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Hip and Arthritis: Treatment Alternatives To Remain Active

Hip and Arthritis: Treatment Alternatives To Remain Active. Scott M. Sporer, M.D. Midwest Orthopaedics at RUSH Assistant Professor RUSH University Medical Center Central Dupage Hospital. What is Arthritis?. Loss of Cartilage from the end of the thigh bone (femur) or leg bone (tibia)

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Hip and Arthritis: Treatment Alternatives To Remain Active

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  1. Hip and Arthritis:Treatment Alternatives To Remain Active Scott M. Sporer, M.D. Midwest Orthopaedics at RUSH Assistant Professor RUSH University Medical Center Central Dupage Hospital

  2. What is Arthritis? • Loss of Cartilage from the end of the thigh bone (femur) or leg bone (tibia) • Cartilage is required to provide a smooth surface for the knee to glide

  3. What is Arthritis ?

  4. Epidemiology • Radiographic evidence of arthritis in almost all people > 60 • 10-20% of patients with symptoms • Knee disease twice as prevalent as hip disease in people > 60 • 6.1% of adults >30 have radiographic evidence OA with pain on most days.

  5. Epidemiology • Women twice as likely to have disease as men • Inside portion of the Knee 10x more likely • 60-80% of joint load through medial compartment

  6. Knee Anatomy • Femur (Thigh Bone) • Tibia (Shin Bone) • Patella (Knee Cap) • 3 “Compartments”

  7. Clinical Presentation • History • Pain • Instability • Change in alignment • Bow Kneed • Knocked Kneed • Difficulty walking • Difficulty with Activities of Daily Living

  8. Clinical Presentation • Physical Examination • Swelling • Limited Motion (contractures) • Limp • Hip and knee pain/deformity

  9. Laboratory Tests • Rarely Required • Fluid Aspiration • Blood Tests

  10. Radiographic Evaluation • Best Method To Evaluate Arthritis • Plain X-Rays • Standing Radiographs • AP/ Lateral • Schuss/Rosenberg Views

  11. Radiographic Evaluation • Joint Space Narrowing • Osteophytes “bone spurs” • Changes in Alignment • MRI, CT Scan, Bone Scans add little information

  12. Treatment Options • Non Surgical • Weight Loss • Exercise • Physical Therapy • Walking Aids • Injections • Surgical • Unicomparmental Knee Replacement • Total Knee Replacement

  13. Patient Education • Use high stools • Avoid high impact activities • Recommend swimming and biking • Obesity • 2-5 times body weight with walking

  14. Patient Education • Exercise • Strengthen muscles around knee • Helps support the joint • Improve flexibility • Make future surgery easier

  15. Medications • “ Two systematic reviews have found that simple analgesics and NSAIDS produce short term pain relief in OA. However, no good evidence that NSAIDS are superior to simple analgesics such as Acetaminophen” -Clinical Evidence 2001

  16. Analgesics • Acetaminophen vs. placebo • 73% vs. 5% of knees with improvement in rest pain

  17. Non-Steroidal Anti-Inflammatory • NSAIDS have been found to be effective in reducing short term pain. The Cochrane Library, Issue 4, 1999 • “Systematic reviews found no important differences in effect between different NSAIDS or doses, but found differences in toxicity…” -Clinical Evidence 2001

  18. Non-Steroidal Anti-inflammatory Medications (NSAIDS) • Possible side Effects • Stomach irritation • Kidney damage • Ulcers • Cox-2 Inhibitors • Fewer side effects • Expensive

  19. Cox – 2 Recommendations • Merck & Co., Inc. - withdrawal of Vioxx on Sept. 30, 2004 increased relative risk for confirmed cardiovascular events • “Patients who are at a high risk for gastrointestinal bleeding, have a history of intolerance to non-selective NSAIDs, or are not doing well on non-selective NSAIDs may be appropriate candidates for Cox-2 selective agents. Individual patient risk for cardiovascular events and other risks commonly associated with NSAIDs should be taken into account”

