Mr Matt Freudmann MB.BCh, MRCS, FRCS(Tr & Orth)

Trauma & Orthopaedic Consultant at Barrow and Kendal

• Defined as “a chronic irreversible degenerative disease of articular cartilage....”

So What is Osteoarthritis?

So What is Osteoarthritis?

Progression from normal joint surface to bare bone exposed.

So What is Osteoarthritis?

So What is Osteoarthritis?

No gap between the bones indicating bone-on-bone arthritis

Gap between the bones indicating some cartilage still present

Who gets it? (risk factors)

Physical job, eg farming

Symptoms and signs?

• Pain • Stiffness • Swelling • Deformity • Crepitus (creaking)

Investigations and diagnosis...

• History • Examination • X-ray • Scans • Blood tests • Diagnostic Injection

Usually all that is required

Treatments options....

• Conservative (eg weight loss, modifying activities or use

walking stick)

• Supplements (eg glocosamine or cod-liver oil)

• Medical (pain killers / anit-inflammatory tablets or gels)

• Orthotics (splints and braces)

• Injections (steroid or hyaluronic acid)

• Keyhole Surgery • Open Surgery • Joint Replacement

Prevention?

Weight loss

Avoid excessive loading of joints Strong muscles

Excercise

Some specifics on hips and knees...

Hips

Symptoms Signs

Hip Joint Replacements

Risks Benefits Outcomes

Knees

Symptoms Signs

Risks Benefits Outcomes

Knees

Knee Joint Replacement ....Partial vs Total

The National Joint Registry • A national database collecting details of every joint replacement done in the UK? • Poor performing implants can be identified • Trusts and individual surgeons with poor results can be identified even if their patient end up in a different hospital

In 2012 the NHS performed: 133,902 Replacements 64,201 Hips 66,700 Knees 1,071 in our Trust

The National Joint Registry

The National Joint Registry Hips • 43% cementless • 33% cemented • 20% Hybrid • 3% Metal-on-metal / resurfacing • 33% patients aged 70-79 • 1% aged <40 • 60% metal on poly

The National Joint Registry Knees • 89% Total Knee Replacements (3%uncemented)

• 8% Unicondylar (partial) Knee Replacements • 1% Patello-femoral Replacements • PFC Sigma most common knee replacement used (the one we use) • Oxford most common UKR (the one I use)

The National Joint Registry What are our results and how do we compare to the rest of the UK?

National Joint Registry data...

National Joint Registry data...

National failure rate for hip replacements after 5 years

National Joint Registry data...

National failure rate for hip replacements after 5 years

Results for our Trust are significantly better than

national average

National Joint Registry data...

The same is true for our results with knee replacements

National Joint Registry data...

Dots below the blue line mean our hospital results are in the best 5% in the UK

National Joint Registry data...

Our mortality rates are also better than the national average

Summary

• Osteoarthritis is very common • It hurts a lot • There is no cure • But joint replacements work well • Our Trust is really good at them!

Questions?