San Ramon, Pleasanton, Livermore 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 --> Articular Cartilage Cartilage cushions bones-->allows bones to move without pain Synovium--> covers joints, produces fluid that reduces friction Synovial Membrane Bone Synovial Fluid Articular Cartilage

Synovial Joints Ligaments connect bones--> stability Muscles and Tendons power joints--> movement

Arthritis Arthritis is Inflammation Body’s normal reaction to injury Chronic inflammation in arthritic joint--> long lasting disability Stiffness Swelling Pain

Osteoarthritis 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 Trauma Obesity 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   Pain Stiffness Fatigue Inflammation Anxiety/ Depression Biofeedback u Visualization Hypnosis Relaxation Yoga Acupuncture Magnets Vegetarian Diet Herbs & Supplements

Joint Protection

Exercise Gentle exercise in moderation Strengthen muscles Prevent stiffness Decrease weight Promote endurance Right program for you

Surgery Arthroscopy Least Invasive Arthroscope Portals Arthroscopy Least Invasive Arthroscope Remove partially damaged cartilage Portals Remove dead cartilage and enzymes that cause inflammation Damaged cartilage Arthroscope

Abrasion / Drilling Abrasion and Drilling Healing response Fibrocartilage= Scar Cartilage Inferior mechanical properties to articular cartilage Less advanced OA Focal arthritis Focal, localized lesion

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 arthritis/defect Traumatic arthritis Small to medium Transferring healthy plug of bone and cartilage to defect in weight bearing area Small Large

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 Replace with a prosthetic joint + Knee Hip + +

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 Muscles and Tendons Quadriceps muscle and tendon not cut Unassisted walking at 2 to 4 weeks Back to Activities/Work 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

American Academy of Orthopaedic Surgeons 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 CO-AXIAL PATH SINGLE INCISION POSTERIOR APPROACH