Hip & Knee OA: 5 Pearls to Delay the Dreaded Total Joint Replacement John R Manfredi MD An Orthopedic Update for Primary Care 8/26/2017 Here are my disclosures Athens Orthopedic Clinic, P.A.

Disclosures I have no disclosures Athens Orthopedic Clinic, P.A.

Epidemiology Athens Orthopedic Clinic, P.A.

Epidemiology Incidence Symptomatic Hip OA 88/100k Symptomatic Knee OA 240/100k OA is the primary dx leading to over 11 million ambulatory care visits/yr Athens Orthopedic Clinic, P.A.

Matt Foley “Motivational Speaker” Athens Orthopedic Clinic, P.A.

Risk Factors Modifiable Articular trauma Occupation Muscular Atrophy Obesity High impact sporting activities Athens Orthopedic Clinic, P.A.

Risk Factors Non-modifiable Gender, Females>Males Increased age Genetics Developmental or acquired deformity Athens Orthopedic Clinic, P.A.

Presentation History Age Functional activity Duration of symptoms Athens Orthopedic Clinic, P.A.

Presentation Symptoms Function-limiting pain Pain at night or rest Swelling/effusion Stiffness Mechanical issues Athens Orthopedic Clinic, P.A.

Presentation Physical Exam Weight, BMI Gait Limb alignment Joint ROM Athens Orthopedic Clinic, P.A.

Imaging Xrays Weight-bearing views Knee sunrise view and 30 degree PA flexion view Hip AP pelvis, AP + lateral of affected hip Athens Orthopedic Clinic, P.A.

Treatment Athens Orthopedic Clinic, P.A.

The Dreaded Joint Replacement Athens Orthopedic Clinic, P.A.

5 PEARLS of Treatment Early Counselling of Young Adults Exercise Weight loss programs Physical Therapy NSAIDS AAOS Guidelines 5/18/2013 Athens Orthopedic Clinic, P.A.

Early Counselling Athens Orthopedic Clinic, P.A.

Early Counselling Athens Orthopedic Clinic, P.A.

Early Counselling Obesity Genetics Job at Risk Activity at Risk Athens Orthopedic Clinic, P.A.

Exercise Athens Orthopedic Clinic, P.A.

Exercise Athens Orthopedic Clinic, P.A.

Exercise is Medicine First line of treatment Low-impact aerobic exercise Combination of supervised and home programs have shown best results Benefits lost after 6 months if exercises discontinued Athens Orthopedic Clinic, P.A.

Athens Orthopedic Clinic, P.A.

Weight Loss Patients with symptomatic arthritis and BMI >25 Combination of diet and exercise Set attainable goals in early management “Lets try and lose 5 pounds before our next visit” Athens Orthopedic Clinic, P.A.

Athens Orthopedic Clinic, P.A.

Physical Therapy Optimize Joint Range of Motion Quadriceps Strengthening Core Strengthening Gait Training Independent Acitivities of Daily Living Athens Orthopedic Clinic, P.A.

Athens Orthopedic Clinic, P.A.

Athens Orthopedic Clinic, P.A.

Medications Athens Orthopedic Clinic, P.A.

Medications NSAIDS Oral and Topical Tramadol Inconclusive Evidence: Tylenol, Opioids, Pain Patches Athens Orthopedic Clinic, P.A.

Athens Orthopedic Clinic, P.A.

Strong Evidence Against Glucosamine and Chondroitin Athens Orthopedic Clinic, P.A.

Strong Evidence Against Acupuncture Athens Orthopedic Clinic, P.A.

Inconclusive Evidence Unloader Braces $$ Manual Therapy Steroids PrP, Stem Cells $$$ Viscosupplementation Athens Orthopedic Clinic, P.A.

Thank You Athens Orthopedic Clinic, P.A.

Athens Orthopedic Clinic, P.A.