all about arthritis kambiz behzadi, m.d. orthopedic surgeon san ramon, pleasanton, livermore san...
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All About All About ArthritisArthritis
Kambiz Behzadi, M.D.Kambiz Behzadi, M.D.
Orthopedic SurgeonOrthopedic Surgeon San Ramon, Pleasanton, LivermoreSan Ramon, Pleasanton, Livermore
Arthritis and YouArthritis and You
Musculoskeletal Conditions affect Musculoskeletal Conditions affect millions of peoplemillions of people
$254 billion per year spent$254 billion per year spent
ArthritisArthritis
40 Million Americans have arthritis40 Million Americans have arthritis 20 Million people suffer from 20 Million people suffer from
OsteoarthritisOsteoarthritis Osteoarthritis most common form of Osteoarthritis most common form of
arthritisarthritis
Synovial JointsSynovial Joints
Bone ends --> Bone ends --> Articular CartilageArticular Cartilage
Cartilage cushions Cartilage cushions bones-->allows bones-->allows bones to move bones to move without painwithout pain
Synovium--> Synovium--> covers joints, covers joints, produces fluid that produces fluid that reduces frictionreduces friction
Articular Cartilage
Bone
Synovial Membrane
Synovial Fluid
Synovial JointsSynovial Joints
Ligaments connect Ligaments connect bones--> stabilitybones--> stability
Muscles and Muscles and Tendons power Tendons power joints--> joints--> movementmovement
ArthritisArthritis
Arthritis is Arthritis is InflammationInflammation
Body’s normal Body’s normal reaction to injuryreaction to injury
Chronic Chronic inflammation in inflammation in arthritic joint--> arthritic joint--> long lasting long lasting disability disability
Inflammation
Swelling
Pain
Stiffness
OsteoarthritisOsteoarthritis Loss of cartilage Loss of cartilage
and joint surfaceand joint surface Second most Second most
common cause of common cause of disability in adultsdisability in adults
7 million physician 7 million physician visits per yearvisits per year
3 million 3 million hospitalizationshospitalizations
$2655 per person$2655 per person
Cartilage
Healthy Knee Osteoarthritic Knee
OsteoarthritisOsteoarthritis
Weight bearing Weight bearing jointsjoints
Hips, knees, feetHips, knees, feet FingersFingers SpineSpine
OsteoarthritisOsteoarthritis
Most of us by our 60s & 70sMost of us by our 60s & 70s
More women than menMore women than men
All races equallyAll races equally
40 million by 202040 million by 2020
Burden of DiseaseBurden of Disease
OsteoarthritisOsteoarthritis Pain in affected Pain in affected
jointsjoints
Pain worse with Pain worse with prolonged useprolonged use
Pain better with Pain better with restrest
Stiffness relieved Stiffness relieved by flexing and by flexing and movementmovement
Osteoarthritis-XrayOsteoarthritis-Xray
Osteoarthritis CausesOsteoarthritis Causes
Primary Osteoarthritis Most Primary Osteoarthritis Most CommonCommon
Thought to be result of AgingThought to be result of Aging Decreased ability to withstand stressDecreased ability to withstand stress Ligaments supporting joints weakenLigaments supporting joints weaken
Secondary OsteoarthritisSecondary Osteoarthritis
Obesity Trauma Surgery
Abnormal joints Gout Diabetes
Hormone disorders
CausesCauses
Goals of TreatmentGoals of Treatment
To Relieve painTo Relieve pain Increase motionIncrease motion Improve strengthImprove strength
Medication- NSAIDsMedication- NSAIDs
NSAIDs are nonsteroidal anti-NSAIDs are nonsteroidal anti-inflammatory drugsinflammatory drugs AspirinAspirin IbuprofenIbuprofen NaproxenNaproxen
MedicationMedication
Cox-2 inhibitors offer the benefits of other NSAIDs with a decreased incidence of gastrointestinal side effects.
