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Your Joint Pain and Treatment Options Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital.

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Presentation on theme: "Your Joint Pain and Treatment Options Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital."— Presentation transcript:

1 Your Joint Pain and Treatment Options Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital

2 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.

3 Joint Pain and Treatment Options 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.

4 Joint Pain and Treatment Options 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, weakness and loss of motion. 4)With progression over time it results in the destruction of the underlying bone and adjacent ligaments.

5 Joint Pain and Treatment Options 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 level aching 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.

6 Joint Pain and Treatment Options 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 joint pain.

7 Joint Pain and Treatment Options 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 heard Fluid on the knee Catching or locking Physical Examination

8 Joint Pain and Treatment Options Diagnosis X-Rays (needs to be done with one view in the standing position) Additional Tests

9 Joint Pain and Treatment Options Nonsurgical Options Diet and Exercise Rest and Joint Care Cane / Walker Medications Cortisone Glucosamine Visco-supplementation Braces

10 Joint Pain and Treatment Options Treatment Options Rest Short-term bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints.

11 Joint Pain and Treatment Options Weight Loss Average American is 20–40 lbs. overweight Average person takes steps/day Reduces stress on weight-bearing joints

12 Joint Pain and Treatment Options Balanced Diet Helps manage weight – Extra pressure on some joints may aggravate your arthritis Stay healthy

13 Joint Pain and Treatment Options Range of Motion Exercises Stretching Maintains normal joint movement Increases flexibility Relieves stiffness Increases the ease of surgery, thus allowing better outcomes.

14 Joint Pain and Treatment Options 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.

15 Joint Pain and Treatment Options Aerobic Exercises Improve cardiovascular fitness Helps control weight May help reduce inflammation in joints For those worried about advancement of arthritis, a Swedish study showed no progression of arthritis with moderate exercise. Walking, Biking

16 Joint Pain and Treatment Options Heat and Cold Therapies Reduce 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

17 Joint Pain and Treatment Options Physical Therapy The goal is to get you back to the point where you can perform normal, everyday activities without difficulty. Preserving good range of motion is key to maintaining the 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

18 Joint Pain and Treatment Options Assistive Devices Make activities easier and less stressful for the joints and muscles. Splint or brace when recommended by a doctor or therapist Walking aides Orthotics Bath stool for use in the shower or tub Sock grippers Other devices are available to assist with everyday activities.

19 Joint Pain and Treatment Options Walking Aides Cane Walker Helps keep you balanced so you dont hurt other joints.

20 Joint Pain and Treatment Options Medications: Analgesics Analgesics, pain relievers, may provide temporary relief of arthritis pain.

21 Joint Pain and Treatment Options Medications: NSAIDs Traditional Aspirin Ibuprofen Naproxen New Cox II

22 Joint Pain and Treatment Options Medications: Topical Pain Relievers Over-the-counter patches, rubs and ointments can provide quick pain relief for people with arthritis that is in just a few joints such as a hand or whose pain isn't severe.

23 Joint Pain and Treatment Options Nutritional Supplements Glucosamine 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

24 Joint Pain and Treatment Options May help osteoarthritis pain and improve function. 1, 2 12 Some studies indicate that glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects 1. Dieppe P, et al. (2002). Osteoarthritis. Clinical Evidence (7): 1071– McAlindon TE, et al. (2000). Glucosamine and chondroitin for treatment of osteoarthritis. A systematic quality assessment and meta-analysis. JAMA, 283(11): 1469– Update on glucosamine for osteoarthritis (2001). Medical Letter on Drugs and Therapeutics, 43(1120): 111–112.

25 Joint Pain and Treatment Options Side Effects of Glucosamine and Chondroitin These arthritis supplements are generally well tolerated. However, side effects can occur. The most commonly reported side effects are: – Nausea – Diarrhea or constipation – Heartburn – Increased intestinal gas See your doctor for complete information.

26 Joint Pain and Treatment Options Glucosamine and Chondroitin People 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

27 Joint Pain and Treatment Options 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.

28 Joint Pain and Treatment Options Corticosteroids Decrease inflammation – Oral – Cream (topical) Short-term side effects include – Swelling, increased appetite Long-term side effects include – Stretch marks, excessive hair growth, osteoporosis, high blood pressure, infections and high blood sugar

29 Joint Pain and Treatment Options Injections: Corticosteroids Injection Effective Temporary

30 Joint Pain and Treatment Options Injections / Visco-supplementation Hyaluronic Acid (Cocks Comb) Injection Effective (5-13 wks) Does Not Prevent Progression

31 Joint Pain and Treatment Options 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

32 Joint Pain and Treatment Options Knee Braces Simple Braces Unloader Braces

33 Joint Pain and Treatment Options When to have a Joint Replacement Joint 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.

