all about arthritis kambiz behzadi, m.d. orthopedic surgeon san ramon, pleasanton, livermore san...

All About All About ArthritisArthritis

Kambiz Behzadi, M.D.Kambiz Behzadi, M.D.

Orthopedic SurgeonOrthopedic Surgeon San Ramon, Pleasanton, LivermoreSan Ramon, Pleasanton, Livermore

Arthritis and YouArthritis and You

Musculoskeletal Conditions affect Musculoskeletal Conditions affect millions of peoplemillions of people

$254 billion per year spent$254 billion per year spent

ArthritisArthritis

40 Million Americans have arthritis40 Million Americans have arthritis 20 Million people suffer from 20 Million people suffer from

OsteoarthritisOsteoarthritis Osteoarthritis most common form of Osteoarthritis most common form of

arthritisarthritis

Synovial JointsSynovial Joints

Bone ends --> Bone ends --> Articular CartilageArticular Cartilage

Cartilage cushions Cartilage cushions bones-->allows bones-->allows bones to move bones to move without painwithout pain

Synovium--> Synovium--> covers joints, covers joints, produces fluid that produces fluid that reduces frictionreduces friction

Articular Cartilage

Bone

Synovial Membrane

Synovial Fluid

Synovial JointsSynovial Joints

Ligaments connect Ligaments connect bones--> stabilitybones--> stability

Muscles and Muscles and Tendons power Tendons power joints--> joints--> movementmovement

ArthritisArthritis

Arthritis is Arthritis is InflammationInflammation

Body’s normal Body’s normal reaction to injuryreaction to injury

Chronic Chronic inflammation in inflammation in arthritic joint--> arthritic joint--> long lasting long lasting disability disability

Inflammation

Swelling

Pain

Stiffness

OsteoarthritisOsteoarthritis Loss of cartilage Loss of cartilage

and joint surfaceand joint surface Second most Second most

common cause of common cause of disability in adultsdisability in adults

7 million physician 7 million physician visits per yearvisits per year

3 million 3 million hospitalizationshospitalizations

$2655 per person$2655 per person

Cartilage

Healthy Knee Osteoarthritic Knee

OsteoarthritisOsteoarthritis

Weight bearing Weight bearing jointsjoints

Hips, knees, feetHips, knees, feet FingersFingers SpineSpine

OsteoarthritisOsteoarthritis

Most of us by our 60s & 70sMost of us by our 60s & 70s

More women than menMore women than men

All races equallyAll races equally

40 million by 202040 million by 2020

Burden of DiseaseBurden of Disease

OsteoarthritisOsteoarthritis Pain in affected Pain in affected

jointsjoints

Pain worse with Pain worse with prolonged useprolonged use

Pain better with Pain better with restrest

Stiffness relieved Stiffness relieved by flexing and by flexing and movementmovement

Osteoarthritis-XrayOsteoarthritis-Xray

Osteoarthritis CausesOsteoarthritis Causes

Primary Osteoarthritis Most Primary Osteoarthritis Most CommonCommon

Thought to be result of AgingThought to be result of Aging Decreased ability to withstand stressDecreased ability to withstand stress Ligaments supporting joints weakenLigaments supporting joints weaken

Secondary OsteoarthritisSecondary Osteoarthritis

Obesity Trauma Surgery

Abnormal joints Gout Diabetes

Hormone disorders

CausesCauses

Goals of TreatmentGoals of Treatment

To Relieve painTo Relieve pain Increase motionIncrease motion Improve strengthImprove strength

Medication- NSAIDsMedication- NSAIDs

NSAIDs are nonsteroidal anti-NSAIDs are nonsteroidal anti-inflammatory drugsinflammatory drugs AspirinAspirin IbuprofenIbuprofen NaproxenNaproxen

MedicationMedication

Cox-2 inhibitors offer the benefits of other NSAIDs with a decreased incidence of gastrointestinal side effects.

Vioxx, Celebrex, Bextra

MedicationMedication

InjectionsInjections

Liquid Liquid cortisonecortisone

HyaluronateHyaluronate SupartzSupartz SynviscSynvisc HylaganHylagan

VitaminsVitamins

Anti-oxidants Anti-oxidants A,C,D,E may help A,C,D,E may help prevent prevent OsteoarthritisOsteoarthritis

No Clinical trialsNo Clinical trials No clear proofNo clear proof

Nutritional SupplementsNutritional Supplements

GlucosamineGlucosamine Chondroitin SulfateChondroitin Sulfate Some Positive resultsSome Positive results

Mild to moderate pain reliefMild to moderate pain relief If not seen within eight weeks, not If not seen within eight weeks, not

likely to benefitlikely to benefit

Alternative MedicineAlternative Medicine

Complimentary approaches may:Complimentary approaches may:

