Transcript Your Joint Pain And Treatment Options

Your Joint Pain and
Treatment Options
Steven L. Drayer M.D.
Private Practice-Lansing/Sparrow Hospital
Joint Pain and Treatment Options
About My Practice
1) Trained at Henry Ford Hospital in Detroit, Michigan.
2) Have been in private practice for 20 years
3) Have been performing joint replacements for 24 years
4) I perform approximately 150 replacements/year, not
including those done for broken hips. These are knee
and hip primarily, but also shoulder and, rarely, elbow.
Joint Pain and Treatment Options
5) I also perform revision surgery for worn out, loose or
painful joint replacements.
6) I update my knowledge on joint replacement surgery
twice a year at educational courses.
7) I’m well trained and experienced in alternative
treatments for arthritis. These include medications,
P.T., exercise, dieting, bracing, injection therapy,
arthroscopic surgery, cartilage transplant and partial
joint replacements.
Joint Pain and Treatment Options
What is arthritis?
1) It is the loss of joint surface that covers the bone. This
special surface allows the bones to glide effortlessly,
smoothly and pain-free. (This is the white, pearly
substance on the end of the chicken bone.)
2) It is not to be confused with osteoporosis which is the
loss of bone mass.
3) The loss of this surface, whether partial or complete,
results in variable pain, stiffness, swelling, weakness
and loss of motion.
4) With progression over time it results in the destruction
of the underlying bone and adjacent ligaments.
Joint Pain and Treatment Options
How does it present?
1) It can either present in a slow gradual fashion or have
a sudden appearance after a minor injury.
2) You can have “good and bad” days. Pain will be low
level aching to intense pain that won’t allow walking on
the leg.
3) You can be stiff and achy in the morning, comfortable
during the day, then painful at the days end.
4) Oft time the pain will lessen with mild to moderate
activities.
5) You may experience popping, locking or catching.
Joint Pain and Treatment Options
6) Prolonged positions will cause increase symptoms, ie.
Standing in line, long car rides or sitting for a movie.
7) You avoid, or have difficulty doing, activities like
kneeling, squatting, stair climbing, getting out of
cars/chairs or even tying your shoes.
8) You have trouble finding a comfortable position while
resting at home with a book or watching t.v.
9) You have trouble with waking up at night due to joint
pain.
Joint Pain and Treatment Options
Diagnosis
Physical Examination
Tenderness to the touch
Weakness in the muscles
Loss of passive and active range of motion
Spurs that can be felt along the bone edges
Grinding, popping or other joint noises that
can be felt or heard
Fluid on the knee
Catching or locking
Joint Pain and Treatment Options
Diagnosis
Additional Tests
X-Rays (needs to be done with one view in the
standing position)
Joint Pain and Treatment Options
Nonsurgical Options
Diet and Exercise
Rest and Joint Care
Cane / Walker
Medications
Cortisone
Glucosamine
Visco-supplementation
Braces
Joint Pain and Treatment Options
Treatment Options
Rest
Short-term bed rest helps reduce both joint
inflammation and pain, and is especially useful when
multiple joints are affected and fatigue is a major
problem.
Individual joint rest is most helpful when arthritis
involves one or only a few joints.
Joint Pain and Treatment Options
Weight Loss
Average American is 20–40 lbs. overweight
Average person takes 5000-7000 steps/day
Reduces stress on weight-bearing joints
Joint Pain and Treatment Options
Balanced Diet
Helps manage weight
–
Extra pressure on some joints may aggravate your arthritis
Stay healthy
Joint Pain and Treatment Options
Range of Motion Exercises
Stretching
Maintains normal joint movement
Increases flexibility
Relieves stiffness
Increases the ease of surgery, thus allowing better
outcomes.
Joint Pain and Treatment Options
Strengthening Exercises
Increasing muscle strength helps support and protect
joints affected by arthritis.
Exercise is an important part of arthritis treatment that
is most effective when done properly and routinely.
Allows easier recovery and shorter rehabilitation after
surgery.
Joint Pain and Treatment Options
Aerobic Exercises
Walking, Biking
Improve cardiovascular fitness
Helps control weight
May help reduce inflammation in
joints
For those worried about
advancement of arthritis, a
Swedish study showed no
progression of arthritis with
moderate exercise.
