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Osteoarthritis and Total Joint Replacement

Risk Factors, Prevention, and Treatment, and the Effects on Sensory Mechanisms Encountered by Osteoarthritic Total Joint Replacement Patients
Neil V. Shah BioNB 4210, Fall 2008 Final Project

An Introduction to Osteoarthritis
Osteoarthritis (OA) is a slow-progressing joint inflammation

that can result from cartilage degeneration.


OA is the most common form of arthritis, even more

common as age increases. Nearly 27 million Americans older than 25 years of age have OA.
By 2030, nearly 20% of Americans (approximately 72

million people) will surpass 65 years of age and be at high risk for OA.
Under the age of 45, male OA patients outnumber females.

After that age, it is more common in women. It is also more likely to develop in overweight people and people with jobs that stress certain joints.

What Does OA Affect?


OA onset at where joints occur, most commonly

affecting the hands and finger-ends, neck, lower back, knees, and hips (Figure 1, left).
It is painful and can negatively influence lifestyle,

Figure 1. (Backside Body View) Courtesy of NIH NAMS It is

bringing on depression and a sense of helplessness, and finances, as treatment options can be expensive. also a very common cause for falls in the elderly. It leads to weakened bone and muscle strength, and this can severely worsen the effects of a fall on an elderly person.

An Osteoarthritic Joint

Figure 2. Courtesy of Shiel 2008, MedicineNet

Two types of OA:


Primary OA: attributed to age, heredity, and activity-related

deterioration on joint cartilage, resulting in a total loss of cartilage cushion between the bones of joints (Figure 2 above). Secondary OA: caused by other diseases/co-morbidities, such as obesity, trauma, diabetes, etc.

Symptoms & Diagnosis of OA


Frequently, OA patients complain of:
Stiffness in a joint after getting out of bed or sitting for a long time
Swelling and pain in one or more joints A Crunching feeling or the sound of bone rubbing on bone

**If your skin turns red or you feel hot, you may not have OA;
it could be of another cause, such as rheumatoid arthritis

Figure 3. Courtesy of CentraCare

Common Ways to Diagnose OA


Patients Clinical History and Physical Exam X-rays (Figure 3, right) or MRI images

read by an Orthopedist

Effective Treatments for OA


Goals of Treatment
Control Pain
Improve Joint Function

Restore Lifestyle
Maintain Normal Weight

Treatment Options
Exercise Strengthening, Aerobic, Agility Weight Control

Pain Medications Acetaminophen Corticosteroids Hyaluronic Acids

Surgery
Complementary Methods Acupuncture Nutritional Supplements

Surgery
Total Joint Replacement (TJR)
Prosthetic devices made from metal alloys (Figure 4, below), high-density

plastic, or ceramic material used to replace severely affected joints. Can be performed for degraded hips, knees, shoulders, and ankles.
Figure 4. Courtesy of DePuy Orthopaedics

Shoulder

Ankle

Knee

Hip

Artificial joints have become increasingly long-lasting (up to 10-15 years).

May require revision or re-replacements after that time.


Joint Resurfacing
The surfaces of the bones in the joint can be surgically resurfaced, or

smoothed out.
In regular replacement, the head of the joint is removed, but in resurfacing,

usually performed in the hip, the head is resurfaced and capped with an implant that will slide into the corresponding implanted cup.
Often a temporary step for those who avoiding

or delaying open surgical intervention (replacement, etc.) or arthroscopy.

Surgery Contd
Arthroscopy
Viewing scope inserted into the joint, allowing a

surgeon to view and detect the site of damage (Figure 5, below)


Sometimes this can be can repaired through an

arthroscope.
Often a successful procedure with

recovery time quicker than open joint surgery.

Figure 5. Courtesy of Essex Knee Surgery

Joint Replacement
Who Can Help You Treat your OA?

Primary Care Physicians Rheumatologists Orthopaedists Physical Therapists Occupational Therapists Nurse Educators

In addition to major orthopedic hospitals, many

Dieticians Physiatrists (Rehab Specialists) Licensed Acupuncture Therapists Psychologists Social Workers

community hospitals can now perform not only therapeutic treatment but surgeries.

More on Joint Replacement


This procedure is continually improving itself, and

new methods are published frequently. Joints can now be customized to the lifestyle and age of the patient
Middle-Aged (40-60) Athletes, Factory Workers,

Frequent Travelers, etc.


Orthopaedic Centers Specializing in Joint

Replacement
Hospital for Special Surgery, New York, NY

NYU Hospital for Joint Diseases, New York, NY


Mayo Clinic, Rochester, MN Cleveland Clinic, Cleveland, OH Duke University Medical Center, Durham, NC

Tips for Those Considering Joint Replacement


Take Painkillers Before Surgery
Inform your physician
Studies in knee replacements have documented reduced pain and

other postoperative effects


Request Inpatient Rehabilitation Soon after the Operation
Studies have shown that patients moved to rehab as early as three

days following surgery have had successful recoveries and reduced hospital costs.
Dont Sit on OA; Approach It In the Long-Term
Dont wait for symptoms to become debilitating to act Studies show that surgeries performed at later stages

of joint deterioration due to OA result in worse postoperative functional status

Falls Can Accelerate Need for Surgery


Common Causes of Falls
Degraded bone density and muscle strength in the hip, knee, and ankle joints. Changes in Visual System

