Contents Degenerative disease of the joints

1

Degenerative disease of the joints

The Bone and Joint Decade 2000 – 2010

Contents

1. Bone and Joint Decade 2000 – 2010

2. Degenerative disease of the joints (osteoarthritis)Ø Etiology

Ø Pathogenesis

Ø Signs and symptoms

Ø Diagnostic possibilities

3. Treatment of osteoarthritis



aims to improve the health-related

quality of life for people with

musculosceletal disorders worldwide.


The Bone and Joint Decade 2000 – 2010 was officially launched in Geneva on 13 January, 2000.

One out of every four American suffers from musculoskeletalconditions.

You are bringing hope to countless people around the world and helping to create a brighter, healthier future for us all.


UNWHO

World Bank

51 Goverments

Decade endorsement

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Facts

• Across the world, musculo-skeletal

conditions affect hundreds of millions of

people, at a huge cost to society (estimated at

$240 billion per year in the USA alone)

• Joint diseases account for half of all chronic

conditions in people aged 50 and over

•The number of individuals over the age

of 50 is expected to double between1990-

2020. In Europe by 2010, for the first

time, there will be more people over 60

years of age than people less than 20

years of age, resulting in a huge

escalation of treatment costs

Osteoarthritis is recognised as acivilisation disease

- is one of the

world’s largest

health care

problems

(WHO)

OsteoarthritisChronic degenerative non-inflamatory

joint disorder in which there is

progressive loss of articular cartilage

accompanied by new bone formation

and capsular fibrosis.

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OsteoarthritisClassification

Primary

(Osteoarthrosis idiopathica)

Secondary

(Osteoarthrosis secundaria)

EpidemiologyOsteoarthritis

18-34 years4%

35-74 years11%

75-79 years85%

Etiology

Secondary osteoarthrosis

• post-traumatic• congenital musculo-sceletal anomalies• post-inflamatory• epiphyseal diseases

Secondary osteoarthritis

Secondary osteoarthritis Etiology

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Patello-femoral pathology

P

L

TLP:LTInsall i Salvati

Osteoarthritismechanical

loadää

tissue resistance

Physiological inter-dependance

Articular cartilage

Synovium Subchondral bone

Cartilage & bonecartilage fibrillation

ääsurface abrasion

ääsubchondral bone thickening

ääcyst formation

Partial thickness damage

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Partial thickness damage Full thickness damage

Joint capsuleand synovial membrane

synovial hypertrophy

capsule fibrosis

capsule thickening

Symptoms

• pain

• stiffness

• restriction of movement

• flexion contracture

Signs

• joint swelling

• muscle wasting

• restriction of passive patellar tracking

• crepitation during movements

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Signs

• joint line

tenderness

• joint effusion

ValgusVarus

Diagnostic methods Diagnostic methods

Osteoarthritis Diagnostic methods

increased transmisionof forces to the

subchondral bone

ääincreased local blood

flow and deposition on existing trabeculae

ääsubchondral sclerosis

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Diagnostic methods

Osteophytes

Cartilage-bone outgrowths that occur most commonly at the margins of OA joints, by the process of enchondral ossification at the junction of hyaline cartilage and synovium/periosteum.

Arthrosis of the hip

Imaging

Normal articular cartilage in MR

SE T1 FL 2D FL 2D FL 2D

Imaging

Damaged articular cartilage

SE T1 SE T1

Arthroscopy

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Treatment of osteoarthritis

Pharmacological treatment Pharmacological treatment CostCost (PLN)(PLN)

0100020003000400050006000700080009000

10000

M D O V C E

MajamilDiclacOlfenVioxxCelebrexArthroplasty

Pharmacological treatmentPharmacological treatment

• Even short-term NSAID treatment may causegastropathy or entheropathy.

• Pathology may be visible within 7 days from the start of NSAID treatment.

• After some NSAID 19% frequency of stomach ulcer is observed in 6 days from the start of treatment.

• The cost of 9-months of sick-leave exceeds the cost of total knee arthroplasty

» ARCANA

Pharmacological treatmentPharmacological treatment

• Hyaluronic acid

• Glikozoaminoglicans/

• chondroityn

expensive, safe, may-be effective

cheaper, safe,

effective

•Hungerford D. S. 2002

Abrasion arthroplastyBone marrow stimulation technique

Mosaicplasty

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MicrofracturesBone marrow stimulation technique varus valgus

High tibial osteotomy

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Cemented arthroplasty

Cementless arthroplastyHip

prosthesis

Cementless hip arthroplastyOsteoarthritis

uni- and tricompartmental involvement

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Total knee arthroplasty

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Social and economic aspects of total knee arthroplasty

• Joint replacement is one of the most cost effective procedures in the whole medicine and surgery.

• When comparisons are made on the basis of the cost of quality adjusted life years, THR has a similar cost effectiveness to coronary artery bypass surgery.

»Laupacis 1994

Quality of life before and after arthroplasty• Preoperative hip and knee patient

groups were compared with similar groups who underwent arthroplasty 2 or 5 years previously.

• Major improvements were observed for pain, sleep, range of motion, and physical ability.

• The health status of patients operated 2 or 5 years ago was similar, suggesting a long-term health quality improvement .

• Rissanen P. and coathors 1995

Cardiovascular fitnessCardiovascular fitness

Inactivity secondary to more severe

osteoarthritis symptoms can result in

cardiovascular deconditioning.

» Ries M. D. and coauthors 1995

Cardiovascular fitnessCardiovascular fitness

Resumption of routine physical

activities after TKR is associated

with a corresponding

improvement in cardiovascular

fitness. In nonoperated patients

deterioration is observed.

» Ries M. D. and coauthors

1996

Arthrodesis

xxxxxxxxxxx

Hip prosthesis

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Complications

» Robertsson and coauthors 2000

Complications

• Infection rate after total knee arthroplasty

1 – 2 %

• Approximate per case cost

(USA)

50 – 60 thous. $

0

1

2

3

4

p a i

primasept.inf.

Sculco T. P. 1993 Hebert C. K. and coauthor 1996» »


• Joint replacement is one of the most cost effective procedures in the whole medicine and surgery.

• When comparisons are made on the basis of the cost of quality adjusted life years, THR has a similar cost effectiveness to coronary artery bypass surgery.

»Laupacis 1994


In over 90% of patients good result of

treatment may still be expected 10 years

after surgery.

» Molhani A. L. i Rand J. A. 1993-1994 r.

» Mason M. D. 1993-1994 r.

» Ranawat C. S., Boachie-Adjej O. 1988 r.

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Goals for the Decade

• Tissue engineering

• Gene therapy

Total knee arthroplastyGoals for the Decade

• Implants with better wear characteristics and improved fixation need to be developed.


• Computer navigation

during surgery


• Less invasive

unicompartmental

arthroplasty

?=

Advanced age is not

necessarily connected

with pain and disability.

Department of OrthopaedicsK. Marcinkowski University of Medical Sciences

in Poznan

Thank you

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Contents Degenerative disease of the joints