Arthritis is COMMON Understanding Knee ArthritisViscosupplement Purify Hylauronic acid from rooster...

Understanding Knee Arthritis

Michael J. Repine MDBoulder Medical Center Orthopedics(303) 872-4018

Your Treatment OptionsOptionsKnee Pain

Arthritis is COMMONMore than 43 million people have some form of arthritis. It is estimated that the number of people affected by arthritis will increase to 60 million by 2020.

Source: CDC


This program will touch upon the following topics:

Review of Knee AnatomyDiscussion of ArthritisLatest Treatment Options for Knee ArthritisExpectations/Outcomes


About MyselfOldest of sixIdentical twinColorado native Two young boys


About MyselfOldest of sixIdentical twinColorado native Two boysI enjoy traveling and languages


About My PracticeUndergraduate at CU BoulderUniversity of Colorado School of Medicine for medical school and residencyBoard certified in 2005, 2015Fourteen years at the Boulder Medical CenterIn addition to the management of arthritis, I enjoy trauma, sports-related and hand injuries


ANATOMYYour Treatment OptionsOptions

Knee Pain

Normal KneeBony Anatomy


The Knee JointMusculature

Multiple muscles acting upon knee joint

Your Treatment OptionsOptionsKnee PainThe Knee Joint

LigamentsLigamentsStabilityStability

Complex array of ligamentsCritical for knee stability and function


The Knee JointCartilage

Cartilage is critical in understanding arthritis


The Knee JointCartilage

Transmits applied loads across mobile surfacesLines the ends of bones Surfaces roll or slide during motionHyaline cartilage is fluid-filled wear-resistant surfaceIt reduces friction coefficient to 0.0025.

“Like the frosting on a piece of cake”


Normal Cartilage

Healthy, normal cartilage rolls easilySmooth motion

“Like the tires on your car”


Damaged CartilageWhen the cartilage is thinned or absent, problems such as pain, instability, limited motion occur.

This mechanical wearing of the cartilage surface leads to deterioration in the joint or ARTHRITIS


What is What is ARTHRITIS?Definition: Inflammation of a joint, usually

accompanied by pain, swelling, andstiffness.


What is What is ARTHRITIS?Definition: The mechanical wearing of the cartilage surface resulting in pain and limited function.

Importantly, this mechanical change is accompanied by biochemical changes


What is What is ARTHRITIS?Normal Anatomy Normal Xrays


What is What is ARTHRITIS?Arthritis Anatomy Arthritic Xrays


Most Common Causes of Arthritis

Degenerative – “wear and tear”

Osteoarthritic – traumatic

Rheumatoid – inflammatory

Bacterial - infectious


Evaluation of Knee Arthritis


Diagnosing Knee PainMedical historyPhysical examinationX-rays, Radiographic StudiesOther tests


SymptomsPAIN

Weight-bearing activitiesWhile sleeping at nightLocated across entire knee or focally to an areaUsually slow in onset


Diagnosis

How and when did the pain start?If the pain has occurred before, how was it treated?What activities aggravate the pain?What activities relieve the pain?

Medical History


Diagnosis

Tenderness to the touchWeakness in the musclesExtent of passive and active range of motionCrepitation

Physical Examination


Diagnosis

X-rays of an arthritic knee:narrowing of the joint spacecystic changes in the boneformation of bone spurs (osteophytes)

X-ray Evaluation


Diagnosis

Blood testsComputerized Topography (CT) scansMagnetic Resonance Imaging (MRI) scans

– Best non-surgical modality to identify focal cartilage defects

Arthroscopy– Small areas of traumatic

arthritis, loose bodies

Additional Tests

Your Treatment OptionsOptionsKnee PainNon-Surgical Treatment

Options for ArthritisYour Treatment OptionsOptions

Knee Pain

Nonsurgical treatment optionsPhysical Therapy

Almost always start with physical therapy

– Improve range of motion– Improve strength– Decreases pain


Nonsurgical treatment optionsMedications

NSAIDS– Decreases inflammation– Decreases pain


Nonsurgical treatment optionsSupplements

Lots of claims

NONE have passed FDA testing as provenPersonal trials


Nonsurgical treatment optionsCortisone injectionPROS

Relatively easyExcellent diagnostic toolWell-toleratedVery predictable reduction in pain


