non-invasive/churgical treatment for osteoarthritis patients che hsin falkenström (oim orthopedie)...
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Non-invasive/churgical treatment for osteoarthritis patients
Che Hsin Falkenström (OIM Orthopedie)
Based on a research project by
Lena Dürling (UMCG), Edsko Hekman (UT), Roel Kuijer (UMCG), Bart Verkerke (UMCG/UT), Sjoerd Bulstra (UMCG)
Anatomy of the knee
Largest joint in the human body
Consists of two articulations:• Between femur and tibia• Between femur and patella
Ligaments holding the bones of the knee in place
Hyaline cartilage is located on the end of femur and tibia
Menisci protect the ends of the bones from rubbing on each other
Osteoarthritis
Degenerative joint disease characterized by destruction of articular cartilage
Cartilage cushion causes friction between bones, causing pain and stiffness of the joint
Causes osteoarthritis
Veroudering
Aangeboren standafwijking
Trauma like sportblessures Chronic overbelasting obesitas
Ontstekingsreacties van het lichaam
Prevalence & incidence osteoarthritis in the Netherlands (2007)
Incidence (per 1.000)
Male Female Age (years)
Prevalence (per 1.000)
Male Female Age (years)
Nationaal Kompas Volksgezondheid, versie 4.3, 6 april 2011, © RIVM, Bilthoven
Male Female Male FemalePer 1000 14,3 23,8 1,6 3,1
Total numbers 115.000 197.000 13.300 25.700
IncidencePrevalence
Expected growth 2000 – 2020: 38%
Current treatments osteoarthritis
Physical therapy
Medication
Lifestyle modification
Churgical treatment Knee replacement Cartilage transplantation
Hypothesis of cartilage regeneration treatment
„osteoarthritic cartilage has some regenerative activity when the damaged cartilage is mechanical unloaded while intermittent fluid pressure and flow is maintained“
Unloading the affected knee joint during movement
Alternative treatment?!Research on the regenerative activity osteoarthritic cartilage
Joint distraction in canine experimentally induced osteoarthritis leads to cartilagerepair accompanied by sustained relieve of pain.S.C. Mastbergen, F. Intema, P. van Roermund, H. Hazewinkel, F.P.J.G. Lafeber; Utrecht/NL
Distraction arthroplasty for treatment of the osteoarthritic kneeA. Nakamae, M. Deie, N. Adachi, T. Nakasa, H. Shibuya, T. Niimoto, A. Okuhara, M. Ochi; Hiroshima/JP
Clinical Benefit of Joint Distraction in the Treatment of Severe Osteoarthritis of the Ankle: Proof of Concept in an Open Prospective Study and in aRandomized Controlled StudyAnne C. A. Marijnissen,1 Peter M. van Roermund,1 Jan van Melkebeek,2 Willem Schenk,3Abraham J. Verbout,1 Johannes W. J. Bijlsma,1 and Floris P. J. G. Lafeber; Utrecht/NL
Prolonged clinical benefit from joint distraction in the treatmentof ankle osteoarthritisJ. J. W. Ploegmakers M.Sc., P. M. van Roermund M.D., Ph.D.z, J. van Melkebeek M.D.,J. Lammens M.D., Ph.D., Professork, J. W. J. Bijlsma M.D., Ph.D., Professory,F. P. J. G. Lafeber Ph.D. and A. C. A. Marijnissen Ph.D.
Joint Distraction
External fixation of the knee joint• Monolateral• Bilateral
Pins are placed in the bones above and below the knee joint
An external system creates a gap of 5mm between the femur and the tibia
Other systems unload the knee joint with springs on both sides of the knee
Improvement Joint Distraction treatment
- Patient can not use it for daily activities
- Very uncomfortable
- Possible inflammation/infection
- Expensive treatment
Patient can use it for daily activities
Comfortable
No inflammation/infection (non-invasisve treatement)
Considerable cost reduction
Problems Goals and wishes
Prototype Joint Distraction Orthosis
Socket: Individual prosthetic socket
Framework: Stainless steel bars
Hinge: Dynamic type hinge
Foot: Ground plate is somewhat rounded to provide an even better degree of foot roll-over
Fixation mechanism for the leg: Strap between these bars
Shoe: Patient has to wear a special shoe at the other leg to compensate the height difference
Follow-up
2011 Further development of prototype
2012 Testing treatment on 10 patients
This is why we are doing this!
Thank you for your attention!