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Your Joint Pain andTreatment Options

Email: [email protected]

Copyright @ Forever Medic Online Pvt. Ltd
http://www.medicyatra.com/


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Joint Pain and Treatment Options

About My Practice

1) Trained at Henry Ford Hospital in Detroit, Michigan.

2) Have been in private practice for 20 years

3) Have been performing joint replacements for 24 years

4) I perform approximately 150 replacements/year, not

including those done for broken hips. These are knee

and hip primarily, but also shoulder and, rarely, elbow.




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5) I also perform revision surgery for worn out, loose or

painful joint replacements.

6) I update my knowledge on joint replacement surgery

twice a year at educational courses.

7) Im well trained and experienced in alternative

treatments for arthritis. These include medications,

P.T., exercise, dieting, bracing, injection therapy,arthroscopic surgery, cartilage transplant and partial

joint replacements.


http://www.medicyatra.com/http://www.medicyatra.com/


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What is arthritis?1) It is the loss of joint surface that covers the bone. This

special surface allows the bones to glide effortlessly,smoothly and pain-free. (This is the white, pearly

substance on the end of the chicken bone.)2) It is not to be confused with osteoporosis which is the

loss of bone mass.

3) The loss of this surface, whether partial or complete,

results in variable pain, stiffness, swelling, weaknessand loss of motion.

4) With progression over time it results in the destructionof the underlying bone and adjacent ligaments.




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How does it present?1) It can either present in a slow gradual fashion or have a

sudden appearance after a minor injury.

2) You can have good and bad days. Pain will be low levelaching to intense pain that wont allow walking on the leg.

3) You can be stiff and achy in the morning, comfortable

during the day, then painful at the days end.

4) Oft time the pain will lessen with mild to moderate activities.

5) You may experience popping, locking or catching.




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6) Prolonged positions will cause increase symptoms, ie.

Standing in line, long car rides or sitting for a movie.

7) You avoid, or have difficulty doing, activities like

kneeling, squatting, stair climbing, getting out of

cars/chairs or even tying your shoes.

8) You have trouble finding a comfortable position while

resting at home with a book or watching t.v.

9) You have trouble with waking up at night due to jointpain.




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Diagnosis

Tenderness to the touch

Weakness in the muscles

Loss of passive and active range of motion

Spurs that can be felt along the bone edges

Grinding, popping or other joint noises that

can be felt or heardFluid on the knee

Catching or locking

Physical Examination




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Diagnosis

X-Rays (needs to be done with one view in thestanding position)

Additional Tests




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Nonsurgical Options

Diet and Exercise

Rest and Joint Care

Cane / Walker

Medications

Cortisone

Glucosamine

Visco-supplementation

Braces




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Treatment OptionsRest

Short-term bed rest helps reduce both joint

inflammation and pain, and is especially useful whenmultiple joints are affected and fatigue is a major

problem.

Individual joint rest is most helpful when arthritisinvolves one or only a few joints.




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Weight LossAverage American is 2040 lbs. overweight

Average person takes 5000-7000 steps/day

Reduces stress on weight-bearing joints




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Balanced Diet

Helps manage weight

Extra pressure on some joints may aggravate your arthritis

Stay healthy




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Strengthening Exercises

Increasing muscle strength helps support and protect

joints affected by arthritis.

Exercise is an important part of arthritis treatment that

is most effective when done properly and routinely.

Allows easier recovery and shorter rehabilitation after

surgery.




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Aerobic Exercises

Improve cardiovascular fitness

Helps control weightMay help reduce inflammation in

joints

For those worried about

advancement of arthritis, aSwedish study showed no

progression of arthritis with

moderate exercise.

Walking, Biking




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Heat and Cold TherapiesReduce pain and inflammation

Heat Therapy

Increases blood flow, tolerance for pain, flexibility

Cold Therapy

Cold packs, ice massage, OTC sprays and ointments

Reduces pain by numbing the nerves around the joint




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Physical TherapyThe goal is to get you back to the point where you canperform normal, everyday activities without difficulty.

Preserving good range of motion is key to maintainingthe ability to perform daily activities.

Physical therapists provide exercises designed to

preserve the strength and use of your joints.

Show you the best way to move from one position to another

Teach you how to use walking aids




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Assistive DevicesMake activities easier and less stressful for the joints andmuscles.

Splint or brace when recommended by a doctor or therapist

Walking aidesOrthotics

Bath stool for use in the shower or tub

Sock grippers

Other devices are available to assist with everyday activities.




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Walking Aides

Cane Walker

Helps keep you balanced so you dont hurt other joints.




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Medications: Analgesics

Analgesics, pain relievers,

may provide temporary relief

of arthritis pain.