34 Joint Pain and Treatment Options 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.

35 Joint Pain and Treatment Options

36 Joint Pain and Treatment Options

37 Joint Pain and Treatment Options 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 Exercise Quit smoking Stop certain medications Donate blood Preoperative

38 Joint Pain and Treatment Options 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

39 Joint Pain and Treatment Options 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 and consists of two main parts: A ball (femoral head) at the top of your thigh bone (femur) A rounded socket (acetabulum) in your pelvis Normal hip joint, showing healthy articular cartilage

40 Joint Pain and Treatment Options 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

41 Joint Pain and Treatment Options Total Hip Replacement

42 Joint Pain and Treatment Options Your Knee Joint Femur – 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

43 Joint Pain and Treatment Options Total Knee Joint Replacement End surface of femur replaced with metal End surface of tibia replaced with metal Plastic liner is inserted between femur and tibia Patella is resurfaced with plastic The entire knee is not removed as myth and lore would have it. This is a resurfacing procedure.

44 Joint Pain and Treatment Options Total Knee Replacement

45 Joint Pain and Treatment Options Limitations After Surgery Athletic activities that place excessive stress on the joint replacement will need to be avoided. Examples of these activities include: Skiing (snow or water) Basketball Baseball Contact sports Running Frequent jumping

46 Joint Pain and Treatment Options 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.

47 Technology for Active Patients Trident ® Ceramic Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital

48 Joint Pain and Treatment Options

49 Joint Pain and Treatment Options Realistic Expectations Age Weight Activity level Bone strength Longevity of Hip Replacement

50 New Technologies are Meeting the Needs of the More Active Patient New Technology for Active Patients Trident Ceramic

51 Joint Pain and Treatment Options Hip Implant Options Conventional Hip ImplantsCeramic Hip Implants Metal femoral head Femoral stem Plastic insert Acetabular shell Ceramic femoral head Ceramic insert Acetabular shell

52 Joint Pain and Treatment Options 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.

53 Joint Pain and Treatment Options 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

54 Joint Pain and Treatment Options Trident ® Ceramic System Improvements in material strength, quality and design Advanced processing, testing and quality control produces stable, extremely strong ceramic implants

55 Joint Pain and Treatment Options U.S. Clinical Study The first US clinical study of contemporary ceramic-on- ceramic hip replacements began in 1996 – Over 1,300 hip surgeries – 16 centers in the United States FDA approved Trident ® Ceramic for sale in the US in February 2003

56 Joint Pain and Treatment Options Alumina Ceramics in Hip Replacement Alumina ceramic-on-ceramic components demonstrate significantly lower wear versus conventional metal-on-plastic components in 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.

57 Joint Pain and Treatment Options Range of motion (ROM) of the Trident ® 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 a normal, healthy hip joint An increased ROM may help minimize the risk of hip dislocation

58 Joint Pain and Treatment Options 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.

59 Joint Pain and Treatment Options Ceramic-on-Ceramic Hip Replacement Additional information about ceramic hip replacement is available to you: Call STRYKER or visit 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.

60 Joint Pain and Treatment Options 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 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. Should a singular part wear out, it can be replaced with a simpler, less involved surgery.

61 Minimally Invasive Total Hip Replacement Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital

62 Joint Pain and Treatment Options Topics What is hip arthritis? What is conventional hip replacement surgery? What is MIS hip replacement surgery?

63 Joint Pain and Treatment Options Ready to Consider Hip Replacement? Today, more than 300,000 Americans a year have hip replacement surgery First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years You're Not Alone!

64 Joint Pain and Treatment Options

65 Joint Pain and Treatment Options Replaced Hip X-ray

66 Joint Pain and Treatment Options 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

67 Joint Pain and Treatment Options What are the potential benefits of MIS Hip Surgery? Less soft tissue disruption – Faster discharge from the hospital – Quicker rehab and recovery 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.

68 Joint Pain and Treatment Options What are the potential risks? Results may vary from patient to patient Surgery time may be extended Risk factors relating to anatomy, weight, and prior joint replacements Risks which are normally encountered in conventional THA remain

69 Joint Pain and Treatment Options Is MIS Total Hip Arthroplasty for everyone? No, patient limitations include: Obese, high BMI Muscular males Pre-existing conditions

70 Joint Pain and Treatment Options Stryker Implant Technology Accolade ® TMZF ® is an MIS-friendly implant Compatible with ceramic-on-ceramic technology for long-term results

71 Joint Pain and Treatment Options 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 joint manufacturer. 4)Ask questions!

72 Joint Pain and Treatment Options


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