Download E T B A

EMERGING TECHNOLOGIES IN THE
BATTLE AGAINST KNEE
OSTEOARTHRITIS: NEW ANSWERS TO
OLD QUESTIONS
Dr. Jason Peeler PhD, CAT(C)
Department of Human Anatomy & Cell Science, U of M
Pan Am Clinic Research Foundation
OBJECTIVES OF PRESENTATION
1.
Review Osteoarthritis
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2.
Introduce an Emerging Technology
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3.
What is it?
What causes it?
How is it treated?
Novel application?
Limitations?
Enhancing Quality of Life?
Question Period
OSTEOARTHRITIS
(OA)
 Degenerative
disease of joints that leads to
slow, progressive disruption of the structural
integrity of the cartilage that lines the joint.
 Single most common joint disease (after 65
years of age: 60% in men / 70% in women).
 No Known Cure!!
 Most
Common in weight
bearing joints (knee/hip)
 Insidious onset of pain
 Joint stiffness & swelling
 Progressive loss of ROM
 Enlarged / deformed
joints
 Loss bodies in joint /
joint crepitus
 Narrowing of joint spaces
/ loss of joint integrity
Clinical Diagnosis: X-RAYS
 Standardized
classification system used to
determine severity.





Joint space widening (early)
Subchondral bone sclerosis
Subchondral bone cysts
Osteophytes
Joint space narrowing
KNEE OSTEOARTHRITIS
 Most
common type of OA
 Affects more than 10 million
people in North America
alone
 Cited as the most common
cause of disability!
 Designated as a key
condition for special
attention during the World
Health Organization’s Bone
and Joint Decade (20002010)
TYPES OF KNEE OSTEOARTHRITIS
1. Primary OA


Unknown cause
May be related to a defect in the articular
cartilages genetic and/or cellular composition
2. Secondary OA


OA with a known cause
Most commonly:
Acute Trauma (eg. knee ligament injury)
 Repetitive stress
 Infection
 Hemarthrosis
 Osteonecrosis

ETIOLOGY OF 2º KNEE OSTEOARTHRITIS



Multi - factorial !!!!
Extrinsic factors
Intrinsic factors
1.
2.

Abnormal joint biomechanics
 Limb alignment
 Muscle weakness / imbalance
 Joint instability
Physical Activity
 Too much / Too little
Others????????????
LIMB ALIGNMENT
MUSCLE WEAKNESS
Joint Instability
Surgical Repair
 Can
it be repaired?
 Is patient a good
candidate?
 Timing of surgery? (I – S time)
 Which procedure is best?
 Short & long Term
Prognosis?
ACL INJURY & KNEE OSTEOARTHRITIS
 Research
demonstrates that adolescents
and young adults who sustain an ACL
injury are at substantially increased risk for
the development of future osteoarthritis
(OA): “the young patient with the old knee”.
 >50% of ACL injured knees demonstrate
radiographic evidence of OA 5 – 15 years
after initial injury diagnosis.
Physical Activity
 What’s
best?
 When / how / etc
 Keys are:
 Quality of Life
 Longevity
Too Much vs. Too Little
HOW DO WE AVOID THIS???
CURRENT OA TREATMENTS
 Treatments
focus on optimizing the
patient’s quality of life through the
reduction of joint pain and enhancement of
functional capacity
ETIOLOGY OF 2º KNEE OSTEOARTHRITIS



Multi - factorial !!!!
Extrinsic factors
Intrinsic factors
1.
2.

Abnormal joint biomechanics
 Limb alignment
 Muscle weakness / imbalance
 Joint instability
Physical Activity
 Too much / Too little
Others????????????
#1 MODIFIABLE RISK FACTOR – Body Weight
Research suggests that
each one pound of
weight gain results in a
corresponding 4 pound
increase in knee joint
loads during walking.
Weight Loss?
Physical Activity???
Research
indicates that
walking 15
minutes a day
three times a
week may help
decrease OA pain
by up to 40
percent.
Catch 22 - Scenario
NON-WEIGHT BEARING ACTIVITIES
NEW TECHNOLOGY
Anti-gravity
treadmill
http://www.starling-fitness.com/wp-content/uploads/alterg.jpg
LBPP – LOWER BODY POSITIVE PRESSURE
Grabowski & Kram, 2008
ADVANTAGES
↓ Ground Reaction Forces
 Normal “pain free” functional movement patterns
 Enhanced proprioception (ie. balance)
 Does not affect:

Muscle activation
 Joint Motion
 Limb Swing Mechanics
 Cardiovascular Function


Facilitates regulation of body weight –
ie. Artificial method of achieving instantaneous
weight loss!!!!
Current Research Using Alter – G
Treadmill
•Examining the relationship
between body weight and knee
pain in an OA population
• Early onset
• Elderly
Goals of Research:
•Determine the exact nature of
the body weight/knee pain
relationship in knee OA
•Promote pain free functional
activities in at risk populations
Take Home Message
Optimizing Function in At-Risk Populations
What is OA?
 What causes it?
 #1 modifiable risk factor – Body
Weight!
 Walking is best!
 Emergence of anti-gravity
technologies – Alter G Treadmill
 Enormous application potential of
this new technology with at-risk
populations such as early onset OA
and the elderly.

ACKNOWLEDGEMENTS
Dr. Peter MacDonald, Pan Am Clinic
 Dr. Jeff Leiter, Pan Am Research Foundation
 Ms. Judit Takacs, University of Manitoba

Dr. Paul H.T. Thorlakson Foundation Fund
 Mb. Centre on Aging

Question
Period
WEIGHT SUPPORTED SYSTEMS

Harness systems1
Fixed
 Pulley


Water-based systems
http://www.madonna.org/specialized_programs/technology/bodyweight_support.html