Presentation on theme: "Your Joint Pain and Treatment Options"— Presentation transcript:
1Your Joint Pain and Treatment Options Steven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital
2About My Practice Trained at Henry Ford Hospital in Detroit, Michigan. Have been in private practice for 20 yearsHave been performing joint replacements for 24 yearsI perform approximately 150 replacements/year, not including those done for broken hips. These are knee and hip primarily, but also shoulder and, rarely, elbow.
3I also perform revision surgery for worn out, loose or painful joint replacements. I update my knowledge on joint replacement surgery twice a year at educational courses.I’m 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.
4What is arthritis?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.)It is not to be confused with osteoporosis which is the loss of bone mass.The loss of this surface, whether partial or complete, results in variable pain, stiffness, swelling, weakness and loss of motion.With progression over time it results in the destruction of the underlying bone and adjacent ligaments.
5How does it present?It can either present in a slow gradual fashion or have a sudden appearance after a minor injury.You can have “good and bad” days. Pain will be low level aching to intense pain that won’t allow walking on the leg.You can be stiff and achy in the morning, comfortable during the day, then painful at the days end.Oft time the pain will lessen with mild to moderate activities.You may experience popping, locking or catching.
6Prolonged positions will cause increase symptoms, ie Prolonged positions will cause increase symptoms, ie. Standing in line, long car rides or sitting for a movie.You avoid, or have difficulty doing, activities like kneeling, squatting, stair climbing, getting out of cars/chairs or even tying your shoes.You have trouble finding a comfortable position while resting at home with a book or watching t.v.You have trouble with waking up at night due to joint pain.
7Diagnosis Physical Examination Tenderness to the touch Weakness in the musclesLoss of passive and active range of motionSpurs that can be felt along the bone edgesGrinding, popping or other joint noises that can be felt or heardFluid on the kneeCatching or locking
8Diagnosis Additional Tests X-Rays (needs to be done with one view in the standing position)
9Nonsurgical Options Diet and Exercise Rest and Joint Care Cane / WalkerMedicationsCortisoneGlucosamineVisco-supplementationBraces
10Treatment 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.
11Weight Loss Average American is 20–40 lbs. overweight Average person takes steps/dayReduces stress on weight-bearing joints
12Balanced Diet Helps manage weight Stay healthy Extra pressure on some joints may aggravate your arthritisStay healthy
13Range of Motion Exercises Stretching Maintains normal joint movementIncreases flexibilityRelieves stiffnessIncreases the ease of surgery, thus allowing better outcomes.
14Strengthening 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.
15Aerobic Exercises Walking, Biking Improve cardiovascular fitness Helps control weightMay help reduce inflammation in jointsFor those worried about advancement of arthritis, a Swedish study showed no progression of arthritis with moderate exercise.
16Heat and Cold Therapies Reduce pain and inflammationHeat TherapyIncreases blood flow, tolerance for pain, flexibilityCold TherapyCold packs, ice massage, OTC sprays and ointmentsReduces pain by numbing the nerves around the joint
17Physical TherapyThe 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 anotherTeach you how to use walking aids
18Assistive DevicesMake activities easier and less stressful for the joints and muscles.Splint or brace when recommended by a doctor or therapistWalking aidesOrthoticsBath stool for use in the shower or tubSock grippersOther devices are available to assist with everyday activities.
19Helps keep you balanced so you don’t hurt other joints. Walking AidesCaneWalkerHelps keep you balanced so you don’t hurt other joints.
20Medications: Analgesics Analgesics, pain relievers, may provide temporary relief of arthritis pain.
21Medications: NSAIDsTraditionalAspirinIbuprofenNaproxenNewCox II
22Medications: 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.
23Nutritional 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 approvedWarrant further in-depth studies on their safety and effectiveness, according to the Arthritis Foundation.Source: Arthritis.org website, Aug. 2006
24May help osteoarthritis pain and improve function.1, 2 Some studies indicate that glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects1. Dieppe P, et al. (2002). Osteoarthritis. Clinical Evidence (7): 1071–1090.2. McAlindon TE, et al. (2000). Glucosamine and chondroitin for treatment of osteoarthritis. A systematic quality assessment and meta-analysis. JAMA, 283(11): 1469–1475.3. Update on glucosamine for osteoarthritis (2001). Medical Letter on Drugs and Therapeutics, 43(1120): 111–112.
25Side Effects of Glucosamine and Chondroitin These arthritis supplements are generally well tolerated.However, side effects can occur. The most commonlyreported side effects are:NauseaDiarrhea or constipationHeartburnIncreased intestinal gasSee your doctor for complete information.
26Glucosamine 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 coveringSource: WebMD
27Dietary SupplementsOther than in vitamins and minerals, the long-term effects of most dietary supplements are not known.Talk to your doctor before taking supplements.
28Corticosteroids Decrease inflammation Short-term side effects include OralCream (topical)Short-term side effects includeSwelling, increased appetiteLong-term side effects includeStretch marks, excessive hair growth, osteoporosis, high blood pressure, infections and high blood sugar
30Injections / Visco-supplementation Hyaluronic Acid (Cock’s Comb)InjectionEffective (5-13 wks)Does Not Prevent ProgressionContraindication only if known allergy. Caution with avian proteins, feathers, eggs.
