1. 1. You HaveTwo Roads toTake Surgical Non-surgical
2. 2. Which will you choose? Surgical Non Surgical
3. 3. What is Arthritis ?
4. 4. What are the signs of Arthritis?
5. 5. What are the risk factors?
6. 6. Interesting Facts on Age and Arthritis
7. 7. ArthritisTrivia
8. 8. Summary of Arthritis
9. 9. BeingToo Active NOT
10. 10. What happens with arthritis
11. 11. Instability and Arthritis
12. 12. Response of your Joint to Arthritis Damage = pain
13. 13. Your Bodys Response to Damage REPAIR = RELIEF
14. 14. Joint Homeostasis Damage Repair
15. 15. Summary damage pain repair relief
16. 16. Quiz time A meniscus tear
17. 17. How do we reduce damage?
18. 18. Items causing damage
19. 19. Weight Control
20. 20. Weight Control tips
21. 21. Bad Exercise/ Activity
22. 22. Good Exercises
23. 23. Bow legged Correction
24. 24. Correcting the bow
25. 25. Shoes make a difference
26. 26. What is proper shoe wear ? PushTest-
27. 27. What is a proper shoe? TwistTest NOT
28. 28. What is a proper shoe? SqueezeTest
29. 29. Nutritional Deficiencies
30. 30. Correct Nutritional Deficiencies
31. 31. Glucosamine Yes or No?
32. 32. Summary
33. 33. QuizTime is a
34. 34. Turning onThe Repair of your joint
35. 35. Gel Injections
36. 36. Gel Injections
37. 37. Gel Injections
38. 38. Gel Injections
39. 39. GelInjections
40. 40. Summary of Hyaluronic Acid Injections
41. 41. Quiz time
42. 42. Steroid Injections
43. 43. Steroid Injection
44. 44. Steroid Injections temporary
45. 45. Steroid Injections
46. 46. QuizTime average
47. 47. Summary of Steroids
48. 48. Platelet Rich Plasma (PRP)
49. 49. Platelet Rich Plasma Growth Factors They act like fertilizer for your joints.
50. 50. Platelet Rich Plasma (PRP) Safety Efficacy Efficacy *Teitze, DC et al. entitled The effects of platelet rich plasma in the treatment of large-joint osteoarthritis: a systemic review. (Physiology and Sports Medicine 2014, May;42(2) 27-37)
51. 51. Platelet Rich Plasma Duration
52. 52. Platelet Rich Plasma for soft tissue issues! tendonitis bursitis sprains or tears
53. 53. Platelet Rich Plasma
54. 54. Summary of PRP
55. 55. QuizTime
56. 56. Plasma Proteins Proteins
57. 57. Plasma Proteins A2M IRAP *FrizzieroA, Autolgous conditioned serum for the treatment of osteoarthritis and other possible applications in musculoskeletal disorders. Br Med Bull. 2013: 105: 169-84.
58. 58. Plasma Protein IRAP *Attur M, Plasma levels of interleukin-1 receptor antagonist (IL1Ra) predict radiographic progression of symptomatic knee osteoarthritis. Osteoarthritis Cartilage. 2015 Nov;23(11):1915-24 IRAP is used by many race horses to improve performances.
59. 59. Benefits of Blocking Interluekin-1 ***Dinarello, CA et al, Treating inflammation by blocking interleukin-1 in humans; Semin Immunol. 2013 Dec 15 25(6) 469-84.
60. 60. Plasma Protein a2M Weng S et al, Identification of a2-macroglobulin as a master inhibitor of cartilage- degrading factors that attenuates the progression of post traumatic osteoarthritis, Arthritis Rheumatol. 2014 Jul: 66(7) 1843-53
61. 61. A2M
62. 62. PRP Plus
63. 63. PRP Plus
64. 64. Bone Marrow Concentrate Stem Cells
65. 65. Bone Marrow Concentrate Stem Cells 300% 90%
66. 66. Bone Marrow Concentrate Stem Cell
67. 67. Bone Marrow Concentrate Stem Cell platelet rich plasma.
