Transcript Jenelle Jordan Emcee representing DePuy Orthopaedics, Inc.

Jenelle Jordan
Emcee representing
DePuy Orthopaedics, Inc.
Welcome!
• You should have with you several forms:
– Event Questionnaire – an event feedback form
• Please return this to us at the end of the event
– Personal Assessment Form – a self-test of your
mobility
– “For More Information” Form – please return this
to us to request additional information about knee
replacement
Agenda
• Discuss treatment options for severe
knee and hip pain
• Conservative and injection alternatives
• Patient stories
• Questions & answers
Advances in the
Conservative Management
of
Hip & Knee Arthritis
Steven B. Shine, D. O.
Access Orthopaedics
Northern Ohio Medical Specialists
What is Osteoarthritis?
 Osteoarthritis is the most
common form of arthritis
and the most common joint
disease.
 Over 10 million Americans
have knee osteoarthritis.
 Most people who have
osteoarthritis are older
than age 45.
 Not all are symptomatic
 Women are more
commonly affected than
men.
Arthritis stages
 mild
mild
severe
Arthritis Characteristics
Degenerative condition of bones
and joints
 Pain
 Swelling
 Limited movements in joints
Leading Causes of Disability
Among U.S. Adults
V103
Hip / Knee Joints - the largest joints in the body
- weight-bearing joints
Normal Knee
Arthritic Knee
Arthritis Diagnoses are Increasing
60
59 mil.
Million
50
40
40 mil.
30
20
10
0
2000
2020
(Projected)
Joint Replacement Advances
1986
10-12 in.
2006
4-6 in.
Types of Arthritis
 Osteoarthritis (wear and
tear)
 Inflammatory arthritis
 Post-traumatic arthritis
caused by:
 Fractures / Trauma
 Ligament injury
 Meniscus / cartilage injury
Osteoarthritis Management
Treatment








Exercise / Physical Therapy
Weight Control
Prescription Medication
Glucosamine
Steroid Injections
Use of Heat and Cold
Joint Fluid Therapy
Surgery (arthroscopy,
osteotomy or replacement)

(Alternative therapy - magnets /
copper bracelets)
Arthritis Progression
 Large sections of cartilage
may wear away
completely with time.
 The joint may lose its
normal shape as the
cartilage breaks down.
Osteoarthritis
(Degenerative Arthritis)
Exercises for arthritis
 Closed chain exercises for the lower
extremities are any form of exercises where your
feet stay in contact with the point of resistance.
 goal to achieve = 30 minutes minimum – daily –
Water Exercise – “less stress”
Why water exercise:
 Buoyancy and warm water helps
relieves arthritis pain and stiffness.
 Warm water raises body temperature,
which increases circulation.
 Gentle exercise on joints and muscles.
 Helps build muscle strength.
Non-Surgical Treatment
Options for Knee Pain
 Orthotics & Braces
 Assistive devices (Cane, lift
chair, ramps. etc.)




Walking
Bathrooms
Climbing
Dressing
Steroid Injections
- relief for weeks to months







Celestone
Kenalog
Aristocort
Solu-Medrol
Depo-Medrol
Aristospan
Decadron
Joint Fluid Therapy (Visco - Supplementation)
“Rooster combs”
Synvisc


Supartz
Hyalgan
Orthovisc
Hyaluronate is the natural lubricant and shock absorber in all joints.
Osteoarthritis reduces the body’s ability to produce it’s own hyaluronate.
Indications:





Prescription medication is not controlling pain
It is a device, not a drug, therefore no drug to drug interactions
Preference to avoid or delay surgery
Local treatment specific to the knee
Binds to substance ‘p’

