1. No MRI Needed Osteoarthritic kneeHealthy knee

2. Burden of Disease 39.4 million visits to physicians offices 750,000 hospitalizations OA cost $125 billion/year.

3. Source: Bone & Joint Decade, Fit to a T Osteoarthritis Hospitalizations 0 500,000 1,000,000 1,500,000 2,000,000 OA 513,000 Heart Attack Stroke Breast Cancer 184,300 228,000 Annual incidence 750,000

4. Arthritis Increases With Age US Population Crowninshield et al, CORR 443, 2006 Female Male Age

5. On the Other Hand….The Boomer Population is Active Baby boomers are staying more active & want to continue their recreation Knee arthritis most common problem for active boomers

6. Primary Osteoarthritis: Most Common Thought to be result of aging Decreased ability of cartilage to repair itself Ligaments and muscles supporting joints weaken

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

8. Arthritis Increases with Body Mass Index U.S. Adult Population Incidence (%) Crowninshield. Hip International Vol. 16 2006

10. It’s a weight issue?

11. A little goes a long way A 5-kg weight loss in the prior 10 years in overweight women resulted in a more than 50% decrease in symptomatic knee osteoarthritis. Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1992; 116:535-539.

12. Occupational Risk Factors – kneeling or squatting – walking more than two miles a day – lifting at least 55 pounds regularly – shipyard or dock worker, miner, and carpet or floor layer

13. Symptoms Pain in affected joints Pain worse with prolonged overuse Pain better with rest and exercise Stiffness relieved by flexing

14. Diagnosis History Physical exam X-rays Blood test to rule out other diseases

15. Diagnosis Osteoarthritic kneeHealthy knee

17. So Bones…..What’s the treatment

18. The Degenerative Knee Goals of Treatment Educate the patient  pain  disability,  mobility Impede progression of disease

19. Variety of Non-Operative Methods

20. Behavorial Modification losing weight switching from running or jumping exercises to swimming or cycling minimizing activities that aggravate the condition, such as climbing stairs

21. Exercise Strengthening exercises increase range of motion and flexibility Physical therapy 21

22. Pain Avoidance of Motion Increased Muscle Tightness Loss of Motion Osteoarthritis (Inflammation of Joints)

23. Supportive Devices Cane energy-absorbing shoes or inserts brace or knee sleeve can be helpful

24. Other Methods heat or ice water exercises liniments elastic bandages

25. Drug Treatments Tylenol (acetaminophen) Aspirin Anti-Inflammatories – NSAIDS – COX2 Inhibitors – Steroids Nutriceuticals