Ease symptomsEase symptoms

Improve outlook and attitudeImprove outlook and attitude

Alternative MedicineAlternative Medicine

Complimentary approaches will not:Complimentary approaches will not: Cure acute illnessCure acute illness Replace proven medical treatment for Replace proven medical treatment for

osteoarthritisosteoarthritis

Alternative MedicineAlternative Medicine

  Pain Stiffness Fatigue Inflammation Anxiety/Depression

Biofeedback    

Visualization      

Hypnosis      

Relaxation      

Yoga  

Acupuncture  

Magnets    

Vegetarian Diet

Herbs & Supplements

Therapy Symptoms

Joint ProtectionJoint Protection

ExerciseExercise

Gentle exercise in Gentle exercise in moderationmoderation

Strengthen musclesStrengthen muscles Prevent stiffnessPrevent stiffness Decrease weightDecrease weight Promote endurancePromote endurance Right program for Right program for

youyou

SurgerySurgery ArthroscopyArthroscopy Least InvasiveLeast Invasive ArthroscopeArthroscope Remove partially Remove partially

damaged cartilagedamaged cartilage PortalsPortals Remove dead Remove dead

cartilage and cartilage and enzymes that cause enzymes that cause inflammationinflammation

Arthroscope

Portals

Damaged cartilage

Abrasion / DrillingAbrasion / Drilling

Abrasion and Abrasion and DrillingDrilling

Healing responseHealing response Fibrocartilage= Fibrocartilage=

Scar CartilageScar Cartilage Inferior mechanical Inferior mechanical

properties to properties to articular cartilagearticular cartilage

Less advanced OALess advanced OA Focal arthritisFocal arthritis

Focal, localized lesionFocal, localized lesion

OsteotomyOsteotomy

Realignment of Realignment of JointsJoints

Transfer Weight to Transfer Weight to less involved part less involved part of jointof joint

60s and 70s60s and 70s Less popularLess popular Does not provide Does not provide

good long term good long term resultsresults

Mosaicplasty / OATSMosaicplasty / OATS

Localized focal Localized focal arthritis/defectarthritis/defect

Traumatic arthritisTraumatic arthritis Small to medium Small to medium Transferring Transferring

healthy healthy plug of plug of bone and cartilagebone and cartilage to defect in weight to defect in weight bearing areabearing area

Small Large

ACIACI Articular Cartilage Articular Cartilage

ImplantationImplantation ““Pot hole in the road”Pot hole in the road” Two operationsTwo operations Cartilage harvested Cartilage harvested

and sent to Lab, to and sent to Lab, to grow in Culturegrow in Culture

Cartilage cells Cartilage cells transplanted into the transplanted into the defectdefect

In future may be In future may be applicable to large applicable to large lesions/primary OAlesions/primary OA

Total Joint ReplacementTotal Joint Replacement

Considered last Considered last Solution for Solution for ArthritisArthritis

Improved Improved AmbulationAmbulation

Decreased PainDecreased Pain Increased ROMIncreased ROM 90%+ good to 90%+ good to

excellent resultsexcellent results

Total Joint ReplacementTotal Joint Replacement Removal Removal

of of diseased diseased jointjoint

Replace Replace with a with a prosthetic prosthetic jointjoint

+

+

+

Knee

Hip

Minimally Invasive Minimally Invasive SurgerySurgery

Continuous Continuous advances in joint advances in joint replacement replacement proceduresprocedures

MIS= Minimally MIS= Minimally Invasive SurgeryInvasive Surgery

MISMIS 8-12 inches --> 3 to 5 8-12 inches --> 3 to 5

inchesinches Same implants Same implants Minimal trauma to Minimal trauma to

Muscles and TendonsMuscles and Tendons Quadriceps muscle Quadriceps muscle

and tendon not cutand tendon not cut Unassisted walking at Unassisted walking at

2 to 4 weeks2 to 4 weeks Back to Back to

Activities/Work Activities/Work SoonerSooner

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SummarySummary

Osteoarthritis affects in excess of 20 Osteoarthritis affects in excess of 20 Million AmericansMillion Americans

Accurate Diagnosis importantAccurate Diagnosis important Understand the nature of this Understand the nature of this

ProblemProblem Many treatment Options availableMany treatment Options available Benefits and limitations Benefits and limitations Choose the right treatment for youChoose the right treatment for you Get back into the gameGet back into the game

ArthritisArthritis

www.nih.gov/niams/

www.aboutarthritis.com

American Academy of Orthopaedic Surgeons www.aaos.org

Arthritis Foundation www.arthritis.org

www.behzadisportsdoc.com

THANK YOUTHANK YOU

MIS THRMIS THR

TWO INCISIONCO-AXIAL PATH

SINGLE INCISIONPOSTERIOR APPROACH