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  1. Arthritis SeminarSolutions for Knee, Shoulder and Hip Mark G. Kowall, M.D., M.B.A. Orthopedic Specialty Associates Templeton, California March 5, 2013

  2. Osteoarthritis “A Big Problem” More than 40 Million Americans have arthritis (joint inflammation) 27 Million people suffer from Osteoarthritis 40 million by 2020

  3. Burden of Disease All races equally More women than men after 50 Most of us by our 60s & 70s 475,000 Knee Replacements performed annually

  4. Osteoarthritis Shoulders Spine Hips Hands Fingers Knees Feet

  5. What is a Joint??? Bone Synovial membrane Joint space filled with Synovial Fluid “the oil” Articular cartilage “the tread”

  6. “Joint Wear”=“Tread Wear” Cartilage Healthy Knee Osteoarthritic Knee “tread wear”

  7. The Knee

  8. Inside the Knee Joint Normal Cartilage Advanced Arthritis

  9. Femoral Head (The “Hip Ball”)

  10. Causes Primary Osteoarthritis (Most Common) Result of aging Decreased ability of cartilage to repair itself Ligaments supporting joints weaken

  11. Causes Secondary Osteoarthritis Obesity Joint Injury Surgery Gout Congenital abnormal joints

  12. Effect of Weight Loss“Take home point” • For each pound of weight loss  4 pound reduction in the forces hitting the knee while walking. • “Less weight, Less load on the knee” Arthritis and Rheumatism, July 2005

  13. University of North CarolinaStudy • “Almost 50% of all U.S. adults and nearly 66% of obese adults will develop painful arthritis by the age of 85”

  14. An Aside Point Osteoarthritis Is NOT Osteoporosis

  15. Osteoporosis Loss of Bone Density Normal Bone Osteoporotic Bone

  16. Symptoms of arthritis Pain in affected joints Pain worse with prolonged use Stiffness after periods of inactivity Grating or “Catching”sensation with movement

  17. Diagnosis History Physical Exam Blood Test- to rule out other diseases Online “Knee Pain Assessment” (see website) X-Rays

  18. Knee X-Ray “Bald Tire” Healthy knee Osteoarthritic knee

  19. Hip X-Ray Tread Gone Healthy Hip Osteoarthritic Hip

  20. Shoulder X-Ray Advanced Arthritis Normal

  21. Treatment

  22. Goals of Treatment Make Your Life Better!!! by Relieving pain Increasing motion Improving strength

  23. Treatment varies with severity “Ladder Approach to Treatment”

  24. 1st Rung of LadderMedication

  25. Medication- NSAIDs NSAIDs are nonsteroidal anti-inflammatory drugs Aspirin Ibuprofen Naproxen

  26. Vitamins & Nutritional Supplements Glucosamine / Chondroitin Sulfate Some positive results for moderate to advance arthritis Recently, the American Academy of Orthopedic Surgeons recommended againstits use for patients with osteoarthritis of the knee (Dec, 2008) Fish Oil (Omega-3 Fatty Acids) Diet rich in Fruits and Vegetables

  27. Alternative Medicine Techniques Pain Stiffness Fatigue Inflammation Anxiety/ Depression Biofeedback u u u Visualization u u Hypnosis u u Relaxation u u Yoga u u u u u u u u Acupuncture u u u u Magnets u u u Vegetarian Diet u u u Herbs & Supplements u u u u u Therapy Symptom Tai Chi

  28. Next Rung of the Ladder Injections Cortisone (steroid) Visco-Supplementation (SynviscOne,Orthovisc, Hyalgan,Supartz,Euflexxa)

  29. Joint Protection- Daily Exercise Daily range of motion exercise (Stretching) Strengthening exercises every other day Endurance exercises three times per week

  30. Exercise Dos Talk to your doctor first Consider athletic trainer or physical therapist

  31. Braces Sleeves • neoprene • improve balance? • local warmth • control swelling • high compliance

  32. Braces Unloaders • “unload” or take pressure of the arthritic side of knee • decrease pain • improve walking tolerance • poor compliance • expensive

  33. External Support Aids “Unloads” the joint

  34. When all else fails to improve pain………..

  35. Surgery“Top of the Ladder”

  36. Asking Questions About Surgery Alternatives Benefits and for how long? Risks? What is procedure called? How is it done? Results? Return to “normal” activity?

  37. Surgical Options-Arthroscopy Mini incisions Outpatient

  38. Arthroscopy – Debridement(Shaving of articular Cartilage (“tread”) • A means of “smoothing” the coating cartilage • In conjunction to treating meniscus tears • Not designed for treatment of arthritis alone

  39. Arthroscopy – MicrofractureKnee and Shoulder • small awl used to make holes in bone • promote re-growth of cartilage

  40. Arthroscopy – “OATS” Procedure • transfer of healthy “tread” to “bald” area

  41. Surgical Options: Joint Replacement Knee Hip

  42. Total Knee Replacement Side view

  43. Surgical Instrumentation

  44. Surgical Instrumentation Femur Tibia

  45. Implants

  46. Total Hip Replacement

  47. Total Hip Replacement

  48. Total Shoulder Replacement

  49. Duke University Medical CenterStudy • Hip Replacement Surgery “Seniors with arthritis who undergo Hip Replacement are twice as likely to show improvements in functioning and ability to care for themselves” (no age limit on the benefits!!)

  50. New Technologies