Nonsurgical treatment optionsCortisone injectionCONS

Must be placed carefullyMasks symptomsCan soften cartilageUsed to “buy” time


Nonsurgical treatment optionsViscosupplement

Purify Hylauronic acid from rooster combs or bacterial growth“Oil-additive” to joint fluid


Nonsurgical treatment optionsViscosupplementPROS

Protects remaining cartilageImproves biochemical environment of jointReliable reduction in pain


Nonsurgical treatment optionsViscosupplementCONS

NONE– * With appropriate

patient selectionSmall potential for reaction with repetitive administration


Nonsurgical treatment optionsStem Cell Therapy

Great claims of what can be treatedPromising early anecdotal reportsExpensiveLikely the best future option for moderate arthritis


Surgery Treatment Options


Surgical Treatment AlgorithmFocal versus Global


Surgical Treatment AlgorithmIndividualized with each patient


Decision Variables

Physiology

Expectations

Anatomy Physiology

Expectations

AnatomyFocal or Global arthritis

Age, strength, range of motion


Decision Variables

Physiology

Expectations

Anatomy Physiology

Expectations

Anatomy


Surgical treatmentFocal cartilage damage

Must catch damage earlyBest treated before secondary bony changes occur

“Pothole”


Surgical treatmentFocal cartilage damage

MicrofractureLargely treated arthroscopically


Surgical treatmentFocal cartilage damageCartilage Transplantation


Surgical treatmentFocal cartilage damageResurfacing


Surgical Treatment

Global Arthritis


Surgical treatmentMore advanced arthritis requires more advanced surgical options


Surgical treatmentAdvanced Arthritis

Patient determines the appropriate time for surgical interventionInfluenced by XrayUnlike hip arthritis, You Unlike hip arthritis, You CAN“miss the boat” for certain procedures


Surgical treatmentAt this point decision is between a At this point decision is between a partial knee replacement versus a replacement versus a total knee replacement.


Surgical treatmentPartial versus Total

Patient VariablesAgeWeightRange of motionAlignmentAdditional arthritis?X-raysExpectations


Surgical treatment

My Philosophy:Do Do ONE surgery well


Surgical treatmentPartial Knee Replacement

Three distinct compartments



Makoplasty technique



Computer assisted

Preoperatively template from CT Scan

Extreme precision


Surgical treatmentPartial Knee ReplacementResurfacing


Partial Knee Replacement


Surgical treatmentTotal Knee Replacement

Tri-compartmental arthritisMal-alignmentKnee contracturesPatient factors



Makoplasty technique


Computer Assisted Knee ReplacementMakoplasty

Technique:– Preoperative CT scan data is synced to intraoperative

data with a probe– Implant positioning and surgical resection can be

planned before any cuts are actually made



Computer assisted

Preoperatively template from CT Scan

Extreme precision


Surgical treatmentTotal Knee ReplacementReal time guidance

Balance knee ligaments

Less invasive



“Game changer”



“Game changer”


Recovery


Recovery

Begins immediatelyImprovements in anesthesia/pain control also facilitate immediate mobilityStart working with therapy to get out of bedWBAT


Summary

You choose the time to intervene for knee replacementHave to work hard at recovery

Very predictable outcome with a painless and fully functional knee joint


Thank YouMichael J. Repine MD

Boulder Medical Center Orthopedics(303) 872-4018


Replaced Knee X-ray

Arthritis is COMMON Understanding Knee ArthritisViscosupplement Purify Hylauronic acid from rooster...

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