Joint Pain and Treatment Options
Heat and Cold Therapies
Reduce pain and inflammation
Heat Therapy
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Increases blood flow, tolerance for pain, flexibility
Cold Therapy
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Cold packs, ice massage, OTC sprays and ointments
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Reduces pain by numbing the nerves around the joint
Joint Pain and Treatment Options
Physical Therapy
The goal is to get you back to the point where you can
perform normal, everyday activities without difficulty.
Preserving good range of motion is key to maintaining
the ability to perform daily activities.
Physical therapists provide exercises designed to
preserve the strength and use of your joints.
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Show you the best way to move from one position to another
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Teach you how to use walking aids
Joint Pain and Treatment Options
Assistive Devices
Make activities easier and less stressful for the joints and
muscles.
Splint or brace when recommended by a doctor or
therapist
Walking aides
Orthotics
Bath stool for use in the shower or tub
Sock grippers
Other devices are available to assist with everyday
activities.
Joint Pain and Treatment Options
Walking Aides
Cane
Walker
Helps keep you balanced so you don’t hurt other joints.
Joint Pain and Treatment Options
Medications: Analgesics
Analgesics, pain relievers,
may provide temporary relief
of arthritis pain.
Joint Pain and Treatment Options
Medications: NSAIDs
Traditional
Aspirin
Ibuprofen
Naproxen
New
Cox II
Joint Pain and Treatment Options
Medications: Topical Pain Relievers
Over-the-counter patches, rubs and ointments can
provide quick pain relief for people with arthritis that is
in just a few joints − such as a hand − or whose pain
isn't severe.
Joint Pain and Treatment Options
Nutritional Supplements
Glucosamine and Chondroitin may relieve joint pain.
Occur in the body naturally; vital to normal cartilage
function.
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Researchers are also studying chondroitin for use
in making medicines more effective and helping to
prevent blood clots (anticoagulant).
Not FDA approved
Warrant further in-depth studies on their safety and
effectiveness, according to the Arthritis Foundation.
Source: Arthritis.org website, Aug. 2006
Joint Pain and Treatment Options
May help osteoarthritis pain and improve
function.1, 2
Some studies indicate that glucosamine may
help as much as ibuprofen in relieving
symptoms of osteoarthritis, particularly in the
knee, with fewer side effects
1. Dieppe P, et al. (2002). Osteoarthritis. Clinical Evidence (7): 1071–1090.
2. McAlindon TE, et al. (2000). Glucosamine and chondroitin for treatment
of osteoarthritis. A systematic quality assessment and meta-analysis.
JAMA, 283(11): 1469–1475.
3. Update on glucosamine for osteoarthritis (2001). Medical Letter on
Drugs and Therapeutics, 43(1120): 111–112.
Joint Pain and Treatment Options
Side Effects of Glucosamine and
Chondroitin
These arthritis supplements are generally well tolerated.
However, side effects can occur. The most commonly
reported side effects are:
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Nausea
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Diarrhea or constipation
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Heartburn
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Increased intestinal gas
See your doctor for complete information.
Joint Pain and Treatment Options
Glucosamine and Chondroitin
People with osteoarthritis who have diabetes should
talk with a doctor before they take glucosamine
because it may influence blood sugar (glucose).
Do not take glucosamine if you are allergic to shellfish.
–
Glucosamine is made from shellfish covering
Source: WebMD
Joint Pain and Treatment Options
Dietary Supplements
Other than in vitamins and minerals, the long-term
effects of most dietary supplements are not known.
Talk to your doctor before taking supplements.
Joint Pain and Treatment Options
Corticosteroids
Decrease inflammation
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Oral
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Cream (topical)
Short-term side effects include
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Swelling, increased appetite
Long-term side effects include
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Stretch marks, excessive hair growth, osteoporosis, high blood
pressure, infections and high blood sugar
Joint Pain and Treatment Options
Injections: Corticosteroids
Injection
Effective
Temporary
Joint Pain and Treatment Options
Injections / Visco-supplementation
Hyaluronic Acid (Cock’s Comb)
Injection
Effective (5-13 wks)
Does Not Prevent Progression
Joint Pain and Treatment Options
Hyaluronic Acid
Natural substance that lubricates the joint
Injection
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Lubricates the joint
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Provides temporary relief of pain and movement
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80 to 85% of individuals who are treated with this series of
injections have some amount of pain relief which lasts anywhere
from nine to 12 months.*
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Approved for knee osteoarthritis
*http://uconnsportsmed.uchc.edu/patientinfo/whathurts/treatment/hyaluronic_acid.html
Joint Pain and Treatment Options
Knee Braces
Simple Braces
“Unloader” Braces
Joint Pain and Treatment Options
When to have a Joint Replacement
Joint replacement may be a treatment option when:
Pain is chronic or more recent and disabling
Pain interferes with desired activities
Pain interferes with daily activities, recreational or work
activities
Significant loss of motion (this will become permanent)
occurs.
