Download Seth - Cartilage.Talk part 2

No MRI Needed
Healthy knee
Osteoarthritic knee
Burden of Disease
• 39.4 million visits to physicians offices
• 750,000 hospitalizations
• OA cost $125 billion/year
.
Osteoarthritis Hospitalizations
Annual incidence
2,000,000
1,500,000
1,000,000
750,000
513,000
500,000
228,000
0
OA
Heart
Attack
Stroke
184,300
Breast
Cancer
Source: Bone & Joint Decade, Fit to a T
Arthritis Increases With Age
US Population
70
Incidence (%)
60
Female
50
Male
40
30
20
10
0
<24
25-34 35-44 45-54 55-64 65-74 75-84
Age
Crowninshield et al, CORR 443, 2006
85 +
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
Primary Osteoarthritis: Most Common
• Thought to be result of aging
• Decreased ability of cartilage to repair itself
• Ligaments and muscles supporting joints
weaken
Secondary Osteoarthritis
• Obesity
• Trauma
• Gout
• Surgery
• Diabetes
•
Hormone
• Abnormal joints
disorders
Arthritis Increases with Body Mass Index
U.S. Adult Population
50
45
Incidence (%)
40
35
30
25
20
Underweight
Healthy
Crowninshield. Hip International Vol. 16 2006
Overweight
Obese
It’s a weight issue?
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.
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
Symptoms
• Pain in affected joints
• Pain worse with prolonged
overuse
• Pain better with rest and
exercise
• Stiffness relieved by flexing
Diagnosis
•
•
•
•
History
Physical exam
X-rays
Blood test to rule out other
diseases
Diagnosis
Healthy knee
Osteoarthritic knee
So Bones…..What’s the treatment
The Degenerative Knee
Goals of Treatment
• Educate the patient
•
•  pain
•  disability , 
mobility
• Impede progression
of disease
Variety of Non-Operative Methods
Behavorial Modification
• losing weight
• switching from running or jumping exercises
to swimming or cycling
• minimizing activities that aggravate the
condition, such as climbing stairs
Exercise
• Strengthening exercises
• increase range of motion
and flexibility
• Physical therapy
21
Osteoarthritis
(Inflammation of Joints)
Pain
Loss of
Motion
Avoidance
of
Motion
Increased
Muscle
Tightness
Supportive Devices
• Cane
• energy-absorbing shoes
or inserts
• brace or knee sleeve
can be helpful
Other Methods
• heat or ice
• water exercises
• liniments
• elastic bandages
Drug Treatments
• Tylenol (acetaminophen)
• Aspirin
• Anti-Inflammatories
– NSAIDS
– COX2 Inhibitors
– Steroids
• Nutriceuticals