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

2. Arthritis and You Musculoskeletal Conditions affect millions of people
$254 billion per year spent

3. Arthritis 40 Million Americans have arthritis
20 Million people suffer from Osteoarthritis
Osteoarthritis most common form of arthritis

4. 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

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

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

7. 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

8. Osteoarthritis
Weight bearing joints
Hips, knees, feet
Fingers
Spine

9. Osteoarthritis
Burden of Disease
All races equally
More women than men
Most of us by our 60s & 70s
40 million by 2020

10. Osteoarthritis Pain in affected joints Pain worse with prolonged use
Pain better with rest
Stiffness relieved by flexing and movement

11. Osteoarthritis-Xray

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

13. Secondary Osteoarthritis
Causes
Trauma
Obesity
Surgery
Abnormal joints
Gout
Diabetes
Hormone disorders

14. Goals of Treatment
To Relieve pain
Increase motion
Improve strength

15. Medication- NSAIDs NSAIDs are nonsteroidal anti-inflammatory drugs
Aspirin
Ibuprofen
Naproxen

16. Medication
Cox-2 inhibitors offer the benefits of other NSAIDs with a decreased incidence of gastrointestinal side effects.
Vioxx, Celebrex, Bextra

17. Medication Injections Liquid cortisone Hyaluronate Supartz Synvisc
Hylagan

18. Vitamins Anti-oxidants A,C,D,E may help prevent Osteoarthritis
No Clinical trials
No clear proof

19. Nutritional Supplements
Glucosamine
Chondroitin Sulfate
Some Positive results
Mild to moderate pain relief
If not seen within eight weeks, not likely to benefit

20. Alternative Medicine Complimentary approaches may: Ease symptoms
Improve outlook and attitude

21. Alternative Medicine Complimentary approaches will not:
Cure acute illness
Replace proven medical treatment for osteoarthritis

22. 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

23. Joint Protection

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

25. 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

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

27. Osteotomy Realignment of Joints
Transfer Weight to less involved part of joint
60s and 70s
Less popular
Does not provide good long term results

28. 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

29. 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

30. Total Joint Replacement
Considered last Solution for Arthritis
Improved Ambulation
Decreased Pain
Increased ROM
90%+ good to excellent results

31. Total Joint Replacement
Removal of diseased joint
Replace with a prosthetic joint +
Knee
Hip + +

32. Minimally Invasive Surgery
Continuous advances in joint replacement procedures
MIS= Minimally Invasive Surgery

33. 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

34. 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

35. American Academy of Orthopaedic Surgeons
Arthritis
Arthritis Foundation
American Academy of Orthopaedic Surgeons

36. THANK YOU

37. MIS THR
TWO INCISION
CO-AXIAL PATH
SINGLE INCISION
POSTERIOR APPROACH