All About Arthritis

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All About Arthritis

• Kambiz Behzadi, M.D.
• Orthopedic Surgeon
• San Ramon, Pleasanton, Livermore

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Arthritis and You

• Musculoskeletal Conditions affect millions of
  people
• 254 billion per year spent

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Arthritis

• 40 Million Americans have arthritis
• 20 Million people suffer from Osteoarthritis
• Osteoarthritis most common form of arthritis

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Synovial Joints

• Bone ends --gt Articular Cartilage
• Cartilage cushions bones--gtallows bones to move
  without pain
• Synovium--gt covers joints, produces fluid that
  reduces friction

Synovial Membrane
Bone
Synovial Fluid
Articular Cartilage
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Synovial Joints

• Ligaments connect bones--gt stability
• Muscles and Tendons power joints--gt movement

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Arthritis
Inflammation

• Arthritis is Inflammation
• Bodys normal reaction to injury
• Chronic inflammation in arthritic joint--gt long
  lasting disability

Stiffness
Swelling
Pain
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Osteoarthritis
Cartilage

• Loss of cartilage and joint surface
• Second most common cause of disability in adults
• 7 million physician visits per year
• 3 million hospitalizations
• 2655 per person

Healthy Knee
Osteoarthritic Knee
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Osteoarthritis

• Weight bearing joints
• Hips, knees, feet
• Fingers
• Spine

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Osteoarthritis
Burden of Disease
All races equally
More women than men
Most of us by our 60s 70s
40 million by 2020
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Osteoarthritis

• Pain in affected joints
• Pain worse with prolonged use
• Pain better with rest
• Stiffness relieved by flexing and movement

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Osteoarthritis-Xray
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Osteoarthritis Causes

• Primary Osteoarthritis Most Common
• Thought to be result of Aging
• Decreased ability to withstand stress
• Ligaments supporting joints weaken

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Secondary Osteoarthritis
Causes
Trauma
Obesity
Surgery
Abnormal joints
Gout
Diabetes
Hormone disorders
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Goals of Treatment

• To Relieve pain
• Increase motion
• Improve strength

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Medication- NSAIDs

• NSAIDs are nonsteroidal anti-inflammatory drugs
• Aspirin
• Ibuprofen
• Naproxen

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Medication

• Cox-2 inhibitors offer the benefits of other
  NSAIDs with a decreased incidence of
  gastrointestinal side effects.
• Vioxx, Celebrex, Bextra

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Medication

• Injections
• Liquid cortisone
• Hyaluronate
• Supartz
• Synvisc
• Hylagan

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Vitamins

• Anti-oxidants A,C,D,E may help prevent
  Osteoarthritis
• No Clinical trials
• No clear proof

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Nutritional Supplements

• Glucosamine
• Chondroitin Sulfate
• Some Positive results
• Mild to moderate pain relief
• If not seen within eight weeks, not likely to
  benefit

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Alternative Medicine

• Complimentary approaches may
• Ease symptoms
• Improve outlook and attitude

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Alternative Medicine

• Complimentary approaches will not
• Cure acute illness
• Replace proven medical treatment for
  osteoarthritis

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Alternative Medicine
Therapy
Symptoms
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Joint Protection
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Exercise

• Gentle exercise in moderation
• Strengthen muscles
• Prevent stiffness
• Decrease weight
• Promote endurance
• Right program for you

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Surgery
Portals

• Arthroscopy
• Least Invasive
• Arthroscope
• Remove partially damaged cartilage
• Portals
• Remove dead cartilage and enzymes that cause
  inflammation

Damaged cartilage
Arthroscope
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Abrasion / Drilling

• Abrasion and Drilling
• Healing response
• Fibrocartilage Scar Cartilage
• Inferior mechanical properties to articular
  cartilage
• Less advanced OA
• Focal arthritis

Focal, localized lesion
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Osteotomy

• Realignment of Joints
• Transfer Weight to less involved part of joint
• 60s and 70s
• Less popular
• Does not provide good long term results

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Mosaicplasty / OATS

• Localized focal arthritis/defect
• Traumatic arthritis
• Small to medium
• Transferring healthy plug of bone and cartilage
  to defect in weight bearing area

Small
Large
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ACI

• Articular Cartilage Implantation
• Pot hole in the road
• Two operations
• Cartilage harvested and sent to Lab, to grow in
  Culture
• Cartilage cells transplanted into the defect
• In future may be applicable to large
  lesions/primary OA

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Total Joint Replacement

• Considered last Solution for Arthritis
• Improved Ambulation
• Decreased Pain
• Increased ROM
• 90 good to excellent results

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Total Joint Replacement

• Removal of diseased joint
• Replace with a prosthetic joint

Knee
Hip


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Minimally Invasive Surgery

• Continuous advances in joint replacement
  procedures
• MIS Minimally Invasive Surgery

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MIS

• 8-12 inches --gt 3 to 5 inches
• Same implants
• Minimal trauma to Muscles and Tendons
• Quadriceps muscle and tendon not cut
• Unassisted walking at 2 to 4 weeks
• Back to Activities/Work Sooner

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Summary

• Osteoarthritis affects in excess of 20 Million
  Americans
• Accurate Diagnosis important
• Understand the nature of this Problem
• Many treatment Options available
• Benefits and limitations
• Choose the right treatment for you
• Get back into the game

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Arthritis
www.aboutarthritis.com
Arthritis Foundation www.arthritis.org

• www.nih.gov/niams/

American Academy of Orthopaedic Surgeons
www.aaos.org
www.behzadisportsdoc.com
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THANK YOU
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MIS THR
SINGLE INCISION POSTERIOR APPROACH
TWO INCISION CO-AXIAL PATH