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Osteoarthritis(OA)
Dr. Timothy Payne, MD
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What is Osteoarthritis?
Osteoarthritis is primarily a non-inflammatory degenerative disorder of moveable joints characterized by an imbalance between the synthesis and degradation of the articular cartilage, leading to the classic pathologic changes and destruction of cartilage
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Osteoarthritis Incidence
• Found in 80-87% of people over age 55• Found in over 95% of people of 65• Found in 40 million adults• 20 million have hip or knee arthritis; 10
million treat it• 5 million have severe degenerative joint
disorder• 400,000 TKRs and 160,000 total hips per
year
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Progression of Disease
• First signs of disease (Mild OA)– Cartilage starts to
wear down and thin out
– May not have any pain or stiffness or be hindered in any activity unless it is prolonged
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Progression of Disease
• Moderate OA– Thinning cartilage causes
bones to rub on each other, causing pain with weight-bearing
– Joint space narrows– Pain tends to worsen as day
progresses and is present with most activity
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Progression of Disease
• Severe OA– Bone on bone contact creates inflammation,
pain, swelling and development of osteophytes (bone spurs)
– Pain is generally constant
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Common Treatments
• NSAIDs (non-steroidal anti-inflammatory drugs)
• Physical Therapy
• Hyaluronic Acid Injections
• Bracing
• BioniCare
• Total Knee Replacement
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NSAIDs
• Non-steroidal anti-inflammatory drugs– E.g. Tylenol, Advil,
Aleve, Celebrex, Naprosyn
• Typically prescribed as a first line treatment; often tried by patients prior to physician visit
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NSAIDs
• Advantages– Easily to take, readily available
• Disadvantages– Gastrointestinal, hepatic (liver) and renal
(kidney) complications, especially when taken over long period of time
– Does not slow down progression of disease (treats symptoms)
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Physical Therapy
• Typically consists of – Strengthening exercises– Non-impact aerobic activity to reduce weight– Balance, gait and posture exercises
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Physical Therapy
• Advantages– Focuses specifically on needs of patient– Individual attention by therapist
• Disadvantages– Expensive
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Hyaluronic Acid Injections
• An injection into the knee that lubricates and cushions your joint
• Made from a natural substance similar to healthy joint fluid – Brand names:
Synvisc, Orthovisc, Hyalgan, Supartz
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Hyaluronic Acid Injections
• Advantages– One injection (or series of injections) can
provide relief for several months
• Disadvantages– Does not address the mechanical wear and
tear during weight-bearing activities– Pain, swelling or infection possible at injection
site
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Bracing
• A brace is applied to the leg which takes pressure off of the affected compartment (shares the load during weight-bearing)
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Bracing
• Advantages– Non-invasive– Can reduce additional wear and tear
• Disadvantages– Some braces may be cumbersome for
patients
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BioniCare
• An electrical stimulation device that replicates the signal a healthy knee gives off during weight bearing to reduce pain and other symptoms.
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BioniCare
• Advantages– Non-invasive, very low risk– Studies show reduced pain, improved function and
the effects of the device can be equal to a total knee replacement (2/3rds of patients deferred a TKA for 4 years after using the device)
• Disadvantages– Must be worn for approximately 750 hours to receive
significant benefits (about 3 months with daily use of 6 hours per day)
– Applied with electrodes in a brace, which may be cumbersome for some
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Total Knee Replacement
• Typically recommended when patient has severe pain that prevents normal functioning, and other more conservative methods have failed
• The ends of the femur (thigh bone) and the top of the tibia (shin) along with the patella are replaced with metal and plastic components
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Total Knee Replacement
• Advantages– Worn down surfaces are replaced– Outcomes (reduced pain, improved function)
usually very good
• Disadvantages– Invasive, inherent risks with surgery – Requires physical therapy and exercise post-
surgical for optimal outcomes (may be several months)
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• Questions??
• Thank you!