  20. Glucosamine/ Chondroitin Sulfate • Not Regulated by FDA • Expensive • Unknown Side Effects • Effective in several studies

  21. Cortisone Injection • May provide Temporary Relief • Decreases inflammation • May accelerate cartilage damage • Small Risk of Infection • 78% of patients note improvement

  22. Hyaluronic Acid Injection • Considered a medical device • Works best for less severe arthritis • Series of 3 to 5 injections • Small Risk of Infection • Allergic Reaction • 2/3rd patients note mild improvement

  23. Arthroscopy • Theory: • Degenerating cartilage releases inflammatory mediators • Subsequent cartilage damage • May be replaced by cartilage type tissue

  24. Arthroscopy

  25. Surgical Treatment • Unicompartment Knee Replacement • Total Knee Replacement

  26. Unicompartmental Knee • Arthritis in only 1 compartment of knee • Used in either Young or Old patient • Ligaments Intact • No systemic Disease • Weight <200# • Occupation

  27. Radiographs

  28. Surgical Technique – Minimally Invasive

  29. Why Minimally Invasive • Earlier Mobilization • Cost • Shorter Hospital Stay • Quicker Rehabilitation • Less Blood Loss • ? Easier conversion to Total knee replacement

  30. Total Knee Arthroplasty • Resurface All Three Surfaces • Tibia • Femur • Patella • Components fixed to bone with “cement”

  31. Total Knee Arthroplasty

  32. Surgical Procedure

  33. MIS in TKA Mini/MIS QS TKA Mini 12-14 cm Quad Snip Standard 20-30 cm Quad Incision Q-S 7-10 cm No Quad

  34. MIS Patient Selection • Male <250 #, Female < 225# • Motivated • Range of motion > 90˚ • Flexion Contracture < 10 ˚ • Fixed varus <10 ˚ or valgus <15 ˚

  35. MIS TKA Contraindications • Deficient or scared skin • Severe diabetic; steroids • Osteoporosis • Prior major intra-articular surgery • Relative Contraindications • Extremely Muscular • Inflammatory arthritis • Patella Baja • Extremely Large sizes

  36. Total Knee Replacement • Long Term Results • 96% Functioning Well at 10 Years

  37. How To Decide ? • Individual Decision • Hurtful not Harmful • Is if affecting you? • What are your expectations?

  38. Hip Arthritis

  39. Hip Arthritis? • Loss of Cartilage between the top of the thigh bone (ball), and the acetabulum (socket) • Cartilage is required to provide a smooth surface for the hip to glide

  40. Hip Anatomy

  41. Clinical Presentation • History • Pain • Difficulty walking • Difficulty with Activities of Daily Living

  42. Radiographic Evaluation • Best Method To Evaluate Arthritis • Plain X-Rays • Joint Space Narrowing • Osteophytes “bone spurs”

  43. Treatment Options • Non Surgical • Weight Loss • Exercise • Physical Therapy • Walking Aids • Injections • Surgical • Total Hip Arthroplasty • Minimally Invasive Total Hip Arthroplasty

  44. Patient Education • Avoid high impact activities • Recommend swimming and biking • Obesity • 2-5 times body weight with walking

  45. Patient Education • Exercise • Strengthen muscles around hip • Helps support the joint • Improve flexibility • Make future surgery easier

  46. Exercise

  47. Medications • Provide Temporary Relief of Pain • Similar Efficacy among Medications

  48. Non-Steroidal Anti-inflammatory Medications (NSAIDS) • Possible side Effects • Stomach irritation • Kidney damage • Ulcers • Cox-2 Inhibitors • Fewer side effects • Expensive

  49. Cortisone Injection • Used infrequently in Hip Arthritis • May help with Diagnosis • Decreases inflammation • May accelerate cartilage damage • Small Risk of Infection

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