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Boomeritis

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Title: Slide 1 Author: Dr. Hardy Singh Last modified by: hsingh Created Date: 9/28/2004 10:53:19 PM Document presentation format: On-screen Show Company – PowerPoint PPT presentation

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Title: Boomeritis


1
Boomeritis Arthritis of the hip and knee joint
Hardy Singh, M.D.
2
Welcome.
  • Hardy Singh, M.D.
  • 3404 Wake Forest Road
  • Suite 201
  • Raleigh, NC 27609
  • (919) 256-1511
  • www.seortho.net

3
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

4
Joint Efforts
  • Putting the spring back in your steps.
  • Or..
  • Charting your course to a more normal lifestyle.

5
Choosing an orthopaedic surgeon
  • How are orthopaedic surgeons trained?
  • What is Board Certification?
  • What is a fellowship?

6
Topics..
  • Arthritis
  • Joint Anatomy
  • Treatment options

7
The Arthritis Foundation
  • Half of Americans diagnosed with arthritis dont
    think anything can be done to help them.

8
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.

9
Anatomy
  • Ligaments
  • Connect bone to bone
  • Tendons
  • Connect muscle to bone
  • Cartilage
  • Lubricates and cushions movement

10
Cartilage Tires
  • Covers bone ends in every joint
  • White, slippery tissue
  • One-quarter inch thick
  • Can be damaged

11
What is Arthritis..?
  • 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
  • SourceCenters for Disease Control and Prevention

12
Rheumatoid Arthritis
  • Inflammatory arthritis
  • Often affects many joints at once
  • Can occur at any age, even children
  • Excess synovial fluid

13
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

14
Osteoarthritis (continued)
  • Begins as small area
  • Eventually results in bone-on-bone contact
  • Results in swollen, painful and stiff joints

15
Osteoarthritis
Healthy knee x-ray
Arthritic knee x-ray
16
Osteoarthritis
Normal hip Xray
Arthritic Hip X-ray
17
(No Transcript)
18
Symptoms of Arthritis
  • Joints warm to the touch
  • Joints swelling
  • Joint pain and immobility
  • Joint stiffness
  • Joint weakness (buckling)
  • Decreased activity
  • Impaired lifestyle
  • Joint deformities

19
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

20
Exercise Nourishes Cartilage
  • 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.

21
Types of Exercise
  • Walking
  • Swimming
  • Bicycling
  • Water aerobics
  • Work with physical therapist.
  • Posture
  • Lift correctly
  • Rest
  • ADLs

22
Modifying Activities of Daily Living
  • Posture
  • Lift correctly
  • Rest

23
Weight Control (Being Overweight)
  • 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
  • Accelerates rate of cartilage destruction2
  • Makes it harder to exercise properly before and
    after surgery2.
  • Harrington, I. J. (1976) A bioengineering
    analysis of force actions at the knee in normal
    and pathological gait. Biomed. Eng., 11167172.
  • Felson, D. T. Weight and osteoarthritis. J.
    Reumatol, 43 79, 1995.

24
Too much to handle..
25
Ice.is nice
  • Decreases local circulation
  • Decreases swelling
  • Acts as a local anti-inflammatory
  • Decreases pain
  • Improves exercise tolerance

26
Heat is nice
  • Increases local circulation
  • Promotes relaxation
  • Helps muscles and joints stretch
  • Decreases joint and muscle aches

27
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.

28
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

29
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.

30
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

31
Medications/NSAIDs
  • Acetaminophen, Aspirin, Naproxen, Ibuprofen,
    Celebrex.
  • Host of NSAIDs (as needed best)
  • Effective in reducing swelling
  • Stomach and blood side-effects.
  • Topical Creams Capsaicin, zostrix (from red
    peppers)
  • Helps block pain.

32
Hyaluronate


                   
  • 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 86538-545
33
Cortisone
  • 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
851197-1203.
34
Is Surgery for You?
  • This should be a cooperative one between you,
    your family, your family physician and your
    orthopaedic surgeon.

35
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

36
Surgery
  • Chondroplasty, RF ablation
  • OATS, microfracture
  • Carticel
  • Osteotomies
  • Partial joint replacement
  • Orthoglide spacer
  • Total joint replacement

37
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.
  • Arthroscopysham for arthritis.

38
Osteotomy
39
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.

40
Total knee/Hip replacement
  • Primary Components

Femoral component Plastic liner Tibial tray
Shell Liner Head Stem
41
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

42
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_at_10 yrs
  • 80_at_15 yrs
  • 75_at_20 yrs.

43
Possible Complications
  • Most are successfully treatable
  • Types of possible complications
  • Loosening
  • Infection
  • Wear
  • Blood clots
  • Dislocation
  • Nerve Injury

44
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.

45
Home Planning
  • Safety bars
  • Secure handrails
  • Stable chair
  • Toilet seat riser
  • Remove all loose carpets and cords
  • Same floor living space

46
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

47
A few weeks later..
48
New Implant- FDA approved 2006
  • ORTHOGLIDE

49
What type of patient is this for??
  • A patient who is having persistent pain mainly
    from inside part of the knee
  • A patient whos received all other non-surgical
    therapies and is still having pain
  • A patient whos surgeon has told them their next
    step is a Uniarthroplasty or TKR

50
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

51
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.

52
Current Patient Results
53
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
    doctor-diagnosed 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.

54
Closing
  • 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.

55
Future
  • Identifying high risk patients.
  • Genetic basis
  • Disease prevention through
  • Health
  • Lifestyle
  • Disease modifications.

56
Thank you
Hardy Singh, M.D.
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