Arthritis and the Management of the Painful Knee

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Presentation transcript:

Arthritis and the Management of the Painful Knee

Keith Stube, MD WNY Knee and Orthopedics Kenmore Mercy Hospital

Knee Arthritis

Arthritis

Arthritis 30 millions Americans affected Not one disease-100 different types of arthritis related diseases Most common- osteoarthritis, rheumatoid arthritis

Arthritis OA- most common form of joint disease, 20 million affected, 80% of people over age of 50 RA- systemic auto- immune disease, affects over 2 million people

Osteoarthritis “wear and tear” “bone on bone” Pathologic hallmark is focal loss of cartilage

Osteoarthritis symptoms- moderate to severe persistent pain Loss of mobility Decrease of motion Altered activity level Deformity

Osteoarthritis Treatment Goals- Freedom, increase range of motion, improved quality of life

Treatment-osteoarthitis Rehabilitation-PT Restore or improve function through use of exercise, pain relief and educational programs

Treatment-Osteoarthitis Analgesics- NSAIDs, Tylenol injections- steroids, gel injections Weight loss

Treatment-osteoarthritis Unloader brace- Changes alignment of knee, excellent for patients with some deformity

Treatment-osteoarthritis Alternative treatments- Glucosamine Chondroitin sulphate Vit E Tumeric

Surgical options Arthroscopy-does not treat arthritis Indicated only for mechanical symptoms

Surgical treatment Joint Replacement- Goals to reduce pain, increase ADL, increase mobility and function, improve quality of life

Surgical treatment Joint replacement 600,000/year Very predictable- <15 % revision rate 90% patient satisfaction Improves quality of life like CABG

Surgical treatment Osteotomy- Cutting tibia and changing alignment of knee 60% survival at 10 years

Osteotomy

Surgical treatment Partial Knee Replacement- Replacing only the arthritic compartment , usually medial Good survival rate in appropriate patients

Partial knee replacement

Surgical treatment TKR- Replacing the arthritic surfaces with metal and plastic implants Maintain ligaments Maintain muscle and motion

Surgical treatment Complications Infection 1-2% Blood clots 1-2% Instability Limited range of motion Difficulty kneeling