A Role for Research at the InMotion Musculoskeletal Institute

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Chronic Joint Symptoms and Arthritis
Not Just One Disease!
A Role for Research
at the

InMotion Musculoskeletal Institute
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Arthritis

• Arthritis is an inflammation in a joint.
• The symptoms of arthritis include joint
• Pain
• Stiffness
• Swelling
• Warmth and redness
• There are more than 100 distinct conditions that
  comprise complex disorders termed arthritis
• The most common form of arthritis is called
  osteoarthritis (approx. 65) or degenerative
  joint disease. It is commonly known as wear and
  tear arthritis.
• Rheumatoid arthritis (approx. 7) is an
  autoimmune disease in which the joint lining
  becomes inflamed eventually leading to joint
  destruction.

Bone Erosion
Swollen and Inflamed Synovium
Cartilage Destruction
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Arthritis
Facts

• Arthritis is one of the most prevalent chronic
  health problems and the nations leading cause
  of disability among Americans over age 15
• Arthritis related costs to the US economy total
  125 Billion annually
• As many as 1 in 3 adults in the US suffer from
  chronic joint symptoms or arthritis.
• Doctor diagnosed arthritis in US
• Women 24.3 million
• Men 17.1 million
• Children 300 thousand
• By 2030 67-70 million Americans will be diagnosed
  with arthritis

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Arthritis
Risk Factors

• Age - 50 of adults over 65 years of age have
  doctor diagnosed arthritis
• Female Gender - After age 45, osteoarthritis is
  more common in women
• Joint injury/Overuse/Sports - Repeated trauma
  from sports related activities
• Obesity - Incidence of osteoarthritis increases
  with the amount of weight joints have to bear
• Joint Alignment - Joints that are mal-aligned
  (bow legs), lax (double-jointedness) or dislocate
  are more likely to develop osteoarthritis
• Hereditary - defect in genes responsible for
  collagen the major component in cartilage can
  cause arthritis

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Arthritis
Diagnosis

• Joint lining becomes inflamed, thickens and
  releases prostaglandins contributing to pain and
  swelling.
• Cartilage breaks down and eventually erodes away.
• Bone beneath the cartilage thickens and the joint
  may lose its shape.
• Bony surfaces begin to rub together causing pain
  and may form protrusions, called bone spurs.
• X-rays show
• Thinning of the space between bones forming the
  joint as cartilage erodes away
• Bone spurs or protrusions around the margin of
  the joint
• Increase in bone density (sclerosis) at the
  margin of the joint

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Arthritis
Reduce the Impact of Arthritis by

• Seeing a doctor for correct and accurate
  diagnosis
• Get active regular physical activity helps
  build and maintain healthy bones, muscles and
  joints
• Control weight losing 10 pounds relieves 40
  pounds of pressure on the knee joints.
• Prevent sports injuries take preventative
  measures now to minimize joint injuries and
  trauma
• Modify job tasks correct posture for bending
  and lifting can reduce strain on joints

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Arthritis
Treatment for Mild Arthritis

• Over the counter food supplements
• Glucosamine and Chondroitin Sulfate
• Fish oils (Omega 3 capsules)
• Over-the-counter pain medications
• Acetaminophen (Tylenol)
• Aspirin (potential gastrointestinal side effects)
• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Ibuprofen (Advil, Motrin, Nuprin)
• Ketoprofen (Orudis)
• Naproxen (Aleve)
• Supportive devices
• Canes and walking aids
• Hot and cold compresses
• Exercise
• Weight control or weight loss

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Arthritis
Treatment for Moderate Arthritis

• Prescription medications
• Cox-2 Inhibitors (Celebrex, Vioxx, Bextra)
• Non-steroidal Antiinflammatory drugs (NSAIDS)
• Injections (into joint space)
• Steroids
• Hyaluronic Acid
• Surgical Intervention
• Arthroscopy or mini-arthrotomy
• Debridement of bone spurs or damaged tissue
• Micro fracture or drilling of focal cartilage
  defects

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Arthritis
Treatment for Severe Arthritis

• Surgical Intervention
• Osteotomy for alignment correction
• Hemi-Arthroplasty of the Hip
• Unicondylar Replacement for the knee
• Total Joint Replacement

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Arthritis
Total Hip Replacement (Arthroplasty)

• Approximately 400,000 hip arthroplasties were
  performed in the U.S. in 2006
• Women are 60 more likely to receive hip
  replacement than men
• Since Sir John Charnleys development of the
  modern total hip replacement design in the 1960s
  with the use of an acrylic bone cement to fix
  the components to bone, this procedure has
  revolutionized the treatment for painful
  arthritic conditions of the hip

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Arthritis
Treatment

• Today total hip arthroplasty is one of the most
  successful procedures performed by orthopaedic
  surgeons
• Total hip arthroplasty components are made using
• High strength aerospace metal alloys
• Cobalt chromium alloy
• Titanium alloy
• Bearing components (couples) utilizing
• Wear resistant Ultra High Molecular Weight
  Polyethylene
• Metal-on-metal bearing couples
• Ceramic-on-ceramic bearing couples

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Arthritis
Total Knee Replacement (Arthroplasty)

• Approximately 600,000 knee arthroplasties were
  performed in the U.S. in 2006
• Women are 70 more likely to receive a knee
  replacement than men
• According to the Arthritis Foundation, outcomes
  for total knee replacement generally have 90-95
  patient satisfaction and an implant lifespan
  greater than 95 at 10 and 15 years with some
  designs

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Arthritis
Our Goal
Translating Ideas into Treatment
Clinical Case Report

• Female Amateur Golfer from North Carolina with
  Osteoarthritis of Both Knees.
• 1993 at 61 Years Old
• Left Total Knee Replacement
• February 2000 at 68 Years Old
• Right Knee Replacement
• June 2000
• Won Super Senior Championship of Carolinas Golf
  Association by 26 strokes scoring a hole-in-one
  in quarterfinals.
• It feels good to be back in action.
• Barbara Young

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Goal of Musculoskeletal Care

• Relieve Pain
• Return Function/Mobility
• Minimize Surgical Trauma

Musculoskeletal Research into Joint Disease
and Total
Joint Replacement can provide
? Innovative Discoveries ? Better
Materials ? New Treatment Options ?
Biologic Solutions ? Economic Benefits
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InMotion a Partnership / Collaboration for
ResearchHospitals Clinics Universities -
Industry
Translational Research Model
Patient Care
Fundamental Research
Applied Research
Clinical Research
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Realizing the Dream

• Your Support and Assistance to InMotion will
  Help us Realize our Dream
• InMotion Funding Priorities
• Clinician Scientists - to connect the patients
  problems to laboratory solutions
• Biologic/Biomaterials Research - to discover
  regenerative medicine solutions for damaged
  tissues
• Biomechanics Expertise - to rapidly verify the
  strength of the solutions
• Clinical Research Team - to evaluate treatment
  options and determine best patient care
  practices
• World-Class Scientific Facilities - to enable
  breakthrough discoveries
• Collaborative Environment to foster an
  Interdisciplinary Approach to solve Major
  Clinical Problems