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Medications: NSAIDsTraditional

Aspirin

Ibuprofen

Naproxen

NewCox II




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Medications: Topical Pain Relievers

Over-the-counter patches, rubs and ointments can

provide quick pain relief for people with arthritis that isin just a few joints such as a hand or whose pain

isn't severe.




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Nutritional SupplementsGlucosamine and Chondroitin may relieve joint pain.

Occur in the body naturally; vital to normal cartilage

function. Researchers are also studying chondroitin for use

in making medicines more effective and helping to

prevent blood clots (anticoagulant).

Not FDA approved

Warrant further in-depth studies on their safety and

effectiveness, according to the Arthritis Foundation.

Source: Arthritis.org website, Aug. 2006




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May help osteoarthritis pain and improve function.1, 2

Some studies indicate that glucosamine may help asmuch as ibuprofen in relieving symptoms of

osteoarthritis, particularly in the knee, with fewer sideeffects




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Side Effects of Glucosamine andChondroitin

These arthritis supplements are generally well tolerated.

However, side effects can occur. The most commonlyreported side effects are:

Nausea

Diarrhea or constipation

Heartburn

Increased intestinal gas

See your doctor for complete information.




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Glucosamine and ChondroitinPeople with osteoarthritis who have diabetes should

talk with a doctor before they take glucosamine

because it may influence blood sugar (glucose).

Do not take glucosamine if you are allergic to shellfish.

Glucosamine is made from shellfish covering

Source: WebMD




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Dietary Supplements

Other than in vitamins and minerals, the long-term

effects of most dietary supplements are not known.

Talk to your doctor before taking supplements.




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Injections: Corticosteroids

Injection

Effective

Temporary




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Injections / Visco-supplementation

Hyaluronic Acid (Cocks Comb)

Injection

Effective (5-13 wks)

Does Not Prevent Progression




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Hyaluronic Acid

Natural substance that lubricates the joint

Injection

Lubricates the joint

Provides temporary relief of pain and movement

80 to 85% of individuals who are treated with this series of

injections have some amount of pain relief which lasts anywhere

from nine to 12 months.* Approved for knee osteoarthritis

*http://uconnsportsmed.uchc.edu/patientinfo/whathurts/treatment/hyaluronic_acid.html




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Knee BracesSimple Braces Unloader Braces




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When to have a Joint ReplacementJoint replacement may be a treatment option when:

Pain is chronic or more recent and disabling

Pain interferes with desired activities

Pain interferes with daily activities, recreational or work

activities

Significant loss of motion (this will become permanent)

occurs.




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When to have a Joint Replacement

When rest pain becomes prominent.

When you have joint pain that wakes you up at night.

When there has been a failure of medical treatment to

relieve pain.

When there is severe bony deformity on x-ray.




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Joint Pain and Treatment OptionsEmail: [email protected]



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Joint Replacement

Preparing for a joint replacement

procedure begins weeks before the actual

day of surgery.

In general, patients may need:Routine blood tests

Urinalysis

Physical examination

ExerciseQuit smoking

Stop certain medications

Donate blood

Preoperative



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Total Joint Replacement

Goals of total joint replacement

are to help:

Relieve pain

Restore motion

Improve function

Improve fitness and health

Restore quality of life



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Your Hip Joint

A joint is formed by the ends

of 2 or more bones.

The hip must bear the full

force of your weight andconsists of two main parts:

A ball (femoral head) at the

top of your thigh bone

(femur)

A rounded socket

(acetabulum) in your pelvisNormal hip joint, showing healthy articular cartilage



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What Causes Hip Joint Pain?

One of the most common

causes of joint pain is arthritis.

The most common types of

arthritis are:Osteoarthritis (OA)

Rheumatoid Arthritis (RA)

Post-traumatic Arthritis

Avascular Necrosis

Diseased hip joint, showing worn cartilage



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Total Hip Replacement



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Your Knee JointFemur thigh bone

Cartilage tissue between bones that

provides cushioning

Patella knee cap

Tibia shin bone

Synovium tissue that provides

lubricating fluid to joint

Ligament flexible tissue that holds

knee joint together



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Total Knee Joint Replacement

End surface of femur replacedwith metal

End surface of tibia replacedwith metal

Plastic liner is inserted betweenfemur and tibia

Patella is resurfacedwith plastic

The entire knee is not removedas myth and lore would have it.

This is a resurfacing procedure.



Email: enquiry@medicyatra com


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Total Knee Replacement





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Limitations After Surgery

Athletic activities that placeexcessive stress on the

joint replacement will needto be avoided. Examples

of these activities include:Skiing (snow or water)

Basketball

Baseball

Contact sports

Running

Frequent jumping





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Enhanced Performance After Surgery

1) My goal as a joint surgeon is to meet the activity

demands of my patients.

