WORLD ARTHRITIS DAY. 12.10.14.

WEBSITE: HTTP://RAMSONIORTHOSURGEON.COM/

DR R K SONI. MS ORTHO. LRCP EDINBURGH. LRCP&S GLASGOW.M.CH ORTHO & TRAUMA . LIVERPOOL .UK

Consultant Orthopaedic arthroscopy and Joint replacement surgeon.. Bhopal. MP J K Hospital.Website: http://ramsoniorthosurgeon.com/

“Our Focus is your health”.

World Arthritis Day 2005

Arthritis – Quality of life , living without Pain.

World Arthritis Day: "Small Things Matter”

12.10.07

World Arthritis Day in 2011

Move to

Improve

Find relief for aches and painsWorld Arthritis Day

12 October 2014

Healthy Living .

Physical activity Healthy eating Lifestyle choices, including alcohol

and smoking Emotional wellbeing Self management and motivation

If you have confidence and believe you can do some thing you are much more likely to succeed.

Arthritis

Has been present in Humans since 4500 BC

S No All Men Women

1 Osteoarthritis 2.7 1.0 3.9

2 Hypertension 1.3 0.4 1.9

3 Slipped disc 1.3 0.3 1.9

4 Diabetes 1.1 1.5 0.8

5 Spondylosis 1.1 0.5 1.5

6 Migrain 1.0 0.2 1.5

7 Asthma 0.7 0.3 1.0

8 Rheumatoid 0.5 0.3 0.7

9 Hypothyroidism 0.5 00 0.9

10 Dyslipidaemia 0.4 0.3 0.5

Osteoarthritis affects about 10% of population above 55 years of age. Osteoarthritis is India’s number one ailment: Diabetes is ranked 4 th.% of total affected by the disease.

NICOLAS ANDRY . ( 1741) FRENCH PHYSICIAN.

( ART OF PREVENTION AND CORRECTION OF DEFORMITIES IN CHILDREN.)

Arthritis symptoms

1. pain. 2. swelling . 3. stiffness. 4Morning stiffness . 5. deformity. 6. gradual reduction in walking

distance. 7. sleep disturbed `

Arthritis and deformity

Excessive calcium and joint pain 1.Hyperparathyroidism:

2. one of the feature is joint pain due to hypercalcaemia.

3. High serum ca level is ass with high systolic and Diastolic blood pressure.

4. High serum calcium is highly predictive of MI.

Serum ca level is predictive of cardiovascular disease in men.

Increased uric acid level and joint pain.

Gout attack can be precipitated Dehydration Injury Fever Heavy eating Heavy drinking Recent operation

Lemon and arthritis

No relation . If any thing it is helpful in pt with arthritis.

Yogurt / and joint pain.

Yogurt is good for joint pain.

Alcohol and Arthritis.

. Known Risk factor: 1- for Gout. 2. Osteoporosis. 3. Obesity. And obesity increases risk

of OA three fold. 4. Memory loss. 5. Contra indication for many Drugs , Alcohol and drug interaction.

Smoking and Arthritis .

Smokers are twice more likely to develop Rheumatoid Arthritis.

Osteoporosis . Delayed fracture healing . Degenerative disc disease.

Diet and Arthritis

1.More Fruits and vegetables. 2.Omega 3 fatty acids, 3.Olive oil . 4.Vit c . 5. Avoid high cooking temperature 6.Vegetarian diet . 7. Avoid food containing additives

and preservatives.

Weight / Obesity/ Arthritis

Wt

BMI;- 25-to 30. ---Overweight > 30. ----- Obese > 35 . ---- Morbidly obese

Obesity trends in UK / India

UK Low

socioeconomic status

India Higher

socioeconomic status.

Bigger is not always better.

Prevention of Arthritis/ Arthroscopy

Focal femoral condyle resurfacing.

Total knee replacement.

Not Pt specific instruments or cutting blocks

Pt Specific Knee implant

Enhanced arthroplasty recovery Programme. 1. Pre Op Pt Education. 2. Pre and Post op Hb level. 3. Pre op neutrition.: Low Albumin

and transferrin levels are predictors of longer

Recovery. Preemptive analgesia. Gabapentin and Cox 2 inhibitors

from 1st day of op upto 7 days.

Risk and Benefit of joint replacement

Risk. Infection. DVT . PE. Stiffness, Residual pain

BENEFIT No Pain . Deformity

correction . No Medication . Psychososial

benefit. Mood Life span

Longevity of the knee replacement.

Fear of operation .

Fear of operation

Anecdotal Surgeon , Qualification, Training and

experience. Financial aspect Pt

Surgeon

Gov/ MCI Rules/ Regulation. Accountability.

Chances of failure after two stage revision ( THR)

Prognostic factors. Elevated BMI Smoking . Anaemia Connective tissue disease .

Exercise and

Arthritis

Does exercise and physical activity helps or hurt arthritis.

Exercises

Exercise ( Contd)

Increases strength and flexibility. Reduces joint pain. Reduces fatigue Helps in maintaining healthy wt. Make u feel better & improves

sense of well being. Decreases depression and

elevates Mood.

Exercises for Arthritis

1. Range of motion exercises .

2. Strengthening exercises .

3. Aerobic or endurance exercises .

Arthritis ( osteoarthritis) Age related or wear and tear

arthritis. Inflammatory: - RA. , Gouty, Ca PD, Traumatic. Infective.

Prevalence of arthritis ( Wt) 16% of under or normal wt adults. 22% of over wt 31% of obese adultsHave doctor diagnosed arthritis

Over all 66% of Over wt or obese adults

53% of normal adults.

Benefits of fish-derived fat Japan ; fish consumption is higher

than USA, UK the prevalence of RA is lowest 0.4%.

Drugs

1. Corticosteroids. Prednisolone etc

AVN of femoral head, Humeral head. Talus etc2. Diuretics; increase the risk of gout3. Drug induced Lupus;-

Procainamide, hydralazine

The relation between total joint arthroplasty and risk for serious cardiovascular events in pt with moderate – severe OA .

BMJ 2013 347

Objective : whether THR & TKR reduces the risk for serious cardiovascular events in pt with severe OA

2200 adults with OA hip and Knee aged 55 or more followed until death / 7 yrs .

Factors that exacerbate the risk of CVD

Hypertension. Diabetes . Smoking. High BMI. Increased stress . use of NSAID underlying inflammation. Physical inactivity.

40 % of adults aged over 65 are physically inactive due to OA

18% of adult American have OA

Reasons for Increased all cause mortality due to cardiovascular causes.

Functional limitation due to OA. NSAID use. Increased psychosocial stress.

Proven benefits of total joint arthroplasty for improving

1. pain. 2. mobility 3. gait. 4. quality of life, 5.Overall function.

Benefits of total joint arthroplasty Improvement in 1.pain. 2. mobility. 3. gait. 4. Quality of life 5. walking distance. 6. mood.

Total joint arthroplasty is associated with 40 % reduction in subsequent risk of serious cardiovascular event

Choose Wisely.

AVOID: 1. Routine Post op DVT U/S in pt with THR and TKR.

2. arthroscopic knee wash out for OA knee for long term relief.

Do NOT 3. use Glucosamine and chondroitin to treat OA Knee.

4. use Lat Heel wedge for Med Compartment OA .

5.Syn Visc or Hyalgan for OA Knee. 6. Post op Splinting of wrist after CTR