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Arthritis Seminar Solutions for Knee, Shoulder and Hip. Mark G. Kowall, M.D., M.B.A. Orthopedic Specialty Associates Templeton , California March 5, 2013. Osteoarthritis. “A Big Problem” More than 40 Million Americans have arthritis (joint inflammation)

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arthritis seminar solutions for knee shoulder and hip
Arthritis SeminarSolutions for Knee, Shoulder and Hip

Mark G. Kowall, M.D., M.B.A.

Orthopedic Specialty Associates

Templeton, California

March 5, 2013

osteoarthritis
Osteoarthritis

“A Big Problem”

More than 40 Million Americans

have arthritis (joint inflammation)

27 Million people suffer from Osteoarthritis

40 million by 2020

burden of disease
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

osteoarthritis1
Osteoarthritis

Shoulders

Spine

Hips

Hands

Fingers

Knees

Feet

what is a joint
What is a Joint???

Bone

Synovial membrane

Joint space filled with Synovial Fluid

“the oil”

Articular cartilage

“the tread”

joint wear tread wear
“Joint Wear”=“Tread Wear”

Cartilage

Healthy Knee

Osteoarthritic Knee

“tread wear”

inside the knee joint
Inside the Knee Joint

Normal Cartilage

Advanced Arthritis

causes
Causes

Primary Osteoarthritis (Most Common)

Result of aging

Decreased ability of cartilage to repair itself

Ligaments supporting joints weaken

causes1
Causes

Secondary Osteoarthritis

Obesity

Joint Injury

Surgery

Gout

Congenital abnormal joints

effect of weight loss take home point
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

university of north carolina study
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”

an aside point
An Aside Point

Osteoarthritis

Is NOT

Osteoporosis

osteoporosis
Osteoporosis

Loss of Bone Density

Normal Bone

Osteoporotic Bone

symptoms of arthritis
Symptoms of arthritis

Pain in affected joints

Pain worse with prolonged use

Stiffness after periods of inactivity

Grating or “Catching”sensation with movement

diagnosis
Diagnosis

History

Physical Exam

Blood Test- to rule out other diseases

Online “Knee Pain Assessment” (see website)

X-Rays

knee x ray
Knee X-Ray

“Bald Tire”

Healthy knee

Osteoarthritic knee

hip x ray
Hip X-Ray

Tread Gone

Healthy Hip

Osteoarthritic Hip

shoulder x ray
Shoulder X-Ray

Advanced

Arthritis

Normal

goals of treatment
Goals of Treatment

Make Your Life Better!!!

by

Relieving pain

Increasing motion

Improving strength

treatment varies with severity
Treatment varies with severity

“Ladder Approach to Treatment”

medication nsaids
Medication- NSAIDs

NSAIDs are nonsteroidal anti-inflammatory drugs

Aspirin

Ibuprofen

Naproxen

vitamins nutritional supplements
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

alternative medicine techniques
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

next rung of the ladder
Next Rung of the Ladder

Injections

Cortisone (steroid)

Visco-Supplementation (SynviscOne,Orthovisc, Hyalgan,Supartz,Euflexxa)

joint protection daily exercise
Joint Protection- Daily Exercise

Daily range of motion exercise (Stretching)

Strengthening exercises every other day

Endurance exercises three times per week

exercise dos
Exercise Dos

Talk to your doctor first

Consider athletic trainer or physical therapist

braces
Braces

Sleeves

  • neoprene
  • improve balance?
  • local warmth
  • control swelling
  • high compliance
braces1
Braces

Unloaders

  • “unload” or take pressure of the arthritic side of knee
  • decrease pain
  • improve walking tolerance
  • poor compliance
  • expensive
external support aids
External Support Aids

“Unloads” the joint

slide34
When all else fails

to improve pain………..

asking questions about surgery
Asking Questions About Surgery

Alternatives

Benefits and for how long?

Risks?

What is procedure called?

How is it done?

Results?

Return to “normal” activity?

surgical options arthroscopy
Surgical Options-Arthroscopy

Mini incisions

Outpatient

arthroscopy debridement shaving of articular cartilage tread
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
arthroscopy microfracture knee and shoulder
Arthroscopy – MicrofractureKnee and Shoulder
  • small awl used to make holes in bone
  • promote re-growth of cartilage
arthroscopy oats procedure
Arthroscopy – “OATS” Procedure
  • transfer of healthy “tread” to “bald” area
surgical options joint replacement
Surgical Options: Joint Replacement

Knee

Hip

duke university medical center study
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!!)

laboratory
Laboratory
  • Recombinant Gene Therapy (synthesize the growth factors which produce new cartilage)
  • Specific Growth Factors promote cartilage (tread) maintenance and repair
  • May limit the progression of arthritis
  • Platelet Rich Plasma (PRP)
slide52
Recent discovery of a natural occurring molecule in the body that can counter the progression of arthritis

Genes and Development

traditional tka vs high flex tka

New Implant Designs

Traditional TKA vs. High Flex TKA
  • Designed to safely accommodate flexionup to 125
  • Designed to safely accommodate flexionup to 155
gender specific knee implant

New Implant Designs

Gender Specific Knee Implant

Women have a different shaped knee joint

patient specific instrumentation
Patient Specific Instrumentation
  • MRI or CT based technology
  • 3D model created of knee
  • Surgery Planning
  • Customized pin guides or cutting blocks
complications
Complications
  • Mini-Incision Surgery for the knee reduces recovery time but increases wound healing problems.

Clinical Orthopedics and Related Research

  • Mini-Incision and alternative approaches for the hip---controversial!!!!
consumer beware
Consumer Beware

Bozic K J, et al. Impact of direct to consumer advertising on physician attitudes and behavior in orthopedic surgery American Academy of Orthopedic Surgeons

**Poll of 737 hip and knee surgeons

**Over 75% of surgeons reported that direct-to-consumer (DTC) advertising negatively impacted their practice and the relationship with patients.

**Ads presented a skewed view of procedures and devices by exaggerating the benefits and down playing risks.

**(Patients) were not more educated about the risks and benefits, not more educated about the alternatives, not more educated about the costs and that they were less open to alternatives after reading or viewing direct-to-consumer advertisements

resources
Resources
  • www.ShoulderKneeSpecialists.com
  • Surgical Procedure Animations
  • Health Library
  • Important Links