degenerative disease of the joints
TRANSCRIPT
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Degenerative disease of the joints
The Bone and Joint Decade 2000 – 2010
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Contents
1. Bone and Joint Decade 2000 – 2010
2. Degenerative disease of the joints (osteoarthritis)Ø Etiology
Ø Pathogenesis
Ø Signs and symptoms
Ø Diagnostic possibilities
3. Treatment of osteoarthritis
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The Bone and Joint Decade 2000 – 2010
The Bone and Joint Decade 2000 – 2010
aims to improve the health-related
quality of life for people with
musculosceletal disorders worldwide.
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The Bone and Joint Decade 2000 – 2010
The Bone and Joint Decade 2000 – 2010 was officially launched in Geneva on 13 January, 2000.
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One out of every four American suffers from musculoskeletal conditions.
You are bringing hope to countless people around the world and
helping to create a brighter, healthier future for us all.
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The Bone and Joint Decade 2000 – 2010
UN
WHO
World Bank
51 Goverments
Decade endorsement
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Facts
• Across the world, musculo-skeletal
conditions affect hundreds of millions of
people, at a huge cost to society (estimated at
$240 billion per year in the USA alone)
• Joint diseases account for half of all chronic
conditions in people aged 50 and over
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•The number of individuals over the age
of 50 is expected to double between 1990-
2020. In Europe by 2010, for the first
time, there will be more people over 60
years of age than people less than 20
years of age, resulting in a huge
escalation of treatment costs
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Osteoarthritis is recognised as acivilisation disease
- is one of the
world’s largest
health care
problems
(WHO)
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OsteoarthritisChronic degenerative non-inflamatory
joint disorder in which there is
progressive loss of articular cartilage
accompanied by new bone formation
and capsular fibrosis.
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OsteoarthritisClassification
Primary
(Osteoarthrosis idiopathica)
Secondary
(Osteoarthrosis secundaria)
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EpidemiologyOsteoarthritis
18-34 years4%
35-74 years11%
75-79 years85%
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Etiology
Secondary osteoarthrosis
• post-traumatic
• congenital musculo-sceletal anomalies
• post-inflamatory
• epiphyseal diseases
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Secondary osteoarthritis
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Secondary osteoarthritis
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Etiology
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Patello-femoral pathology
P
L
TLP:LTInsall i Salvati
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Osteoarthritismechanical
load
ää
tissue resistance
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Physiological inter-dependance
Articular cartilage
Synovium Subchondral bone
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Cartilage & bonecartilage fibrillation
ääsurface abrasion
ääsubchondral bone thickening
ääcyst formation
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Partial thickness damage
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Partial thickness damage
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Full thickness damage
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Joint capsuleand synovial membrane
synovial hypertrophy
capsule fibrosis
capsule thickening
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Symptoms
• pain
• stiffness
• restriction of movement
• flexion contracture
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Signs
• joint swelling
• muscle wasting
• restriction of passive patellar
tracking
• crepitation during movements
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Signs
• joint line
tenderness
• joint effusion
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ValgusVarus
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Diagnostic methods
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Diagnostic methods
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Osteoarthritis
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Diagnostic methods
increased transmisionof forces to the
subchondral bone
ääincreased local blood
flow and deposition on existing trabeculae
ääsubchondral sclerosis
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Diagnostic methods
Osteophytes
Cartilage-bone outgrowths that occur most commonly at the margins of OA joints, by the process of enchondral ossification at the junction of hyaline cartilage and synovium/periosteum.
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Arthrosis of the hip
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Imaging
Normal articular cartilage in MR
SE T1 FL 2D FL 2D FL 2D
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Imaging
Damaged articular cartilage
SE T1 SE T1
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Arthroscopy
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Treatment of osteoarthritis
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Pharmacological treatment Pharmacological treatment CostCost (PLN)(PLN)
0
10002000
30004000
500060007000
80009000
10000
M D O V C E
MajamilDiclacOlfenVioxxCelebrexArthroplasty
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Pharmacological treatmentPharmacological treatment
• Even short-term NSAID treatment may causegastropathy or entheropathy.
• Pathology may be visible within 7 days from the start of NSAID treatment.
• After some NSAID 19% frequency of stomach ulcer is observed in 6 days from the start of treatment.
• The cost of 9-months of sick-leave exceeds the cost of total knee arthroplasty
» ARCANA
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Pharmacological treatmentPharmacological treatment
• Hyaluronic acid
• Glikozoaminoglicans/
• chondroityn
expensive, safe, may-be effective
cheaper, safe,
effective
•Hungerford D. S. 2002
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Abrasion arthroplastyBone marrow stimulation technique
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Mosaicplasty
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MicrofracturesBone marrow stimulation technique
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varus valgus
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High tibial osteotomy
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Cemented arthroplasty
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Cementless arthroplasty
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Hip prosthesis
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Cementless hip arthroplasty
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Osteoarthritisuni- and tricompartmental involvement
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Total knee arthroplasty
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Social and economic aspects of total knee arthroplasty
• Joint replacement is one of the most cost
effective procedures in the whole
medicine and surgery.
• When comparisons are made on the basis
of the cost of quality adjusted life years,
THR has a similar cost effectiveness to
coronary artery bypass surgery.
»Laupacis 1994
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Quality of life before and after arthroplasty• Preoperative hip and knee patient
groups were compared with similar groups who underwent arthroplasty 2 or 5 years previously.
• Major improvements were observed for pain, sleep, range of motion, and physical ability.
• The health status of patients operated 2 or 5 years ago was similar, suggesting a long-term health quality improvement.
• Rissanen P. and coathors 1995
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Cardiovascular fitnessCardiovascular fitness
Inactivity secondary to more severe
osteoarthritis symptoms can result in
cardiovascular deconditioning.
» Ries M. D. and coauthors 1995
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Cardiovascular fitnessCardiovascular fitness
Resumption of routine physical
activities after TKR is associated
with a corresponding
improvement in cardiovascular
fitness. In nonoperated patients
deterioration is observed.
» Ries M. D. and coauthors
1996
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Arthrodesis
xxxxxxxxxxx
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Hip prosthesis
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Complications
» Robertsson and coauthors 2000
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Complications
• Infection rate after total knee arthroplasty
1 – 2 %
• Approximate per case cost
(USA)
50 – 60 thous. $
0
1
2
3
4
p a i
primasept.inf.
Sculco T. P. 1993 Hebert C. K. and coauthor 1996» »
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Social and economic aspects of total knee arthroplasty
• Joint replacement is one of the most cost
effective procedures in the whole
medicine and surgery.
• When comparisons are made on the basis
of the cost of quality adjusted life years,
THR has a similar cost effectiveness to
coronary artery bypass surgery.
»Laupacis 1994
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Social and economic aspects of total knee arthroplasty
In over 90% of patients good result of
treatment may still be expected 10 years
after surgery.
» Molhani A. L. i Rand J. A. 1993-1994 r.
» Mason M. D. 1993-1994 r.
» Ranawat C. S., Boachie-Adjej O. 1988 r.
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Goals for the Decade
• Tissue engineering
• Gene therapy
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Total knee arthroplastyGoals for the Decade
• Implants with better
wear characteristics
and improved fixation
need to be developed.
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Total knee arthroplastyGoals for the Decade
• Computer navigation
during surgery
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Total knee arthroplastyGoals for the Decade
• Less invasive
unicompartmental
arthroplasty
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?=
Advanced age is not
necessarily connected
with pain and disability.
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Department of OrthopaedicsK. Marcinkowski University of Medical Sciences
in Poznan
Thank you