2) We now have a more active older population.

3) The newer materials now available are more durable

and longer lasting to meet these demands. (ceramics,

high density polyethylene, HA coated components,

metal-on metal.)

4) There are certainly higher risk activities for joint

patients, yet many on the previous slide can be

undertaken by experienced individuals.





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Technology for Active Patients

Trident Ceramic

Steven L. Drayer M.D.

Private Practice-Lansing/Sparrow Hospital



J i t P i d T t t O ti



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J i t P i d T t t O ti



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Realistic Expectations

Age

Weight

Activity level

Bone strength

Longevity of Hip Replacement



New Technology for Active PatientsTrident Ceramic

http://www.medicyatra.com/http://www.medicyatra.com/http://www.medicyatra.com/


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New Technologies areMeeting the Needs of the

More Active Patient






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Hip Implant Options

Conventional Hip Implants Ceramic Hip Implants

Metal femoral head

Femoral stem

Plastic insert

Acetabular shell

Ceramic femoral head

Ceramic insert

Acetabular shell






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Ceramic in Hip Replacement

Superior wear performance in laboratory testing

compared to metal-plastic bearings*

Excellent biocompatibility

Long clinical history

Provides smooth surface with low friction

Extremely hard material

*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th

Ann. Mtg. ORS, 51, 1998.






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Experience with Ceramics

Ceramic is used in aeronautics, bullet proof vests and

golf clubs

Ceramics in hip replacement have evolved over the

past 30 years

Early use in the US revealed limitations






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Trident Ceramic System

Improvements in material strength, quality and design

Advanced processing, testing and quality control

produces stable, extremely strong ceramic implants




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Alumina Ceramics in HipReplacement

Alumina ceramic-on-ceramic components

demonstrate significantly lower wear versus

conventional metal-on-plastic componentsin laboratory testing.

Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th

Ann. Mtg. ORS, 51, 1998.

q y@ y





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Range of motion (ROM) of theTrident Ceramic System

Although there are many factors that will influence your

range of motion, the Trident Ceramic System is

designed to accommodate the range of motion as in anormal, healthy hip joint

An increased ROM may help minimize the risk of hip

dislocation

q y@ y





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Trident Ceramic System

Biocompatible

Reduces friction

Extremely hard

Superior wear properties to

other bearings available on the

market today*

*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th

Ann. Mtg. ORS, 51, 1998.

q y@ y





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Ceramic-on-CeramicHip Replacement

Additional information about ceramic hip replacement is

available to you:

Call 1-888-STRYKER or

visit www.aboutstryker.com

Individual results may vary. There are potential risks and recovery takes time. The life of any joint replacement will depend on your weight, age, activity

level and other factors. Only an orthopaedic surgeon can tell if surgery is right for you.

q y y



http://www.aboutstryker.com/http://www.medicyatra.com/http://www.aboutstryker.com/http://www.medicyatra.com/


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Joint Replacement Survival

1) In the 50 year old and greater age group 95% of the

replaced joints are functioning well at over 20 years.

2) In the younger than 50 year old group 70% are

functioning well at 10-15 years after placement.

3) This data does not include the data on the new

ceramic and metal on metal hip replacements.

4) Finally, all joint replacements are now modular. Shoulda singular part wear out, it can be replaced with a

simpler, less involved surgery.

q y y




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Minimally Invasive

Total Hip ReplacementSteven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital





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p

Topics

What is hip arthritis?

What is conventional hip replacement surgery?

What is MIS hip replacement surgery?



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Replaced Hip X-ray





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What is Minimally Invasive Surgery?

MIS is a general term used to describe a surgical

procedure that often utilizes a smaller incision(s) than

conventional surgery. In these cases MIS more

accurately describes Mini Incision Surgery

Other MIS procedures reduce the amount of soft tissue

(muscles and tendons, etc) that are disrupted during

surgery. In these cases MIS more accurately

describes Minimally Invasive Surgery





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What are the potential benefits ofMIS Hip Surgery?

Less soft tissuedisruption

Faster discharge from thehospital

Quicker rehab andrecovery

Less blood loss

Reduced pain

Smaller scar

Source: Keggi, Kristaps J., Total Hip Arthroplasty Through

A Minimally Invasive Anterior Surgical Approach JBJS,Vol. 85-A.



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Is MIS Total Hip Arthroplasty foreveryone?

No, patient limitations include:

Obese, high BMIMuscular males

Pre-existing conditions



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What Do I Do?

1) Talk to your orthopedic

surgeon.2) Find out the best joint

treatment option for you.

3) Visit the website of your

surgeon, AAOS or jointmanufacturer.

4)Ask questions!

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