Arthritis of the Knee, Hip and Shoulder · Anatomy of the Knee, Hip and Shoulder Types of Arthritis...
Transcript of Arthritis of the Knee, Hip and Shoulder · Anatomy of the Knee, Hip and Shoulder Types of Arthritis...
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Arthritis of the
Knee, Hip and Shoulder
Michael W. Schweppe, M.D.Orthopedic Associates of Dutchess County
Chief of Orthopedics, Northern Dutchess Hospital
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Anatomy of the Knee, Hip and Shoulder
Types of Arthritis
Diagnosis of Arthritis
Treatment Options
Topics
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The Knee
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Femur
Anatomy of the Knee
Bone View
Patella
Tibia
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Medial ColateralLigament (MCL)
Anatomy of the Knee
Ligaments
Lateral Colateral
Ligament (LCL)
Anterior and Posterior Cruciate Ligaments
(ACL and PCL)
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Radiographic Anatomy of the Knee
X-Ray View
Femur (Thighbone)
Patella (Kneecap)
Tibia (Shinbone)
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The Hip
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Pelvis
Anatomy of the Hip
Bone View
Femur
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Anatomy of the Hip
Bone View
Acetabulum
(Hip Socket)
Femoral Head
(Hip Ball)
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Radiographic Anatomy of the Hip
X-Ray View
Acetabulum (Socket)
Femoral Head (Ball)
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The Shoulder
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Anatomy of the Shoulder
Bone View
Glenoid
Humeral Head
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Radiographic Anatomy of the Shoulder
X-Ray View
Humeral Head (Ball)
Glenoid (Socket)
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Cartilage
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Rubbery tissue found in joints
Cushions and protects the
ends of bones
Provides smooth gliding
surface for bones
Cartilage
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Cartilage
Anatomy of the Knee
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Anatomy of the Hip
Cartilage
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Anatomy of the Shoulder
Cartilage
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Arthritis
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Affects 43 million
Americans each year
Over 100 different types
Defined as inflammation
of the joint
Arthritis
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Osteoarthritis
Rheumatoid arthritis
Two Primary Types of Arthritis
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Rheumatoid Arthritis
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Affects about 2.5 million Americans annually
Physically disabling disease
Medical disabling disease
Rheumatoid Arthritis
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An autoimmune disorder
Usually affects more than one joint at a time
Inflammatory joint condition
Joint’s lubricating fluid increases pressure inside joint
Synovium thickens
Erode the cartilage
What is Rheumatoid Arthritis?
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Osteoarthritis
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Affects 23 million Americans
10x more common then RA
Less physically disabling disease
Not typically medical disabling disease
Osteoarthritis
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What is Osteoarthritis?
Not an autoimmune disorder
Degenerative disease
Usually affects ONE joint at a time
Degenerative joint condition
Wear and tear
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Knee Osteoarthritis: Disease
Progression• Early-stage: Mild disease
● Minimal pain
● Sports related injuries
● Minor defects/ loss of cartilage
• Mid-stage: Moderate disease● Increased or moderate pain
● Reduced mobility
● Changes to lifestyle/sports activities
● Moderate cartilage defects
● One or two compartments
• Late-stage: Severe disease● Severe pain
● Leading cause of disability
● Walking, stair climbing challenging
● Severe cartilage loss and limb deformity
● All three compartments
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Knee Osteoarthritis: Radiographic
Grades
Normal or Early Stage Mild or Moderated
Late or Severe
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Knee Osteoarthritis: Causes
• Injury or Trauma
• Sports
• MVA
• Long Term activities
• Running controversial
• Obesity
• Joint Reactive Forces
• 1 lbs. = 7 lbs. knee
• Heredity
• Known causes
• Unknown causes
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Diagnosis
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History
Symptoms
Physical Exam
X-Rays
Blood Tests
Diagnosing Osteoarthritis
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Symptoms of Arthritis
Pain
Joint Swelling
Stiffness
Decreased activity
Impaired lifestyle
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Decreased range of
motion
Tenderness
