1. Arthritis and the Management of the Painful Knee

2. Keith Stube, MD WNY Knee and Orthopedics
Kenmore Mercy Hospital

3. Knee Arthritis

4. Arthritis

5. Arthritis 30 millions Americans affected
Not one disease-100 different types of arthritis related diseases
Most common- osteoarthritis, rheumatoid arthritis

6. Arthritis OA- most common form of joint disease, 20 million affected,
80% of people over age of 50
RA- systemic auto- immune disease, affects over 2 million people

7. Osteoarthritis “wear and tear” “bone on bone”
Pathologic hallmark is focal loss of cartilage

8. Osteoarthritis symptoms- moderate to severe persistent pain
Loss of mobility
Decrease of motion
Altered activity level
Deformity

9. Osteoarthritis Treatment Goals-
Freedom, increase range of motion, improved quality of life

10. Treatment-osteoarthitis
Rehabilitation-PT
Restore or improve function through use of exercise, pain relief and educational programs

11. Treatment-Osteoarthitis
Analgesics-
NSAIDs, Tylenol
injections- steroids, gel injections
Weight loss

12. Treatment-osteoarthritis
Unloader brace-
Changes alignment of knee, excellent for patients with some deformity

13. Treatment-osteoarthritis
Alternative treatments-
Glucosamine
Chondroitin sulphate
Vit E
Tumeric

14. Surgical options Arthroscopy-does not treat arthritis
Indicated only for mechanical symptoms

15. Surgical treatment Joint Replacement-
Goals to reduce pain, increase ADL, increase mobility and function, improve quality of life

16. Surgical treatment Joint replacement 600,000/year
Very predictable- <15 % revision rate
90% patient satisfaction
Improves quality of life like CABG

17. Surgical treatment Osteotomy-
Cutting tibia and changing alignment of knee
60% survival at 10 years

18. Osteotomy

19. Surgical treatment Partial Knee Replacement-
Replacing only the arthritic compartment , usually medial
Good survival rate in appropriate patients

20. Partial knee replacement

21. Surgical treatment TKR-
Replacing the arthritic surfaces with metal and plastic implants
Maintain ligaments
Maintain muscle and motion

22. Surgical treatment Complications Infection 1-2% Blood clots 1-2%
Instability
Limited range of motion
Difficulty kneeling