No MRI Needed

Osteoarthritic kneeHealthy knee

Burden of Disease

• 39.4 million visits to physicians offices

• 750,000 hospitalizations

• OA cost $125 billion/year.

Source: Bone & Joint Decade, Fit to a T

Osteoarthritis HospitalizationsOsteoarthritis Hospitalizations

0

500,000

1,000,000

1,500,000

2,000,000

OA

513,000

Heart Attack

Stroke Breast Cancer

184,300228,000

Annu

al in

cide

nce

750,000

Arthritis Increases With AgeArthritis Increases With AgeUS PopulationUS Population

0

10

20

30

40

50

60

70

Inci

den

ce (

%)

<24 25-34 35-44 45-54 55-64 65-74 75-84 85 +

Crowninshield et al, CORR 443, 2006

Female

Male

Age

On the Other Hand….The Boomer Population is Active

• Baby boomers are staying more active & want to continue their recreation

• Knee arthritis most common problem for active boomers

Primary Osteoarthritis: Most Common

• Thought to be result of aging

• Decreased ability of cartilage to repair itself

• Ligaments and muscles supporting joints weaken

Secondary Osteoarthritis

• Obesity

• Trauma

• Surgery

• Abnormal joints

• Gout

• Diabetes

• Hormone disorders

20

25

30

35

40

45

50

Underweight Healthy Overweight Obese

Arthritis Increases with Body Mass IndexU.S. Adult Population

Inci

denc

e (%

)

Crowninshield. Hip International Vol. 16 2006

It’s a weight issue?

A little goes a long way

• A 5-kg weight loss in the prior 10 years in overweight women resulted in a more than 50% decrease in symptomatic knee osteoarthritis.

Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1992; 116:535-539.

Occupational Risk Factors

– kneeling or squatting

– walking more than two miles a day

– lifting at least 55 pounds regularly

– shipyard or dock worker, miner, and carpet or floor layer

Symptoms

• Pain in affected joints

• Pain worse with prolonged overuse

• Pain better with rest and exercise

• Stiffness relieved by flexing

Diagnosis

• History• Physical exam• X-rays• Blood test to rule out other

diseases

Diagnosis

Osteoarthritic kneeHealthy knee

So Bones…..What’s the treatment

The Degenerative Knee Goals of Treatment• Educate the patient• • pain

• disability , mobility

• Impede progression of disease

Variety of Non-Operative Methods

Behavorial Modification

• losing weight

• switching from running or jumping exercises to swimming or cycling

• minimizing activities that aggravate the condition, such as climbing stairs

Exercise

• Strengthening exercises

• increase range of motion and flexibility

• Physical therapy

21

Pain

Avoidance of

Motion

IncreasedMuscle

Tightness

Loss of Motion

Osteoarthritis(Inflammation of Joints)

Supportive Devices

• Cane

• energy-absorbing shoes or inserts

• brace or knee sleeve can be helpful

Other Methods

• heat or ice

• water exercises

• liniments

• elastic bandages

Drug Treatments

• Tylenol (acetaminophen)• Aspirin• Anti-Inflammatories– NSAIDS– COX2 Inhibitors– Steroids

• Nutriceuticals