabs and shrimp
• Not a cure. Does not rebuild
cartilage.
• May help with keeping cartilage
spongy.
• Some anti-inflammatory properties.
Vitamins/ Minerals
• Some studies indicate higher incidence of
arthritis in people with low Vitamin C and
D intake
• Too much calcium does not cause arthritis
– Too little calcium can cause osteoporosis
• Arthritis patients should take vitamins
regularly
Medications/NSAID’s
• Acetaminophen, Aspirin, Naproxen,
Ibuprofen, Celebrex.
• Host of NSAID’s (as needed best)
• Effective in reducing swelling
• Stomach and blood side-effects.
• Topical Creams: Capsaicin, zostrix (from
red peppers)
– Helps block pain.
Hyaluronate
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Naturally occurring substance in cartilage
Relieves pain
Restores function
Provides lubrication to cartilage
Relief may last from 6 to12 months.
Hyalgan, Supartz, Synvisc, etc..
Few side effects..pseudosepsis
Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the
knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004; 86:538-545
Cortisone
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Naturally Occurring Hormone.
Anti-inflammatory
Short term pain relief
Reduce swelling
Relief is variable
Long-term use may injure cartilage.
Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S. Corticosteroid compared with hyaluronic acid injections for
the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am. 2003; 85:1197-1203.
Is Surgery for You?
• This should be a
cooperative one
between you, your
family, your family
physician and your
orthopaedic
surgeon.
The Orthopaedic
Evaluation
• Medical history
including:
– Previous injuries and
surgeries
– Current medications
– Lifestyle issues and
demands
• Physical examination
• X-rays
• Occasionally blood
tests, MRI or bone
scan
Surgery
Chondroplasty, RF ablation
OATS, microfracture
Carticel
Osteotomies
Partial joint replacement
Orthoglide spacer
Total joint replacement
Arthroscopy
• Controversial for Degenerative knee
• Mechanical symptoms= success.
– Relieves pain from torn meniscus, Loose
bodies, pathologic plica, osteophytes, notch
stenosis
• Severity of arthritis= failure
• Less successful with malalignment/ Gait
issues.
• Arthroscopy=sham for arthritis.
Osteotomy
“Minimally Invasive”
Surgery
• Traditional joint
replacement surgery is
performed through an 8 10 inch incision
• Some patients may
qualify for a “minimal”
incision, only 4 inches to
6 inches long
• Your surgeon will select
the best approach for
your unique situation.
Total knee/Hip replacement
• Primary Components
Femoral component
Plastic liner
Tibial tray
Shell
Liner
Head
Stem
Preparing for Total Joint
Replacement
• Donate some of your
own blood
• Stop taking certain
drugs before surgery
• Begin exercises to
speed your recovery
after surgery
• Plan for home therapy
and rehabilitation after
surgery
Total joint replacement
Realistic expectations
90 percent of individuals who undergo total
joint replacement experience a dramatic
reduction of pain and a significant
improvement in the ability to perform
common activities of daily living.
• Survivorship:
– 90%@10 yrs
– 80%@15 yrs
– 75%@20 yrs.
Possible Complications
• Most are successfully treatable
• Types of possible complications:
– Loosening
– Infection
– Wear
– Blood clots
– Dislocation
– Nerve Injury
The Recovery Process
• Use your "new" joint
shortly after your
operation
• Begin walking shortly
after surgery
• Initially, you will walk
with a walker,
crutches or a cane.
Home Planning
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Safety bars
Secure handrails
Stable chair
Toilet seat riser
Remove all loose
carpets and cords
• Same floor living
space
The Recovery Process
• There will be
temporary pain in the
replaced joint
• The muscles are weak
from inactivity
• The tissues are
healing
• Pain will end in a few
weeks or months
A few weeks later..
New Implant- FDA
approved 2006
• ORTHOGLIDE
What type of patient is this
for??
• A patient who is having
persistent pain mainly from
inside part of the knee
• A patient who’s received all
other non-surgical therapies
and is still having pain
• A patient who’s surgeon has
told them their next step is a
Uniarthroplasty or TKR
How it works
• Reduces the forces placed on the painful middle
part of the knee by redistributing them to the
other less painful half
• Increase the contact area of the moving parts in
the knee, thus reducing painful point forces
• Decrease the bone-on-bone friction by providing
a smooth glide path for the femur to move on
The OrthoGlide
Advantages…
• Provides pain relief without compromising the knee
anatomy
• No bone cuts
• 2-3 inches long, combined with arthroscopy
• Total procedure time: 45-60 min.
• Does not “Burn any Bridges”
• Easy conversion to other surgical options (i.e. Uni, TKR)
• Home next day, no Physical Therapy
• Weight bearing as tolerated.
Current Patient Results
WOMAC Score
OrthoGlide Results
100
90
80
70
60
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40
30
20
Pain
Function
Pre-op
3 Month
n=48
6 Month
n=48
1 Year
n=1
Future of arthritis
• By the year 2030, an estimated one
quarter of the projected total adult
population, or 64.9 million adults aged 18
years and older, will have doctordiagnosed arthritis, compared to the 42.7
million adults in 2002.*
• These estimates may be conservative as
they do not account for current trends in
obesity.
Closing
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Education of various options
We can/must successfully treat arthritis
Surgery is a last resort
Returning patients to activity and
employment is critical
• We must work together.
Future
• Identifying high risk patients.
• Genetic basis
• Disease prevention through
– Health
– Lifestyle &
– Disease modifications.
Thank you
Hardy Singh, M.D.