68. 68. Bone Marrow Concentrate Safety Safety- *World J Gastroenterol. 2014 Oct 14;20(38):14051-7 **Lalu MM et al, Safety of Cell Therapy with Mesenchymal Stromal Cells (SafeCell): A systemic Review and Metanalysis of Clinical Trials. PLoS One. 2012 Oct 25 7(10) e47559. ***Herniguo P et al, Cancer risk is not increased in patients treated for orthopedic disesases with autologous bone marrow concentrate. J Bone Joint Surg Am, 2013 Dec 18: 95(24) 2215-21
69. 69. Bone Marrow Concentrate Stem Cell Convenience
70. 70. Bone Marrow Concentrate Stem Cell
71. 71. Bone Marrow Concentrate Stem Cell Efficacy (Does itWork?) one injection more two surgeries. *Ref- Autologous bone marrow-derived mesenchymal stem cells versus autologous chondrocyte implantation: an observational cohort study. Nejadnik H., American Journal of Sports Medicine 2010 Jun;38(6):1110
72. 72. Stem Cells improve outcomes of common surgeries improve **Wong, KL. et al Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years' follow-up. Arthroscopy 2013 Dec;29(12):2020-8 ***KohYG et al, Adipose Derived Mesenchymal StemCells with Microfracture vs. Microfracture Alone: 2-Year Follow up of a Prospective RandomizedTrial, Arthroscopy, 2016 Jan, 32(1) 97- 109
73. 73. Bone Marrow Concentrate Stem Cell For Hips Hernigou, P, et al, Cell Therapy of hip necrosis with autologous marrow grafting , Indian J Orthop.2009 Jan-Mar; 43(1): 40-45
74. 74. Bone Marrow Concentrate Stem Cells for Knee Arthritis Centeno C, et al, Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft, Biomed Res Int. 2014;2014:370621
75. 75. Bone Marrow Concentration Stem Cell therapy compared to Hyaluronic Injections Stem Cell group did better! Vega A, et al,Treatment of KneeOsteoarthritis with Allogeneic Bone Marrow Mesenchymal Stem Cells: A Randomized ControlledTrial,Transplantation, 2015Aug;99(8); 1681-90
76. 76. Bone Marrow Concentrate Stem Cells for Arthritis Larger Groups Centeno, C et al, A dose response analysis of a specific bone marrow concentrate treatment protocol for knee osteoarthritis, BMC Musculoskelet Disord. 2015; 16:258
77. 77. Long-Term Results Bone Marrow Concentrate StemCell Emadedin M., et al, Long-Term Follow up of Intra-articular Injection of Autologous Mesenchymal Stem Cells in Patients with Knee, Ankle or Hip Osteoarthritis, Arch Iran Med. 2015, Jun;18(6): 336-44
78. 78. Stem CellTherapy and Meniscus Repair HanaYu, et al, Meniscus repair using mesenchymal stem cells- a comprehensive review, Stem Cell ResTher. 2015; 6(1): 86.
79. 79. LongerTerm Results of Stem CellTherapy for arthritis of knee and hip 1128 54 months 91% had at least 50% improvement Michalek J, Autologous adipose tissue-derived stromal vascular fraction cells in patients with osteoarthritis, CellTransplant, 2015 Jan 20. doi: 10.3727
80. 80. Arthroscopic Surgery
81. 81. Safety Efficacy *Hagino, T et al Complications after arthroscopic knee surgery. Achieves of Orthopedic Trauma Surgery , 2014 November; 134(11):1561-4 **Herrlin, SV et al Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscus tears? A five year follow-up . Journal of Knee Surgery, Sports, Traumatology and Arthroscopy 2013 Feb;21(2):358-64
82. 82. Arthroscopic Surgery
83. 83. Arthroscopic Surgery
84. 84. Joint Replacement Surgery What is it?
85. 85. Joint Replacement Safety : 16% 3.4 % 10.9%
86. 86. Reliable Reproducible Durable-
87. 87. Patient Satisfaction after Joint Replacement 27%- 30% *Lam, YF et al, A Review of the Clinical Approach to Persistent Pain Following Total Hip Replacement, HongKongMedJ , 2016 Dec: 22(6): 600-7 **Wylde, V et al, Total Knee Replacement: Is it Really and Effective Procedure for All?; Knee, 2007, Dec 14 (6): 417-23
88. 88. Joint Replacement Costs Cost :
89. 89. Joint Replacement
90. 90. Convenience of Joint Replacement Require someone to help 24/7 for 3 weeks
91. 91. Stem CellVs. Knee Replacement
92. 92. Stem CellVs. Knee Replacement Stem Cell Group had Faster improvement
93. 93. Stem CellVs. Knee Replacement Knee Replacement Group had Higher Longer Higher More Longer More medical complications
94. 94. Stem CellVs. Knee Replacement higher patient satisfaction: 70% pointed to the stem cell knee
95. 95. Success for Cell BasedTherapy Am I a candidate forCell BasedTherapy? OR If your joint is stable with no or very rare episodes of catching or giving away, you can consider cell based therapies.
96. 96. Success for Cell BasedTreatments Am I a candidate for cell based therapy ? OR If your joint has only rare episodes of swelling and you do not require draining more than 4 times per year, you can consider cell based therapy
97. 97. Am I a Candidate forCell Therapy ? OR If you have mild to moderate bowing of your joint and you do not notice the bow under your pants, you can consider cell based therapies
98. 98. Success for Cell BasedTherapy Am I a candidate for Cell Based Treatments? OR If you have mild to moderate loss of motion of the joint and can dress yourself without any aids, you should consider cell based therapies.
99. 99. Have more than two surgical risk factors If you have more than two of these risk factors, you should consider cell based therapies
100. 100. Success for Cell BasedTherapy Am I a Candidate for Cell BasedTherapy? If you are not willing to undergo the risks, commitments and inconveniences of joint replacement surgery you can consider cell based therapy
101. 101. Lower Risk Everyones welcome!
102. 102. Must also figure in time lost from occupation may be Payment plans available
103. 103. Knee Arthroscopy Bone Marrow Stem CellAnd
104. 104. Benefits of Stem CellTherapy with Surgery Proven Benefits Less Expensive Less Painful- More Convenient-
105. 105. Which did you choose? Surgical Non Surgical