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Mr Matt Freudmann MB.BCh, MRCS, FRCS(Tr & Orth)
Trauma & Orthopaedic Consultant at Barrow and Kendal
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• Defined as “a chronic irreversible degenerative disease of articular cartilage....”
So What is Osteoarthritis?
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So What is Osteoarthritis?
Progression from normal joint surface to bare bone exposed.
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So What is Osteoarthritis?
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So What is Osteoarthritis?
No gap between the bones indicating bone-on-bone arthritis
Gap between the bones indicating some cartilage still present
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Who gets it? (risk factors)
Physical job, eg farming
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Symptoms and signs?
• Pain • Stiffness • Swelling • Deformity • Crepitus (creaking)
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Investigations and diagnosis...
• History • Examination • X-ray • Scans • Blood tests • Diagnostic Injection
Usually all that is required
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Treatments options....
• Conservative (eg weight loss, modifying activities or use
walking stick)
• Supplements (eg glocosamine or cod-liver oil)
• Medical (pain killers / anit-inflammatory tablets or gels)
• Orthotics (splints and braces)
• Injections (steroid or hyaluronic acid)
• Keyhole Surgery • Open Surgery • Joint Replacement
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Prevention?
Weight loss
Avoid excessive loading of joints Strong muscles
Excercise
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Some specifics on hips and knees...
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Hips
Symptoms Signs
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Hip Joint Replacements
Risks Benefits Outcomes
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Knees
Symptoms Signs
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Risks Benefits Outcomes
Knees
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Knee Joint Replacement ....Partial vs Total
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The National Joint Registry • A national database collecting details of every joint replacement done in the UK? • Poor performing implants can be identified • Trusts and individual surgeons with poor results can be identified even if their patient end up in a different hospital
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In 2012 the NHS performed: 133,902 Replacements 64,201 Hips 66,700 Knees 1,071 in our Trust
The National Joint Registry
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The National Joint Registry Hips • 43% cementless • 33% cemented • 20% Hybrid • 3% Metal-on-metal / resurfacing • 33% patients aged 70-79 • 1% aged <40 • 60% metal on poly
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The National Joint Registry Knees • 89% Total Knee Replacements (3%uncemented)
• 8% Unicondylar (partial) Knee Replacements • 1% Patello-femoral Replacements • PFC Sigma most common knee replacement used (the one we use) • Oxford most common UKR (the one I use)
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The National Joint Registry What are our results and how do we compare to the rest of the UK?
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National Joint Registry data...
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National Joint Registry data...
National failure rate for hip replacements after 5 years
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National Joint Registry data...
National failure rate for hip replacements after 5 years
Results for our Trust are significantly better than
national average
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National Joint Registry data...
The same is true for our results with knee replacements
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National Joint Registry data...
Dots below the blue line mean our hospital results are in the best 5% in the UK
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National Joint Registry data...
Our mortality rates are also better than the national average
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Summary
• Osteoarthritis is very common • It hurts a lot • There is no cure • But joint replacements work well • Our Trust is really good at them!
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Questions?