Joint deformities
Swelling
Crepitus
Physical Examination
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X-Ray Analysis
Normal Knee X-Ray Arthritic Knee X-Ray
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X-Ray Analysis
Normal Hip X-ray Arthritic Hip X-ray
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X-Ray Analysis
Normal Shoulder
X-Ray
Arthritic Shoulder
X-Ray
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Treatment
Options
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Weight Loss Home Exercise Physical Therapy Ice Medication Dietary supplements Walking devices Braces Injections Surgery
Treatment Options
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Excess weight places
Excess pressure on joints
Causes osteoarthritis
Aggravate osteoarthritis
Lower extremity not upper
Diet/Weight Loss
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Low Impact
Improves joint mobility
Strengthen muscles
Provides support for joints
Exercise/Physical Therapy
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High Impact
Exercise/Physical Therapy
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Decreases inflammation
Decreases swelling
Decreases pain
Ice
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Tylenol/Acetaminophen
Anti-Inflammatory Medications
Ibuprofen
Aleve
Naprosyn
Celebrex
Relafen
Medication
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Chondroitin Sulfate
Glucosamine Sulfate
Dietary Supplements
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Braces
Multiple types
Help re-align joints
Compression
Braces
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Walking Devices
Cane
Walker
Helps reduce pressure
Walking Device
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Cortisone (Steroid)
Decreases inflammation
Viscosupplimentation
Synvisc
Hyalgan
Injections
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Ultrasound-Guided Injections
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Arthroscopic
Debridement
Joint Replacement
Surgery
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Knee Osteoarthritis: Surgical
Treatment OptionsArthroscopic Surgery
• Early OA
• Repair uncommon
• Mild- Mod OA
• Debridement
• Variable benefits
• Severe OA
• Contraindicated
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Pain negatively affects daily
living
Conservative options failed
Extensive cartilage damage
Joint deformity
When Should Total Joint
Replacement be Considered?
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Eliminate or reduce pain
Enhance mobility
Can improve quality of life
Return to normal activity
Low impact sports and activities
Benefits of Total Joint Replacement
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Damaged bone resurfaced
Components made
metal alloy
Polyethylene
Total Knee Replacement
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Total Knee Replacement
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Primary Knee Components
Femoral Component
Polyethylene Bearing
(Acts as cartilage)
Tibial Tray
(supports polyethylene bearing)
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“MIS”Arthroscopy
Early Stage Sports Injuries Early to mid-stage OA Late stage OA
Total Knee Arthroplasty
(TKA)Partial (Uni) Knee Arthroplasty
Knee Osteoarthritis: Traditional
Treatment
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Total Hip Replacement
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Shell
Liner
Head
Stem
Hip Implants
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Primary Shoulder Components
Humeral Head Polyethylene
Glenoid
Component
Stem
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Total Shoulder Replacement
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Hospital stay approximately 1-2 nights
Assisted walking within 24 hours
Pain medication
Physical therapy
Key to recovery
Help prevent swelling,stiffness, and pain
Regain strength and mobility
Joint Replacement Surgery
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2-4 weeks of discomfort
Physical Therapy for 4-
6 weeks
Home exercise program
as directed by physician
Recovery
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Routine Activities
2-4 weeks
Walking (un-assisted)
Driving
Gardening
Shopping
Housework
Resume Usual Activities
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Low-Impact Activities
1-2 months
Golfing
Dancing
Bowling
Swimming
Bicycling
Work
Resume Usual Activities
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Recent Advances in
Joint Replacement
Minimally Invasive 4 to 5 inch incision
Shorter and less painful recovery
Alternative Materials
Polyethylene
Ceramic Partial Knee Replacement
Customized Patient-Specific Surgical Instruments
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Your symptoms should be diagnosed to
help you get relief
There are many different treatment
options
Osteoarthritis and rheumatoid arthritis
are treatable, manageable conditions
Closing
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Thank You