Joint Pain and Treatment Options
When to have a Joint Replacement
•
When rest pain becomes prominent.
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When you have joint pain that wakes you up at night.
•
When there has been a failure of medical treatment to
relieve pain.
•
When there is severe bony deformity on x-ray.
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Joint Replacement
Preoperative
Preparing for a joint replacement
procedure begins weeks before
the actual day of surgery.
In general, patients may need:
Routine blood tests
Urinalysis
Physical examination
Exercise
Quit smoking
Stop certain medications
Donate blood
Joint Pain and Treatment Options
Total Joint Replacement
Goals of total joint replacement
are to help:
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Relieve pain
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Restore motion
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Improve function
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Improve fitness and health
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Restore quality of life
Joint Pain and Treatment Options
Your Hip Joint
A joint is formed by the ends
of 2 or more bones.
The hip must bear the full
force of your weight and
consists of two main parts:
A ball (femoral head) at the
top of your thigh bone
(femur)
A rounded socket
(acetabulum) in your pelvis
Normal hip joint, showing healthy articular cartilage
Joint Pain and Treatment Options
What Causes Hip Joint Pain?
One of the most common
causes of joint pain is arthritis.
The most common types of
arthritis are:
Osteoarthritis (OA)
Rheumatoid Arthritis (RA)
Post-traumatic Arthritis
Avascular Necrosis
Diseased hip joint, showing worn cartilage
Joint Pain and Treatment Options
Total Hip Replacement
Joint Pain and Treatment Options
Your Knee Joint
Femur – thigh bone
Cartilage – tissue between bones
that provides cushioning
Patella – knee cap
Tibia – shin bone
Synovium – tissue that provides
lubricating fluid to joint
Ligament – flexible tissue that
holds knee joint together
Joint Pain and Treatment Options
Total Knee Joint Replacement
End surface of femur replaced
with metal
End surface of tibia replaced
with metal
Plastic liner is inserted between
femur and tibia
Patella is resurfaced
with plastic
The entire knee is not removed
as myth and lore would have it.
This is a resurfacing procedure.
Joint Pain and Treatment Options
Total Knee Replacement
Joint Pain and Treatment Options
Limitations After Surgery
Athletic activities that place
excessive stress on the
joint replacement will need
to be avoided. Examples
of these activities include:
Skiing (snow or water)
Basketball
Baseball
Contact sports
Running
Frequent jumping
Joint Pain and Treatment Options
Enhanced Performance After Surgery
1) My goal as a joint surgeon is to meet the activity
demands of my patients.
2) We now have a more active “older” population.
3) The newer materials now available are more durable
and longer lasting to meet these demands. (ceramics,
high density polyethylene, HA coated components,
metal-on metal.)
4) There are certainly higher risk activities for joint
patients, yet many on the previous slide can be
undertaken by experienced individuals.
Technology for Active Patients
Trident® Ceramic
Steven L. Drayer M.D.
Private Practice-Lansing/Sparrow Hospital
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Realistic Expectations
Longevity of Hip Replacement
Age
Weight
Activity level
Bone strength
New Technology for Active Patients
Trident Ceramic
New Technologies are
Meeting the Needs of the
More Active Patient
Joint Pain and Treatment Options
Hip Implant Options
Conventional Hip Implants
Ceramic Hip Implants
Acetabular shell
Acetabular shell
Plastic insert
Ceramic insert
Metal femoral head
Ceramic femoral head
Femoral stem
Joint Pain and Treatment Options
Ceramic in Hip Replacement
Superior wear performance in laboratory testing
compared to metal-plastic bearings*
Excellent biocompatibility
Long clinical history
Provides smooth surface with low friction
Extremely hard material
*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th
Ann. Mtg. ORS, 51, 1998.
