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Understanding Knee Arthritis Arthritis

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Understanding Knee Arthritis Arthritis Your Treatment Options Knee Pain Arthritis is COMMON More than 43 million people have some form of Understanding Knee Arthritis arthritis. It is estimated that the number of people affected by arthritis will increase to 60 Michael J. Repine MD million by 2020. Boulder Medical Center Orthopedics (303) 872-4018 Source: CDC Your Treatment Options Your Treatment Options Knee Pain Knee Pain This program will touch upon About Myself the following topics: Oldest of six Review of Knee Anatomy Identical twin Discussion of Arthritis Colorado native Latest Treatment Options for Knee Arthritis Two young boys Expectations/Outcomes Your Treatment Options Your Treatment Options Knee Pain Knee Pain About Myself About My Practice Oldest of six Undergraduate at CU Boulder Identical twin University of Colorado School of Medicine for Colorado native medical school and residency Two boys Board certified in 2005, 2015 I enjoy traveling and Fourteen years at the Boulder Medical Center languages In addition to the management of arthritis, I enjoy trauma, sports-related and hand injuries Your Treatment Options Your Treatment Options Knee Pain Knee Pain ANATOMY Normal Knee Bony Anatomy Your Treatment Options Your Treatment Options Knee Pain Knee Pain The Knee Joint The Knee Joint Musculature Ligaments Multiple muscles Stability acting upon knee Complex array of joint ligaments Critical for knee stability and function Your Treatment Options Your Treatment Options Knee Pain Knee Pain The Knee Joint The Knee Joint Cartilage Cartilage “Like the frosting on a piece of cake” Cartilage is critical in Transmits applied loads understanding arthritis across mobile surfaces Lines the ends of bones Surfaces roll or slide during motion Hyaline cartilage is fluid- filled wear-resistant surface It reduces friction coefficient to 0.0025. Your Treatment Options Your Treatment Options Knee Pain Knee Pain Normal Cartilage Damaged Cartilage “Like the tires on your car” When the cartilage is thinned or absent, problems such as pain, Healthy, normal instability, limited motion occur. cartilage rolls easily This mechanical wearing of the Smooth motion cartilage surface leads to deterioration in the joint or ARTHRITIS Your Treatment Options Your Treatment Options Knee Pain Knee Pain What is ARTHRITIS? What is ARTHRITIS? Definition: Inflammation of a joint, usually Definition: The mechanical wearing of the cartilage accompanied by pain, swelling, and surface resulting in pain and limited function. stiffness. Importantly, this mechanical change is accompanied by biochemical changes Your Treatment Options Your Treatment Options Knee Pain Knee Pain What is ARTHRITIS? What is ARTHRITIS? Normal Anatomy Normal Xrays Arthritis Anatomy Arthritic Xrays Your Treatment Options Your Treatment Options Knee Pain Knee Pain Most Common Causes of Arthritis Evaluation of Knee Arthritis Degenerative – “wear and tear” Osteoarthritic – traumatic Rheumatoid – inflammatory Bacterial - infectious Your Treatment Options Your Treatment Options Knee Pain Knee Pain Diagnosing Knee Pain Symptoms Medical history PAIN Physical examination Weight-bearing activities X-rays, Radiographic Studies While sleeping at night Located across entire Other tests knee or focally to an area Usually slow in onset Your Treatment Options Your Treatment Options Knee Pain Knee Pain Diagnosis Diagnosis Medical History Physical Examination How and when did the pain start? Tenderness to the touch If the pain has occurred before, how was it treated? Weakness in the muscles What activities aggravate the pain? Extent of passive and What activities relieve the pain? active range of motion Crepitation Your Treatment Options Your Treatment Options Knee Pain Knee Pain Diagnosis Diagnosis X-ray Evaluation Additional Tests Blood tests X-rays of an arthritic knee: Computerized Topography (CT) narrowing of the joint scans Magnetic Resonance Imaging space (MRI) scans cystic changes in the – Best non-surgical modality to identify focal cartilage bone defects formation of bone spurs Arthroscopy (osteophytes) – Small areas of traumatic arthritis, loose bodies Your Treatment Options Your Treatment Options Non-Surgical TreatmentKnee Pain Knee Pain Options for Arthritis Nonsurgical treatment options Physical Therapy Almost always start with physical therapy – Improve range of motion – Improve strength – Decreases pain Your Treatment Options Your Treatment Options Knee Pain Knee Pain Nonsurgical treatment options Nonsurgical treatment