Vioxx, Celebrex, Bextra
MedicationMedication
InjectionsInjections
Liquid Liquid cortisonecortisone
HyaluronateHyaluronate SupartzSupartz SynviscSynvisc HylaganHylagan
VitaminsVitamins
Anti-oxidants Anti-oxidants A,C,D,E may help A,C,D,E may help prevent prevent OsteoarthritisOsteoarthritis
No Clinical trialsNo Clinical trials No clear proofNo clear proof
Nutritional SupplementsNutritional Supplements
GlucosamineGlucosamine Chondroitin SulfateChondroitin Sulfate Some Positive resultsSome Positive results
Mild to moderate pain reliefMild to moderate pain relief If not seen within eight weeks, not If not seen within eight weeks, not
likely to benefitlikely to benefit
Alternative MedicineAlternative Medicine
Complimentary approaches may:Complimentary approaches may:
Ease symptomsEase symptoms
Improve outlook and attitudeImprove outlook and attitude
Alternative MedicineAlternative Medicine
Complimentary approaches will not:Complimentary approaches will not: Cure acute illnessCure acute illness Replace proven medical treatment for Replace proven medical treatment for
osteoarthritisosteoarthritis
Alternative MedicineAlternative Medicine
Pain Stiffness Fatigue Inflammation Anxiety/Depression
Biofeedback
Visualization
Hypnosis
Relaxation
Yoga
Acupuncture
Magnets
Vegetarian Diet
Herbs & Supplements
Therapy Symptoms
Joint ProtectionJoint Protection
ExerciseExercise
Gentle exercise in Gentle exercise in moderationmoderation
Strengthen musclesStrengthen muscles Prevent stiffnessPrevent stiffness Decrease weightDecrease weight Promote endurancePromote endurance Right program for Right program for
youyou
SurgerySurgery ArthroscopyArthroscopy Least InvasiveLeast Invasive ArthroscopeArthroscope Remove partially Remove partially
damaged cartilagedamaged cartilage PortalsPortals Remove dead Remove dead
cartilage and cartilage and enzymes that cause enzymes that cause inflammationinflammation
Arthroscope
Portals
Damaged cartilage
Abrasion / DrillingAbrasion / Drilling
Abrasion and Abrasion and DrillingDrilling
Healing responseHealing response Fibrocartilage= Fibrocartilage=
Scar CartilageScar Cartilage Inferior mechanical Inferior mechanical
properties to properties to articular cartilagearticular cartilage
Less advanced OALess advanced OA Focal arthritisFocal arthritis
Focal, localized lesionFocal, localized lesion
OsteotomyOsteotomy
Realignment of Realignment of JointsJoints
Transfer Weight to Transfer Weight to less involved part less involved part of jointof joint
60s and 70s60s and 70s Less popularLess popular Does not provide Does not provide
good long term good long term resultsresults
Mosaicplasty / OATSMosaicplasty / OATS
Localized focal Localized focal arthritis/defectarthritis/defect
Traumatic arthritisTraumatic arthritis Small to medium Small to medium Transferring Transferring
healthy healthy plug of plug of bone and cartilagebone and cartilage to defect in weight to defect in weight bearing areabearing area
Small Large
ACIACI Articular Cartilage Articular Cartilage
ImplantationImplantation ““Pot hole in the road”Pot hole in the road” Two operationsTwo operations Cartilage harvested Cartilage harvested
and sent to Lab, to and sent to Lab, to grow in Culturegrow in Culture
Cartilage cells Cartilage cells transplanted into the transplanted into the defectdefect
In future may be In future may be applicable to large applicable to large lesions/primary OAlesions/primary OA
Total Joint ReplacementTotal Joint Replacement
Considered last Considered last Solution for Solution for ArthritisArthritis
Improved Improved AmbulationAmbulation
Decreased PainDecreased Pain Increased ROMIncreased ROM 90%+ good to 90%+ good to
excellent resultsexcellent results
Total Joint ReplacementTotal Joint Replacement Removal Removal
of of diseased diseased jointjoint
Replace Replace with a with a prosthetic prosthetic jointjoint
+
+
+
Knee
Hip
Minimally Invasive Minimally Invasive SurgerySurgery
Continuous Continuous advances in joint advances in joint replacement replacement proceduresprocedures
MIS= Minimally MIS= Minimally Invasive SurgeryInvasive Surgery
MISMIS 8-12 inches --> 3 to 5 8-12 inches --> 3 to 5
inchesinches Same implants Same implants Minimal trauma to Minimal trauma to
Muscles and TendonsMuscles and Tendons Quadriceps muscle Quadriceps muscle
and tendon not cutand tendon not cut Unassisted walking at Unassisted walking at
2 to 4 weeks2 to 4 weeks Back to Back to
Activities/Work Activities/Work SoonerSooner
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SummarySummary
Osteoarthritis affects in excess of 20 Osteoarthritis affects in excess of 20 Million AmericansMillion Americans
Accurate Diagnosis importantAccurate Diagnosis important Understand the nature of this Understand the nature of this
ProblemProblem Many treatment Options availableMany treatment Options available Benefits and limitations Benefits and limitations Choose the right treatment for youChoose the right treatment for you Get back into the gameGet back into the game
ArthritisArthritis
www.nih.gov/niams/
www.aboutarthritis.com
American Academy of Orthopaedic Surgeons www.aaos.org
Arthritis Foundation www.arthritis.org
www.behzadisportsdoc.com
THANK YOUTHANK YOU
MIS THRMIS THR
TWO INCISIONCO-AXIAL PATH
SINGLE INCISIONPOSTERIOR APPROACH