1. Dr. Pete Rose Surgical Treatment

2. Fusion Arthroscopy Realignment / reshaping Joint replacement

3. Fusion Traditional treatment for arthritis in the young –“No motion, no pain” Not for patients with multiple joint involvement –Spine, ankle, wrist possible exceptions

4. Arthroscopy

5. Low morbidity outpatient procedure Doesn’t “burn” bridges –Effective against well defined targets Focally torn cartilage –Not effective for generalized joint pain or arthritis

6. Realignment Procedures - Knee Surgically change alignment to “offload” worn area Delay need for joint replacement

13. Operative Plan Combined femoral and proximal tibial osteotomies. –Femoral side correction of varus bow. –Tibial side correction of apex anterior bowing and down slope of the articular surface.

16. Realignment Procedures - Hip Impinging bump on the edge of a malformed femoral head (ball)

18. But… Relatively few patients are good candidates for these procedures –Treat a local problem when the true pathology is global –Usually small “window” between when things start to hurt until the whole joint is damaged