1. 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.

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

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

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

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

7. Risk Factors Non-modifiable Gender, Females>Males Increased age
Genetics
Developmental or acquired deformity
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8. Presentation History Age Functional activity Duration of symptoms
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9. Presentation Symptoms Function-limiting pain Pain at night or rest
Swelling/effusion
Stiffness
Mechanical issues
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10. Presentation Physical Exam Weight, BMI Gait Limb alignment Joint ROM
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11. Imaging Xrays Weight-bearing views
Knee sunrise view and 30 degree PA flexion view
Hip AP pelvis, AP + lateral of affected hip
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12. Treatment
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13. The Dreaded Joint Replacement
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14. 5 PEARLS of Treatment Early Counselling of Young Adults Exercise
Weight loss programs
Physical Therapy
NSAIDS
AAOS Guidelines 5/18/2013
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15. Early Counselling
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16. Early Counselling
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17. Early Counselling Obesity Genetics Job at Risk Activity at Risk
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18. Exercise
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19. Exercise
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20. 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
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21. Athens Orthopedic Clinic, P.A.

22. 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.

23. Athens Orthopedic Clinic, P.A.

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

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

29. Athens Orthopedic Clinic, P.A.

30. Strong Evidence Against
Glucosamine and Chondroitin
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31. Strong Evidence Against
Acupuncture
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32. Inconclusive Evidence
Unloader Braces $$
Manual Therapy
Steroids
PrP, Stem Cells $$$
Viscosupplementation
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33. Thank You
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34. Athens Orthopedic Clinic, P.A.