options Medications Supplements NSAIDS Lots of claims – Decreases inflammation NONE have passed – Decreases pain FDA testing as proven Personal trials Your Treatment Options Your Treatment Options Knee Pain Knee Pain Nonsurgical treatment options Nonsurgical treatment options Cortisone injection Cortisone injection PROS CONS Relatively easy Must be placed carefully Excellent diagnostic tool Masks symptoms Well-tolerated Can soften cartilage Very predictable Used to “buy” time reduction in pain Your Treatment Options Your Treatment Options Knee Pain Knee Pain Nonsurgical treatment options Nonsurgical treatment options Viscosupplement Viscosupplement PROS Purify Hylauronic acid Protects remaining cartilage from rooster combs or bacterial growth Improves biochemical environment of joint “Oil-additive” to joint fluid Reliable reduction in pain Your Treatment Options Your Treatment Options Knee Pain Knee Pain Nonsurgical treatment options Nonsurgical treatment options Viscosupplement Stem Cell Therapy CONS Great claims of what NONE can be treated – * With appropriate Promising early patient selection anecdotal reports Small potential for reaction Expensive with repetitive administration Likely the best future option for moderate arthritis Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical Treatment Algorithm Surgery Treatment Options Focal versus Global Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical Treatment Algorithm Decision Variables Individualized with each patient Focal or Anatomy Physiology Age, Global strength, arthritis range of motion Expectations Your Treatment Options Your Treatment Options Knee Pain Knee Pain Decision Variables Surgical treatment Focal cartilage damage “Pothole” Must catch damage early Best treated before secondary bony changes Anatomy Physiology occur Expectations Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment Focal cartilage damage Focal cartilage damage Microfracture Cartilage Transplantation Largely treated arthroscopically Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical Treatment Focal cartilage damage Global Arthritis Resurfacing Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment More advanced Advanced Arthritis arthritis requires Patient determines the appropriate time for surgical more advanced intervention surgical options Influenced by Xray Unlike hip arthritis, You CAN “miss the boat” for certain procedures Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment At this point decision is Partial versus Total between a partial knee Patient Variables replacement versus a Age total knee replacement. Weight Range of motion Alignment Additional arthritis? X-rays Expectations Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment My Philosophy: Partial Knee Replacement Do ONE surgery well Three distinct compartments Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment Partial Knee Replacement Partial Knee Replacement Makoplasty technique Computer assisted Preoperatively template from CT Scan Extreme precision Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Partial Knee Replacement Partial Knee Replacement Resurfacing Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment Total Knee Replacement Total Knee Replacement Tri-compartmental arthritis Makoplasty technique Mal-alignment Knee contractures Patient factors Your Treatment Options Your Treatment Options Knee Pain Knee Pain Computer Assisted Knee Replacement Surgical treatment Makoplasty Technique: Total Knee Replacement – Preoperative CT scan data is synced to intraoperative Computer assisted data with a probe – Implant positioning and surgical resection can be Preoperatively template planned before any cuts are actually made from CT Scan Extreme precision Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Surgical treatment Total Knee Replacement Total Knee Replacement Real time guidance “Game changer” Balance knee ligaments Less invasive Your Treatment Options Your Treatment Options Knee Pain Knee Pain Surgical treatment Recovery Total Knee Replacement “Game changer” Your Treatment Options Your Treatment Options Knee Pain Knee Pain Recovery Summary Begins immediately You choose the time to Improvements in intervene for knee anesthesia/pain control also replacement facilitate immediate mobility Have to work hard at Start working with therapy to recovery get out of bed Very predictable outcome WBAT with a painless and fully functional knee joint Your Treatment Options Your Treatment Options Knee Pain Knee Pain Thank You Replaced Knee X-ray Michael J. Repine MD Boulder Medical Center Orthopedics (303) 872-4018.
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