Kambiz Behzadi_ M.D. -- Orthopedi by hilen

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									All About Arthritis
    Kambiz Behzadi, M.D.
     Orthopedic Surgeon
  San Ramon, Pleasanton, Livermore
           Arthritis and You

   Musculoskeletal Conditions affect millions
    of people
   $254 billion per year spent
                  Arthritis
   40 Million Americans have arthritis
   20 Million people suffer from Osteoarthritis
   Osteoarthritis most common form of
    arthritis
              Synovial Joints
   Bone ends -->                                  Synovial
    Articular Cartilage      Bone                  Membrane
   Cartilage cushions
    bones-->allows bones
    to move without pain
   Synovium--> covers
    joints, produces fluid
    that reduces friction                            Synovial
                                                     Fluid

                             Articular Cartilage
            Synovial Joints
   Ligaments connect
    bones--> stability
   Muscles and Tendons
    power joints-->
    movement
                     Arthritis
                                          Inflammation
   Arthritis is
    Inflammation
   Body’s normal             Stiffness
    reaction to injury                                   Swelling

   Chronic inflammation
    in arthritic joint-->
    long lasting disability                   Pain
               Osteoarthritis
                                     Cartilage
   Loss of cartilage and
    joint surface
   Second most
    common cause of
    disability in adults
   7 million physician
    visits per year
   3 million
    hospitalizations
   $2655 per person        Healthy Knee     Osteoarthritic
                                             Knee
               Osteoarthritis
   Weight bearing joints
   Hips, knees, feet
   Fingers
   Spine
       Osteoarthritis

    Burden of Disease
       All races
        equally
 More women than men
Most of us by our 60s & 70s
   40 million by 2020
Osteoarthritis
          Pain in affected joints

          Pain worse with
           prolonged use

          Pain better with rest

          Stiffness relieved by
           flexing and movement
Osteoarthritis-Xray
        Osteoarthritis Causes

   Primary Osteoarthritis Most Common
   Thought to be result of Aging
   Decreased ability to withstand stress
   Ligaments supporting joints weaken
   Secondary Osteoarthritis
          Causes

  Obesity      Trauma      Surgery


Abnormal joints    Gout     Diabetes

            Hormone disorders
      Goals of Treatment

 To Relieve pain
 Increase motion

 Improve strength
         Medication- NSAIDs
   NSAIDs are nonsteroidal anti-inflammatory
    drugs
      Aspirin

      Ibuprofen

      Naproxen
               Medication
Cox-2 inhibitors offer the benefits of other
 NSAIDs with a decreased incidence of
 gastrointestinal side effects.

Vioxx, Celebrex, Bextra
Medication
             Injections

        Liquid cortisone

        Hyaluronate
            Supartz
            Synvisc
            Hylagan
Vitamins

       Anti-oxidants A,C,D,E
        may help prevent
        Osteoarthritis
       No Clinical trials
       No clear proof
        Nutritional Supplements
   Glucosamine
   Chondroitin Sulfate
   Some Positive results
     Mild to moderate pain relief
     If not seen within eight weeks, not likely to
      benefit
           Alternative Medicine

   Complimentary approaches may:

       Ease symptoms

       Improve outlook and attitude
         Alternative Medicine

   Complimentary approaches will not:
     Cure acute illness
     Replace proven medical treatment for
      osteoarthritis
             Alternative Medicine
  Therapy                              Symptoms
                Pain       Stiffness   Fatigue   Inflammation   Anxiety/
                                                                Depression
Biofeedback            u        u          u



Visualization          u                                            u

Hypnosis               u                                            u

Relaxation             u                                            u

Yoga                   u        u          u                        u

                       u        u          u                        u

Acupuncture            u        u                     u             u

Magnets                u        u                     u

Vegetarian             u        u                     u
Diet
Herbs &                u        u          u          u             u
Supplements
Joint Protection
                   Exercise
   Gentle exercise in
    moderation
   Strengthen muscles
   Prevent stiffness
   Decrease weight
   Promote endurance
   Right program for you
                  Surgery
                            Portals
   Arthroscopy
   Least Invasive
   Arthroscope
   Remove partially
    damaged cartilage
   Portals
   Remove dead
    cartilage and
    enzymes that cause
    inflammation

                         Arthroscope   Damaged
            Abrasion / Drilling
   Abrasion and Drilling     Focal, localized lesion

   Healing response
   Fibrocartilage= Scar
    Cartilage
   Inferior mechanical
    properties to articular
    cartilage
   Less advanced OA
   Focal arthritis
                 Osteotomy
   Realignment of Joints
   Transfer Weight to
    less involved part of
    joint
   60s and 70s
   Less popular
   Does not provide
    good long term
    results
          Mosaicplasty / OATS
   Localized focal          Small   Large
    arthritis/defect
   Traumatic arthritis
   Small to medium
   Transferring healthy
    plug of bone and
    cartilage to defect in
    weight bearing area
                          ACI
   Articular Cartilage
    Implantation
   “Pot hole in the road”
   Two operations
   Cartilage harvested and
    sent to Lab, to grow in
    Culture
   Cartilage cells
    transplanted into the
    defect
   In future may be
    applicable to large
    lesions/primary OA
Total Joint Replacement
               Considered last
                Solution for Arthritis
               Improved Ambulation
               Decreased Pain
               Increased ROM
               90%+ good to
                excellent results
       Total Joint Replacement
         +
                            Removal of
                             diseased
                             joint
Knee
                            Replace
                             with a
Hip                          prosthetic
                             joint
         +


         +
    Minimally Invasive Surgery
   Continuous advances
    in joint replacement
    procedures
   MIS= Minimally
    Invasive Surgery
                          MIS
   8-12 inches --> 3 to 5
    inches
   Same implants
   Minimal trauma to                  QuickTime™ and a
                                DV/DVCPRO - NTSC d ecompressor

    Muscles and Tendons          are neede d to see this picture.




   Quadriceps muscle and
    tendon not cut
   Unassisted walking at 2
    to 4 weeks
   Back to Activities/Work            QuickTime™ and a
                                      Video d ecompressor
                                 are neede d to see this picture.


    Sooner
                 Summary
   Osteoarthritis affects in excess of 20
    Million Americans
   Accurate Diagnosis important
   Understand the nature of this Problem
   Many treatment Options available
   Benefits and limitations
   Choose the right treatment for you
   Get back into the game
               Arthritis

   www.aboutarthritis.com
          Arthritis Foundation
          www.arthritis.org

      www.nih.gov/niams/
American Academy of Orthopaedic Surgeons
            www.aaos.org
         www.behzadisportsdoc.com
THANK YOU
            MIS THR
TWO INCISION    SINGLE
CO-AXIAL PATH   INCISION
                POSTERIOR
                APPROACH

								
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