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1
Arthritis SeminarSolutions for Knee, Shoulder and Hip
Mark G. Kowall, M.D., M.B.A.
Orthopedic Specialty Associates
Templeton, CaliforniaMarch 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
Most of us by our 60s & 70s
More women than men after 50
All races equally
Burden of Disease
475,000 Knee Replacements performed annually
5
Bone
Joint space filled with Synovial Fluid “the oil” Articular
cartilage“the tread”
Synovial membrane
What is a Joint???
10
Causes
Primary Osteoarthritis (Most Common)
Result of aging
Decreased ability of cartilage to repair itself
Ligaments supporting joints weaken
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”
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
22
Goals of Treatment
Make Your Life Better!!!
by
Relieving pain
Increasing motion
Improving strength
26
Vitamins & Nutritional Supplements
Glucosamine / Chondroitin Sulfate
Some positive results for moderate to advance arthritis
Recently, the American Academy of Orthopedic Surgeons
recommended against its 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
Therapy Symptom Pain Stiffness Fatigue Inflammation Anxiety/
DepressionBiofeedback 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
Tai Chi
28
Next Rung of the Ladder
Injections
Cortisone (steroid)
Visco-Supplementation (Synvisc One,Orthovisc, Hyalgan, Supartz, Euflexxa)
29
Joint Protection- Daily Exercise
1.Daily range of motion exercise (Stretching)
2.Strengthening exercises every other day
3.Endurance exercises three times per week
32
Braces
Unloaders “unload” or take pressure of the arthritic side of knee
decrease pain
improve walking tolerance
poor compliance
expensive
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?
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
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!!)
51
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)
52
Recent discovery of a natural occurring molecule in the body that can counter the progression of arthritis
Genes and Development
53
Traditional TKA vs. High Flex TKA
Designed to safely accommodate flexionup to 125
Designed to safely accommodate flexionup to 155
New Implant Designs
55
Patient Specific Instrumentation
MRI or CT based technology
3D model created of knee
Surgery Planning
Customized pin guides or cutting blocks
58
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!!!!
59
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
61
www.ShoulderKneeSpecialists.com
Surgical Procedure Animations
Health Library
Important Links
Resources