orthopedic team course meeting: nonoperative treatment of...
TRANSCRIPT
![Page 1: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/1.jpg)
Rafael J. Sierra, MDProfessor
Orthopedic SurgeryMayo Clinic
Rochester, MN
1
Orthopedic Team Course Meeting: Nonoperative Treatment of Hip OA
![Page 2: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/2.jpg)
DisclosuresConsultant and Royalty Agreements
Research SupportBiomet Orthopedics
Consultant: Link Orthopedics
Institutional Research Support:
Stryker, Depuy, Zimmer
![Page 3: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/3.jpg)
Introduction
• Hip OA: Most Common Cause of Hip Pain in Older Adults
33 Yo Female Hockey Coach
![Page 4: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/4.jpg)
•Osteoarthritis 50%–DDH –FAI
•Osteonecrosis 30%
•Inflammatory 7.8%
•Postraumatic 7.7
Leading to THA< 55 yo
4
Clohisy et al JBJS 2011
![Page 5: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/5.jpg)
Many Years
2007 2015
5
![Page 6: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/6.jpg)
©2013 MFMER | slide-‹#›
Rate of Degenerative Change
Median Time To Progression Between Tönnis Stages CDH FAI Normal
T0 → T1 15.9 years 12.6 years 17.9 yearsT0 → T2 27.2 years 25.7 years 30.6 yearsT0 → T3/THA 33.1 years – –
Log-Rank Test*
![Page 7: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/7.jpg)
Nonoperative Treatment
•Despite the optimism of alternative bearing surfaces including highly cross linked polyethylene, THA should be recommended only after appropriate nonoperative treatment has been exhausted
7
![Page 8: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/8.jpg)
Outline1.Radiographic features of Hip Arthritis that are commonly missed2.Patients with hip symptoms you don't want to miss as joint preservation may help3.Nonoperative treatment modalities for hip OA and their evidence4.When should I refer for surgery?
8
![Page 9: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/9.jpg)
Whats easy to miss…
9
Anterior Wear PatternInstability
![Page 10: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/10.jpg)
Medial OA
10
Pincer FAI
![Page 11: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/11.jpg)
DDH
11
What not to Miss?
20
FAI
![Page 12: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/12.jpg)
•Nonoperative Treatment may be beneficial in early stages of OA•Results are highly patient dependent
Adult Hip OsteoarthritisNon operative Treatment
12
![Page 13: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/13.jpg)
13
![Page 14: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/14.jpg)
Patient Education
• Decreases Pain• Improves Function• Reduces Stiffness and
Fatigue• Decreased Medicine Use• 20% more Pain relief than
NSAIDS alone
14
![Page 15: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/15.jpg)
15
![Page 16: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/16.jpg)
Assistive Devices
• Reduce Pain and Activity Limitation
• Cane in contralateral hand
• Carry Loads in ipsilateral hand
16
![Page 17: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/17.jpg)
17
![Page 18: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/18.jpg)
NSAIDS
• Randomized Trials showing benefit in hip OA
• Must weight the risk of GI bleed and HTN
18
![Page 19: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/19.jpg)
NSAIDS
19
Seminars in in Rheumatism 2015
![Page 20: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/20.jpg)
• I like to Use
• Placebo controlled trial showed benefits of its use
• Improvements for ~ 3 months
Cortisone Injections
20
![Page 21: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/21.jpg)
• Not FDA approved
•May be best for mild to moderate OA
•Metanalysis shows potential benefit in hip OA
Viscosupplementation
21
![Page 22: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/22.jpg)
Glucosamine-Chondroitin
• Mixed Results. Glucosamine may have short term improvement in pain and function
• Chondroitin: Minimal benefit or non-existent
![Page 23: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/23.jpg)
23
American College of Rheumatology Recommendations 2012
![Page 24: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/24.jpg)
Physical Therapy
•Commonly recommended–Functional Training–Flexibility, Strengthening, endurance–Hydrotherapy
•Manual therapy and ROM
24
![Page 25: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/25.jpg)
25
![Page 26: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/26.jpg)
26
Mostly Level II
![Page 27: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/27.jpg)
Real World..
•Patients Want to Be Active•Many Do not Want to Change their Activity Level•Patients find it hard to loose weight•Hip Replacement is very Successful at all ages…
27
![Page 28: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/28.jpg)
Arthroplasty
•Indications–Hip pain that does not respond to non-operative management–Interfering with patient activity level and quality of life
28
![Page 29: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/29.jpg)
Total Hip Arthroplasty
29
![Page 30: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/30.jpg)
In Conclusion
• Hip Arthritis is Common• Do Not want to Miss Patients with Early
Structural Hip Disease that may benefit from joint preservation
• Patients Education, NSAIDS, Cortisone Injections, Physical therapy are accepted forms for non operative management with differing success rates
30
![Page 31: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/31.jpg)
In Conclusion
• When Failure of nonoperative management referral for THA is very appropriate.
31
![Page 32: Orthopedic Team Course Meeting: Nonoperative Treatment of ...meeting.aahks.net/wp-content/uploads/2016/...treatment-of-Hip-OA-2… · • Hip Arthritis is Common • Do Not want to](https://reader035.vdocument.in/reader035/viewer/2022070714/5ed4bea9cc7f1227ee029336/html5/thumbnails/32.jpg)
Thanks32