More than 155 million injections worldwide
Arthroscopy
Arthroscopic meniscus repair
Partial Meniscectomy
“Bone on Bone” Wear
Total Joint Replacement
Questions?
Dr. Mike Powers
Orthopaedic Surgeon
Access Orthopaedics
What is Osteoarthritis?
• Cartilage deteriorates
and friction is created
between bone
surfaces.
• Symptoms include:
– Chronic knee pain
– Knee stiffness
– Difficulty with everyday
activities (walking,
driving, stair climbing)
Knee Osteoarthritis Treatments
Early
Intervention
Non-surgical
Treatments
Knee
Replacement
• Medication
• Prescription medications • 400,000
• Weight control • Physical therapy
performed
• Exercise
yearly in the
• Injection therapy
U.S.
• Bracing
Total Knee Replacement: Who’s a
candidate?
Many patients that could be helped
by knee replacement do not know
about it or do not seek care
-Lack of knowledge
-Misconceptions
-Fear
19%
28%
26%
11%
Less than 1 year
1-2 years
2-3 years
3-5 years
More than 5 years
16%
• How long are people waiting for surgery?
Total Knee Replacement
• Most common
joint replaced
• First performed in
1968
• Nearly 400,000
TKR’s performed
per year in US
Knee Replacement
Knee replacement surgery is the replacement of the worn
and arthritic surfaces of the knee joint
Are You Ready for Knee
Replacement?
 Does your knee hurt one or more days per week?
 Does the pain interfere with your sleep?
 Is it painful for you to walk with simple daily activities?
 Are pain medications no longer working?
 Is knee pain limiting your exercise regimen?
 Has inactivity from knee pain caused you to gain weight?
 Can you limit activities for a few months to recover from
surgery?
 Are you willing to commit to work hard during rehabilitation
for a successful recovery?
Should You Delay Surgery?
• Early diagnosis and treatment for total knee
replacement are important1
– Delaying surgery can lower quality of life before the
operation and up to two years after surgery2
• Pre-existing medical conditions may become
more serious, delaying elective surgery3
• Osteoarthritis is degenerative – it will not get
better and will likely get worse!
1: Fortin, Paul R., et al. “Outcomes of Total Hip and Knee Replacement.” Arthritis & Rheumatism 42 (1999): 1722-1728
2: Fortin, Paul R., et al. “Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients with Osteoarthritis of the Hip or Knee.”
Arthritis & Rheumatism 46 (12) (2002): 3327-3330
3: www.jointreplacement.com
Surgical Procedure
• Arthritic surface on top of
the shin bone is removed.
• A metal tray (tibial tray) is
placed on top of
remaining bone.
• Tibial insert locked into
tray.
• Incision is closed.
Source: www.Jointreplacement.com, 2006
Hospital Discharge
• You will be released from the hospital as soon as
you can:
–
–
–
–
–
Get in and out of bed safely.
Walk up to 75 feet with your crutches or walker.
Get up and down short flight of stairs.
Access the bathroom.
Demonstrate good muscle contraction of the upper thigh
muscle.
• Hospital stay usually lasts 3 days.
• May continue physical therapy at a rehabilitation
center or at home.
Source: www.Jointreplacement.com, 2006
Recovery in the First Month
• Sutures or staples usually taken out 10-14
days after surgery.
• Motion exercises should be progressing.
• Walker or assistive device for 4 weeks
• Usually can drive at 4 weeks
Source: www.aaos.org , 2006
Recovery After Six Weeks
• Swelling normal for first three to six months
– Elevate leg slightly and apply ice.
• Therapy continues as outpatient home
exercise program
• Return to work in 6 to 12 weeks depending
on type of work.
Source: www.aaos.org , 2006
But You Should Also Know…
• Performance of joint replacements depends on age,
weight, activity level and other factors.
• There are potential risks and recovery takes time.
• People with current infections or conditions limiting
rehabilitation should not have this surgery.
• Potential complications which could result in pain,
stiffness or dislocation of the joint include:
–
–
–
–
Loosening
Fracturing
Wearing of the components
Infection
Knee Replacement Options
• Traditional: fixed-bearing
• Unique: mobile-bearing (also called
Rotating Platform)
Unique Options in
Knee Replacement
• Rotating Platform Knee
– Designed to rotate as it bends, imitating natural knee
movement
• The surfaces roll and glide against each other as the knee
bends, just as your natural knee does
• Designed for patients who want to remain active since it
minimizes implant wear, compared to fixed-bearing knees1
• A multi-center internal study shows 97% patient satisfaction
at 5 years
• 90% survivorship at 20 years
1: McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2)” (2003)
2: DePuy Multi-Center Study (2006)
Why is Rotation Important?
Important Considerations
for Women
• Osteoarthritis affects three times more
women than men1
– Women are more likely than men to be disabled
– The pain is more severe for women2
• Women’s knees rotate more than men’s,
especially during deep bending (kneeling)3
• Current knee replacements are designed to fit
the anatomies of both women and men
1: Hawker, Gillian A., et al. "Differences Between Men and Women in the Rate of Use of Hip and Knee Arthroplasty." The New England Journal of Medicine
342 (2000): 1016-1022
2: Harris Interactive research survey, April 2005
3: Hsu, Wei-Hsiu, et al. “Difference in Torsional Joint Stiffness of the Knee Between Genders.” The American Journal of Sports Medicine Vol. 34, No. 5
(2006): 765-770.
Gender-Specific Implants
• There is no clinical support of the need for genderspecific implants
• All orthopaedic manufacturers have knee implant
systems with sizes appropriate for both females and
