2. Case Presentation 65 yr, male C/O right knee pain, stiffness Can not walk more than 10 mts Can not sleep at night Walks with frame 30/12//20121

3. Physical Exam 30/12//20122

4. Radiograph Knee 30/12//20123

5. Management of OA Knee- an Overview 30/12//20124

6. Conservative treatment Surgical treatment 30/12//20125

7. Weight Reduction Wt loss of 5 kg reduces risk of OA by 50% ( Felson et al: Annals of int med, 1998) Obese women has high risk of OA by Odds ratio of 8.57(Chungford study, Jr of Rheum,1993) 30/12//20126

8. Physiotherapy Cochrane database 2005 Aerobic exercise Quads Xr 30/12//20127

9. Drug Therapy AAOS, Up-to date 2005: Paracetamol –DOC Cochrane review,1997- No diff amoung various NSAIDS Celecoxib Tramadol( acute pain) 30/12//20128

10. Chondroprotective Agents Glucosamine SO4 Chondroitin SO4 NIH multi-centered trial Cochrane review 2005: WOMAC outcomes 30/12//20129

11. Braces Alters biomechanical force loads Cochrane review 2004 30/12//201210

12. Steroid Injections Inhibits accumulation of infl cells Reduces prostaglandin syn Short term benefits in acute pain with effusions ( Cochrane review, AAOS, European ) 30/12//201211

13. Hyaluronic Acid Produced by synovium In OA, HA is decreased Weekly inj for 3-5 weeks Cochrane review- NO ROLE 30/12//201212

14. Arthroscopy Mech symp- loose bodies, locking, giving way, catching Mosely et al, New England jr of Med, 2002 30/12//201213

15. Cartilage Repair Chondrectomy Abrasion, microfracture ACI Microdrill+ blood stem cells Osteochondral graft Grafting- periosteal - mosaicplasty 30/12//201214

16. High Tibial Osteotomy Age:< 60y Uni comp OA Varus def < 10-15deg ROM : 90 deg Flex cont < 15 deg 30/12//201215

17. Joint Replacement Failed conservative treatment AAOS, up-to-date 2005 30/12//201216

18. Overview of management of OA Tailored treatment Non-Pharmoc therapy is the hallmark Exercise is always good Pharmoc therapy is adjunctive Paracetamol, initial Dr O Ch NSAIDS if unresponsive Inj Steroids for acute pain, effusions Hyaluronic acid= ??? Joint replacement when everything has failed 30/12//201217

19. Questions Osteoarthritis is… 1.Inflammatory condition 2.Septic condition 3.Degenerative condition 4.Neuropathic condition 30/12//201218

20. Questions Drug of Choice for initial pain relief is…. 1.Tramadol 2.Paracetamol 3.Ibuprofen 4.Steroids 30/12//201219

21. Questions Role of steroids…. 1.Systemic oral therapy 2.Long term maintenance therapy 3.Short term intra articular injec for acute pain 4.Don’t know…refer to clinic 6 !!! 30/12//201220

22. وَقُل رَّ‌بِّ زِدْنِي عِلْمًا And say, My Lord!Increase me in knowledge (20:114) 30/12//201221