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All About Arthritis,Kambiz Behzadi, M.D.Orthopedic Surgeon San Ramon, Pleasanton, Livermore,Arthritis and You,Musculoskeletal Conditions affect millions of people$254 billion per year spent,Arthritis,40 Million Americans have arthritis20 Million people suffer from OsteoarthritisOsteoarthritis most common form of arthritis,Synovial Joints,Bone ends - Articular CartilageCartilage cushions bones-allows bones to move without painSynovium- covers joints, produces fluid that reduces friction,Articular Cartilage,Bone,Synovial Membrane,Synovial Fluid,Synovial Joints,Ligaments connect bones- stabilityMuscles and Tendons power joints- movement,Arthritis,Arthritis is InflammationBodys normal reaction to injuryChronic inflammation in arthritic joint- long lasting disability,Inflammation,Swelling,Pain,Stiffness,Osteoarthritis,Loss of cartilage and joint surfaceSecond most common cause of disability in adults7 million physician visits per year3 million hospitalizations$2655 per person,Cartilage,Healthy Knee,Osteoarthritic Knee,Osteoarthritis,Weight bearing jointsHips, knees, feetFingersSpine,Osteoarthritis,Most of us by our 60s & 70s,More women than men,All races equally,40 million by 2020,Burden of Disease,Osteoarthritis,Pain in affected jointsPain worse with prolonged usePain better with restStiffness relieved by flexing and movement,Osteoarthritis-Xray,Osteoarthritis Causes,Primary Osteoarthritis Most CommonThought to be result of AgingDecreased ability to withstand stressLigaments supporting joints weaken,Secondary Osteoarthritis,Obesity,Trauma,Surgery,Abnormal joints,Gout,Diabetes,Hormone disorders,Causes,Goals of Treatment,To Relieve painIncrease motionImprove strength,Medication- NSAIDs,NSAIDs are nonsteroidal anti-inflammatory drugsAspirinIbuprofenNaproxen,Medication,Cox-2 inhibitors offer the benefits of other NSAIDs with a decreased incidence of gastrointestinal side effects.Vioxx, Celebrex, Bextra,Medication,InjectionsLiquid cortisoneHyaluronateSupartzSynviscHylagan,Vitamins,Anti-oxidants A,C,D,E may help prevent OsteoarthritisNo Clinical trialsNo clear proof,Nutritional Supplements,GlucosamineChondroitin SulfateSome Positive resultsMild to moderate pain reliefIf not seen within eight weeks, not likely to benefit,Alternative Medicine,Complimentary approaches may:Ease symptomsImprove outlook and attitude,Alternative Medicine,Complimentary approaches will not:Cure acute illnessReplace proven medical treatment for osteoarthritis,Alternative Medicine,Therapy,Symptoms,Joint Protection,Exercise,Gentle exercise in moderationStrengthen musclesPrevent stiffnessDecrease weightPromote enduranceRight program for you,Surgery,ArthroscopyLeast InvasiveArthroscopeRemove partially damaged cartilagePortalsRemove dead cartilage and enzymes that cause inflammation,Arthroscope,Portals,Damaged cartilage,Abrasion / Drilling,Abrasion and DrillingHealing responseFibrocartilage= Scar CartilageInferior mechanical properties to articular cartilageLess advanced OAFocal arthritis,Focal, localized lesion,Osteotomy,Realignment of JointsTransfer Weight to less involved part of joint60s and 70sLess popularDoes not provide good long term results,Mosaicplasty / OATS,Localized focal arthritis/defectTraumatic arthritisSmall to medium Transferring healthy plug of bone and cartilage to defect in weight bearing area,Small,Large,ACI,Articular Cartilage Implantation“Pot hole in the road”Two operationsCartilage harvested and sent to Lab, to grow in CultureCartilage cells transplanted into the defectIn future may be applicable to large lesions/primary OA,Total Joint Replacement,Considered last Solution for ArthritisImproved AmbulationDecreased PainIncreased ROM90%+ good to excellent results,Total Joint Replacement,Removal of diseased jointReplace with a prosthetic joint,+,+,+,Knee,Hip,Minimally Invasive Surgery,Continuous advances in joint replacement proceduresMIS= Minimally Invasive Surgery,MIS,8-12 inches - 3 to 5 inchesSame implants Minimal trauma to Muscles and TendonsQuadriceps muscle and tendon not cutUnassisted walking at 2 to 4 weeksBack to Activities/Work Sooner,Summary,Osteoarthritis affects in excess of 20 Million AmericansAccurate Diagnosis importantUnderstand the nature of this ProblemMany treatment Options availableBenefits and limitations Choose the right treatment for youGet back into the game,Arthritis,/niams/