Joint Pain and Treatment Options
Experience with Ceramics
Ceramic is used in aeronautics, bullet proof vests and
golf clubs
Ceramics in hip replacement have evolved over the
past 30 years
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Early use in the US revealed limitations
Joint Pain and Treatment Options
Trident® Ceramic System
Improvements in material strength, quality and design
Advanced processing, testing and quality control
produces stable, extremely strong ceramic implants
Joint Pain and Treatment Options
U.S. Clinical Study
The first US clinical study of contemporary ceramic-onceramic hip replacements began in 1996
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Over 1,300 hip surgeries
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16 centers in the United States
FDA approved Trident® Ceramic for sale in the
US in February 2003
Joint Pain and Treatment Options
Alumina Ceramics in Hip
Replacement
Alumina ceramic-on-ceramic components
demonstrate significantly lower wear versus
conventional metal-on-plastic components
in laboratory testing.
Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th
Ann. Mtg. ORS, 51, 1998.
Joint Pain and Treatment Options
Range of motion (ROM) of the
Trident® Ceramic System
Although there are many factors that will influence your
range of motion, the Trident® Ceramic System is
designed to accommodate the range of motion as in a
normal, healthy hip joint
An increased ROM may help minimize the risk of hip
dislocation
Joint Pain and Treatment Options
Trident® Ceramic System
Biocompatible
Reduces friction
Extremely hard
Superior wear properties to
other bearings available on the
market today*
*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th
Ann. Mtg. ORS, 51, 1998.
Joint Pain and Treatment Options
Ceramic-on-Ceramic
Hip Replacement
Additional information about ceramic hip replacement is
available to you:
Call 1-888-STRYKER or
visit www.aboutstryker.com
Individual results may vary. There are potential risks and recovery takes time. The life of any joint replacement will depend on your weight, age, activity
level and other factors. Only an orthopaedic surgeon can tell if surgery is right for you.
Joint Pain and Treatment Options
Joint Replacement Survival
1) In the 50 year old and greater age group 95% of the
replaced joints are functioning well at over 20 years.
2) In the younger than 50 year old group 70% are
functioning well at 10-15 years after placement.
3) This data does not include the data on the new
ceramic and metal on metal hip replacements.
4) Finally, all joint replacements are now modular. Should
a singular part wear out, it can be replaced with a
simpler, less involved surgery.
Minimally Invasive
Total Hip Replacement
Steven L. Drayer M.D.
Private Practice-Lansing/Sparrow Hospital
Joint Pain and Treatment Options
Topics
What is hip arthritis?
What is conventional hip replacement surgery?
What is MIS hip replacement surgery?
Joint Pain and Treatment Options
Ready to Consider Hip Replacement?
You're Not Alone!
Today, more than
300,000 Americans a
year have hip
replacement surgery
First performed in 1960,
this procedure is
considered one of the
most important surgical
advances of the past 100
years
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Replaced Hip X-ray
Joint Pain and Treatment Options
What is ‘Minimally Invasive Surgery’?
MIS is a general term used to describe a surgical
procedure that often utilizes a smaller incision(s) than
conventional surgery. In these cases ‘MIS’ more
accurately describes “Mini Incision Surgery”
Other MIS procedures reduce the amount of soft tissue
(muscles and tendons, etc) that are disrupted during
surgery. In these cases ‘MIS’ more accurately
describes “Minimally Invasive Surgery”
Joint Pain and Treatment Options
What are the potential benefits of
MIS Hip Surgery?
Less soft tissue
disruption
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Faster discharge from the
hospital
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Quicker rehab and
recovery
Less blood loss
Reduced pain
Smaller scar
Source: Keggi, Kristaps J., Total Hip Arthroplasty Through
A Minimally Invasive Anterior Surgical Approach JBJS,
Vol. 85-A.
Joint Pain and Treatment Options
What are the potential risks?
Results may vary from patient to patient
Surgery time may be extended
Risk factors relating to anatomy, weight, and prior joint
replacements
Risks which are normally encountered in conventional
THA remain
Joint Pain and Treatment Options
Is MIS Total Hip Arthroplasty for
everyone?
No, patient limitations include:
Obese, high BMI
Muscular males
Pre-existing conditions
Joint Pain and Treatment Options
Stryker Implant Technology
Accolade® TMZF® is an MIS-friendly
implant
Compatible with ceramic-on-ceramic
technology for long-term results
Joint Pain and Treatment Options
What Do I Do?
1) Talk to your orthopedic
surgeon.
2) Find out the best joint
treatment option for you.
3) Visit the website of your
surgeon, AAOS or joint
manufacturer.
4) Ask questions!
Joint Pain and Treatment Options
517.371.3407