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Your Joint Pain and
Treatment Options




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                                                               Joint Pain and Treatment Options
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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.


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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.

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              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.
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            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.


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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.



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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

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Diagnosis
  Additional Tests



 X-Rays (needs to be done with one view in the
 standing position)




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Nonsurgical Options

 Diet and Exercise
 Rest and Joint Care
 Cane / Walker
 Medications
 Cortisone
 Glucosamine
 Visco-supplementation
 Braces
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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.



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Weight Loss
 Average American is 20–40 lbs. overweight
 Average person takes 5000-7000 steps/day
 Reduces stress on weight-bearing joints




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Balanced Diet

 Helps manage weight
  –   Extra pressure on some joints may aggravate your arthritis


 Stay healthy




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Range of Motion Exercises
   Stretching
 Maintains normal joint movement
 Increases flexibility
 Relieves stiffness
 Increases the ease of surgery, thus allowing better
 outcomes.




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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.

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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.
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Heat and Cold Therapies
Reduce pain and inflammation
  Heat Therapy
    –   Increases blood flow, tolerance for pain, flexibility


  Cold Therapy
    –   Cold packs, ice massage, OTC sprays and ointments
    –   Reduces pain by numbing the nerves around the joint




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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.
  –   Show you the best way to move from one position to another
  –   Teach you how to use walking aids

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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.


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  Walking Aides




             Cane                          Walker
                               so Medic Online Pvt. Ltd
Helps keep you balanced Forever you don’t hurt other joints.
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Medications: Analgesics

Analgesics, pain relievers,
may provide temporary relief
of arthritis pain.




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Medications: NSAIDs
Traditional
   Aspirin
   Ibuprofen
   Naproxen


New
   Cox II


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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.




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      Nutritional Supplements
       Glucosamine and Chondroitin may relieve joint pain.
            Occur in the body naturally; vital to normal cartilage
            function.
              –   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.

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Source: Arthritis.org website, Aug. 2006
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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




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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:
      –   Nausea
      –   Diarrhea or constipation
      –   Heartburn
      –   Increased intestinal gas


                    complete information.
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  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              Copyright @ Forever Medic Online Pvt. Ltd
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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.




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Corticosteroids
 Decrease inflammation
  –   Oral
  –   Cream (topical)
 Short-term side effects include
  –   Swelling, increased appetite
 Long-term side effects include
  –   Stretch marks, excessive hair growth, osteoporosis, high blood
      pressure, infections and high blood sugar



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Injections: Corticosteroids


 Injection
 Effective
 Temporary




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Injections / Visco-supplementation

 Hyaluronic Acid (Cock’s Comb)
 Injection
 Effective (5-13 wks)
 Does Not Prevent Progression




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  Hyaluronic Acid

       Natural substance that lubricates the joint
       Injection
         –   Lubricates the joint
         –   Provides temporary relief of pain and movement
         –   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.*
         –   Approved for knee osteoarthritis




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*http://uconnsportsmed.uchc.edu/patientinfo/whathurts/treatment/hyaluronic_acid.html
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Knee Braces
Simple Braces                         “Unloader” Braces




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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.


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When to have a Joint Replacement

•   When rest pain becomes prominent.

•   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.

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    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

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Total Joint Replacement


 Goals of total joint replacement
 are to help:
  –   Relieve pain
  –   Restore motion
  –   Improve function
  –   Improve fitness and health
  –   Restore quality of life

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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



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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



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Total Hip Replacement




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  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
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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.



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Total Knee Replacement




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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

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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.
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Technology for Active Patients

 Trident® Ceramic
 Steven L. Drayer M.D.
 Private Practice-Lansing/Sparrow Hospital




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Realistic Expectations
  Longevity of Hip Replacement
 Age
 Weight
 Activity level
 Bone strength




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                                  New Technology for Active Patients
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                                                                 Trident Ceramic




 New Technologies are
Meeting the Needs of the
  More Active Patient




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  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
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    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.
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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
  –   Early use in the US revealed limitations




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Trident® Ceramic System
 Improvements in material strength, quality and design
 Advanced processing, testing and quality control
 produces stable, extremely strong ceramic implants




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U.S. Clinical Study
 The first US clinical study of contemporary ceramic-on-
 ceramic hip replacements began in 1996
  –   Over 1,300 hip surgeries
  –   16 centers in the United States
 FDA approved Trident® Ceramic for sale in the
 US in February 2003




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    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.
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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




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     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.                         Copyright @ Forever Medic Online Pvt. Ltd
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        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
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level and other factors. Only an orthopaedic surgeon can tell if surgery is right for you. Online Pvt. Ltd
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      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.

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Minimally Invasive
Total Hip Replacement
 Steven L. Drayer M.D.
 Private Practice-Lansing/Sparrow Hospital




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Topics
 What is hip arthritis?
 What is conventional hip replacement surgery?
 What is MIS hip replacement surgery?




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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

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Replaced Hip X-ray




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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”




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What are the potential benefits of
MIS Hip Surgery?
  Less soft tissue
  disruption
   –   Faster discharge from the
       hospital
   –   Quicker rehab and
       recovery
  Less blood loss
  Reduced pain
  Smaller scar

                                                 Source: Keggi, Kristaps J., Total Hip Arthroplasty Through
                     Copyright @ Forever Medic Online Pvt. Ltd Invasive Anterior Surgical Approach JBJS,
                                                 A Minimally
                                                 Vol. 85-A.
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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




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Is MIS Total Hip Arthroplasty for
everyone?
No, patient limitations include:
   Obese, high BMI
   Muscular males
   Pre-existing conditions




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Stryker Implant Technology

Accolade® TMZF® is an MIS-friendly
implant
  Compatible with ceramic-on-ceramic
  technology for long-term results




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 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!
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Description: MedicYatra provides the safe & best Joint Pain treatment and Surgery at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com