males
• More than 60% of knee replacements have been
implanted in women1
• Current knee replacement patients have a 90 to 95%
satisfaction rate with the results of their surgery2
1: American Academy of Orthopaedic Surgeons (http://www.aaos.org/wordhtml/research/stats/Hipkneefacts.htm) (2006)
2: The Arthritis Foundation (http://www.arthritis.org/research/Bulletin/vol51no11/Printable.htm) (2006)
Patient Testimonial
Diane Timple
• 53 year old full time registered nurse
• Osteoathritis failing conservative care
• Left knee replacement 3-28-2006 with the
Depuy Rotating Platform system
• “Best decision I have made in a longtime and
allowed me to hike the Grand Canyon this
past March.”
• “I wish I did it sooner and I will not hesitate
when it comes to my right knee!”
Life After Knee
Replacement Surgery
• Patients encouraged to resume a healthy,
active lifestyle, including participating in lowimpact sports such as:
– Walking
– Swimming
– Cycling
– Golfing
• More aggressive sports or activities should
not be attempted without a doctor’s approval
Timothy R. Lynch, D.O.
Treatment options for severe hip pain
Dr Lynch did not want his section of the lecture up on
the web at this time.
David A. Pocos, D.O.
Miscellaneous Topics
in Joint Replacement
Surgery
Batting “clean-up”
Topics
• Partial knee replacement
• Patellofemoral replacement
• Minimally invasive joint replacement
• Rehabilitation
Partial Knee Replacement
• aka Unicompartmental knee
arthroplasty, unicondylar knee
arthroplasty
Partial Knee Replacement
• Removes damaged cartilage in single
area of the knee, inside or outside
Partial Knee Replacement
Partial Knee Replacement
• Preservation of bone
• Quicker rehabilitation
Partial Knee Replacement
• Strict indications
– Deformity
– Motion
– Stability
– Type of arthritis
• Results less favorable when straying
from the indications
Patellofemoral Replacement
• Replacement of only the joint between
the knee cap (patella) and femur
• Newer procedure
• Good results thus far
• Bone is preserved
Patellofemoral Replacement
Minimally Invasive Surgery
(MIS)
• Minimally Invasive vs. Less Invasive
– Minimally traumatic – less damage to
tissues
– Direct–to–consumer marketing
– Information availability
MIS Hip Replacement
• One-Incision technique (Mini-Incision)
– One incision 3 to 4 inches in length
– Either front or back of thigh
• Two-Incision technique
– On both the front and the back
– Each measuring 2 inches in length
MIS Hip Replacement
• Advantages
– Potentially less trauma
– May be less blood loss
– Less postoperative pain
– May lead to shortened hospital stay
– May reduce recovery time
– Scars smaller
MIS Hip Replacement
• Disadvantages
– Increased risk of complications
• Inappropriate alignment
• Inadequate fixation
• Fracture
– Can be a lengthy procedure
• Increased wound exposure – infection
• Increased blood loss
– Contraindicated in severely obese and very
muscular
MIS Hip - Conclusions
• Not proven
– Traditional hip replacement proven in
clinical studies
– Long-term effects and results of MIS hip
unknown
• Increased risk
MIS Knee Replacement
• Standard knee replacement
– Quadriceps tendon split
• Mini-incision medial parapatellar
MIS Knee Replacement
MIS Knee Replacement
• Midvastus approach
– Split is made in line with muscle fibers
MIS Knee Replacement
• Subvastus approach
– Come in underneath the muscle
MIS Knee Replacement
• Quadricep-sparing approach
– Small incision in joint capsule
– All work done from side
MIS Knee Replacement
• Advantages
– Less trauma (LIS)
– Less bleeding
– Less pain
– ? Shorter hospital stay
– ? Faster rehabilitation
MIS Knee Replacement
• Disadvantages
– Studies still in evaluation
– Potential benefits
– Not for everybody
MIS Knee - Conclusions
• Outcomes seem more attainable than
those of MIS hip
• Retain ability to maintain good
visualization
• Will likely fit into the concept of less
invasive surgery nicely
Rehabilitation
Hospital Discharge
• Hospital stay usually lasts 3 to 4 days.
• May continue physical therapy at a
rehabilitation center or at home.
Hospital Discharge
• You will be released from the hospital as soon as
you can:
–
–
–
–
–
Get in and out of bed safely.
Walk up to 75 feet with your crutches or walker.
Get up and down flight of stairs.
Access the bathroom.
Demonstrate good muscle contraction of the upper thigh
muscle.
Source: www.Jointreplacement.com, 2003
Recovery in the First Week
• Continued use of your walker or crutches
is required.
• With a cemented procedure, increase
weight on sore leg as comfortable.
• With a cementless procedure, place only
the toes down until a follow-up x-ray.
Source: www.Jointreplacement.com, 2003
Recovery in the First Month
• Sutures or staples usually taken out 10-14
days after surgery.
• Do not shower or bathe until the sutures
or staples are removed.
• Motion exercises should be progressing.
Source: www.aaos.org , 2003
Recovery After Six Weeks
• Swelling normal for first 3 to 6 months
– Elevate leg slightly and apply ice.
• Driving
– 4 to 6 weeks depending on side, vehicle, etc.
• Return to work in 6 to 8 weeks depending on
type of work.
Source: www.aaos.org , 2003
Resources
• accessorthopaedics.com
• jointreplacement.com
• kneereplacement.com
• hipreplacement.com
Thank You
Norwalk
Sandusky
Willard
Event Questionnaires
• Please take a moment to complete the
event questionnaires
• Please pick up additional information
about knee replacement as you leave
• Don’t forget your free gift!
Thank you for attending our event:
“Restoring the Joy of Motion”
Questions?
For more information:
Access Orthopaedics
419-663-5000
www.kneereplacement.com
or visit www.aaos.org
TM