31Hyaluronic Acid Natural substance that lubricates the joint Injection Provides temporary relief of pain and movement80 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
33When to have a Joint Replacement Joint replacement may be a treatment option when:Pain is chronic or more recent and disablingPain interferes with desired activitiesPain interferes with daily activities, recreational or work activitiesSignificant loss of motion (this will become permanent) occurs.
34When 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.
37Joint Replacement Preoperative Preparing for a joint replacement procedure begins weeks before the actual day of surgery.In general, patients may need:Routine blood testsUrinalysisPhysical examinationExerciseQuit smokingStop certain medicationsDonate blood
38Total Joint Replacement Goals of total joint replacement are to help:Relieve painRestore motionImprove functionImprove fitness and healthRestore quality of life
39Normal hip joint, showing healthy articular cartilage Your Hip JointA 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 pelvisNormal hip joint, showing healthy articular cartilage
40What 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 ArthritisAvascular NecrosisDiseased hip joint, showing worn cartilage
42Your Knee Joint Femur – thigh bone Cartilage – tissue between bones that provides cushioningPatella – knee capTibia – shin boneSynovium – tissue that provides lubricating fluid to jointLigament – flexible tissue that holds knee joint together
43Total Knee Joint Replacement End surface of femur replaced with metalEnd surface of tibia replaced with metalPlastic liner is inserted between femur and tibiaPatella is resurfaced with plasticThe entire knee is not removed as myth and lore would have it.This is a resurfacing procedure.
45Limitations 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)BasketballBaseballContact sportsRunningFrequent jumping
46Enhanced Performance After Surgery My goal as a joint surgeon is to meet the activity demands of my patients.We now have a more active “older” population.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.)There are certainly higher risk activities for joint patients, yet many on the previous slide can be undertaken by experienced individuals.
47Technology for Active Patients Trident® CeramicSteven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital
49Realistic Expectations Longevity of Hip ReplacementAgeWeightActivity levelBone strength
50New Technologies are Meeting the Needs of the More Active Patient New Technology for Active PatientsTrident CeramicNew Technologies are Meeting the Needs of the More Active Patient
51Conventional Hip Implants Hip Implant OptionsConventional Hip ImplantsCeramic Hip ImplantsAcetabular shellAcetabular shellPlastic insertCeramic insertMetal femoral headCeramic femoral headFemoral stem
52Ceramic in Hip Replacement Superior wear performance in laboratory testing compared to metal-plastic bearings*Excellent biocompatibilityLong clinical historyProvides smooth surface with low frictionExtremely 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.
53Experience with Ceramics Ceramic is used in aeronautics, bullet proof vests and golf clubsCeramics in hip replacement have evolved over the past 30 yearsEarly use in the US revealed limitations
54Trident® Ceramic System Improvements in material strength, quality and designAdvanced processing, testing and quality control produces stable, extremely strong ceramic implants
55U.S. Clinical StudyThe first US clinical study of contemporary ceramic-on-ceramic hip replacements began in 1996Over 1,300 hip surgeries16 centers in the United StatesFDA approved Trident® Ceramic for sale in the US in February 2003The US Clinical began in 1996 with Stryker’s first generation ceramic design, called ABC. Trident was added as part of the Study in Over 1,300 ceramic surgeries were done in the study and “Continued Access” – all prior to FDA approval. Including the control group (metal-poly), over 1500 surgeries were done.
56Alumina 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.
57Range 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 jointAn increased ROM may help minimize the risk of hip dislocation
58Trident® Ceramic System BiocompatibleReduces frictionExtremely hardSuperior 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.
59Ceramic-on-Ceramic Hip Replacement Additional information about ceramic hip replacement is available to you:Call STRYKER orvisitIndividual 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.
60Joint Replacement Survival In the 50 year old and greater age group 95% of the replaced joints are functioning well at over 20 years.In the younger than 50 year old group 70% are functioning well at years after placement.This data does not include the data on the new ceramic and metal on metal hip replacements.Finally, all joint replacements are now modular. Should a singular part wear out, it can be replaced with a simpler, less involved surgery.
61Minimally Invasive Total Hip Replacement Steven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital
62Topics What is hip arthritis? What is conventional hip replacement surgery?What is MIS hip replacement surgery?
63Ready to Consider Hip Replacement? You're Not Alone!Today, more than 300,000 Americans a year have hip replacement surgeryFirst performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years
66What 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”
67What are the potential benefits of MIS Hip Surgery? Less soft tissue disruptionFaster discharge from the hospitalQuicker rehab and recoveryLess blood lossReduced painSmaller scarSource: Keggi, Kristaps J., Total Hip Arthroplasty Through A Minimally Invasive Anterior Surgical Approach JBJS, Vol. 85-A.
68What are the potential risks? Results may vary from patient to patientSurgery time may be extendedRisk factors relating to anatomy, weight, and prior joint replacementsRisks which are normally encountered in conventional THA remain
69Is MIS Total Hip Arthroplasty for everyone? No, patient limitations include:Obese, high BMIMuscular malesPre-existing conditions
70Stryker Implant Technology Accolade® TMZF® is an MIS-friendly implantCompatible with ceramic-on-ceramic technology for long-term results
71What Do I Do? Talk to your orthopedic surgeon. Find out the best joint treatment option for you.Visit the website of your surgeon, AAOS or joint manufacturer.Ask questions!