Age-related changes in sight, such as hardening, yellowing, and clouding of eye lens, decrease in pupil diameter, clouding of intraocular fluids, weakened eye muscles all contribute to decline in sight Among hip fracture patients, vision impairment is more frequent than in people without hip fractures

Changes in Perceptual and Auditory-Vestibular Systems

Declining ability to detect information combining touch and kinesthetic data (haptic perception) hurts ability to properly grasp and manipulate objects Vestibular system, located in the ear, is vital to maintaining and coordinating balance. Age-related changes to these systems hurts ability to adapt to environmental changes or obstacles and greatly increases the risk of falling

Alternatives to Operative Treatment


Therapeutic
Use of Non-Steroidal Anti-inflammatory Drugs (NSAIDs) Aspirin, Ibuprofin (Motrin), and Naproxen (Naprosyn) Physical Therapy Treatment with food supplements (glucosamine & chondroitin) Hyaluronic Acid Injections restores thickness of joint fluid for better

joint lubrication and impact capability


Self-Managed Rest, Exercise, Diet Control with Weight Reduction, Adjustment of Home

(Showers, Stairwells, Chairs, etc.)


Complementary and Alternative Methods (CAM) Acupuncture by inserting fine needles into skin at specific points on

body, they help reduce pain and improve physical function.

What Can You Do To Prevent OA?


Self-Care and Good Health Attitude are Vital Get Educated about OA and how it can affect your life. You should be aware of its frequency of occurrence and thus prepare accordingly. If you have it, join patient education programs or selfmanagement programs to help understand and cope with OA and reduce pain Stay Active with exercise and regular activity Eat Well and Control Your Weight Stay Positive OA can be successfully managed, and research is continuing to improve the lives of OA patients on a daily basis

Intended Audience
This presentation is primarily intended for elderly patients who want a general overview of the risk factors, symptoms, and treatment methods associated with osteoarthritis. It also may be useful for:
People wanting to gain a basic understanding of OA Patients younger than 60 years of age suffering from OA Family members of OA patients wanting to learn more

about their loved ones conditions and ways they can help

This presentation is not intended to serve as a

scientific review of OA nor is it intended to provide information that would be entirely novel to members of academia and medicine. It is merely a resource meant primarily for patient education.

References and Resources

Helpful Resources

Best Hospitals: Orthopedics. 2008. Americas Best Hospitals. US News. Dec. 4, 2008. <http://www.usnews.com/directories/hospitals/index_html/specialty+ihqorth>

Buckelew K. (2007) New technology allows joint replacement on younger patients. Daily Record. Dec. 4, 2008. <http://findarticles.com/p/articles/mi_qn4183/is_20071119/ai_n21125849/pg_1?tag=artBody;col1>
Kulkarni S. (2006) Falls And The Elderly: An Educational Resource. Dec. 4, 2008. <http://courses.cit.cornell.edu/psych431_nbb421/student2006/ssk34/whyfallsoccur.htm> Osteoarthritis. 2002-2006. NIH NIAMS. Dec. 4, 2008. <http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp> Shiel, WC. Osteoarthritis. Sep. 2008. MedicineNet. Dec. 4, 2008. <http://www.medicinenet.com/osteoarthritis/article.htm#Whatis>

Images

Figure 3: Thompson, EG. (2007) X-ray of osteoarthritis of the knee. CentraCare Health System. Dec. 4, 2008. <http://64.143.176.9/library/healthguide/en-us/support/topic.asp?hwid=zm6052> Figure 4. Joint Replacement Technology. 2002-2008. DePuy Orthopaedics. Dec. 4, 2008. <http://www.jointreplacement.com/DePuy/index.html>

References and Resources Contd


Images Contd Figure 5. Rees C. (2008) Anterior cruciate ligament (ACL) reconstruction. Essex Knee Surgery. Dec. 4, 2008. <http://www.essexkneesurgery.co.uk/anterior-cruciate-ligament-reconstruction.php>

Relevant Studies and Publications (May Require Access to University Library Proxy; Can All be accessed through Respective University Library through Google Scholar)
Buvanendran A, Kroin, JS, Truman K, et. al. (2003) Effects of Perioperative Administration of a

Selective Cyclooxygenase 2 Inhibitor of Pain Management and Recovery of Function After Knee Replacement. JAMA. 290: 2411 2418. http://jama.amaassn.org/cgi/content/abstract/290/18/2411?ijkey=2037eae3f1d3b24c17bdf39eab0df590547a26ae& keytype2=tf_ipsecsha
Fortin PR, Clarke AE, Joseph L, et. al. (2001) Outcomes of total hip and knee replacement:

Preoperative functional status predicts outcomes at six months after surgery. Arthr. and Rheum.. 42(8): 1722 1728. http://www3.interscience.wiley.com.proxy.library.cornell.edu/journal/79503171/abstract?SRETRY=0
Grue EV, Kirkevold M, Mowinchel P & Ranhoff AH. (2009) Sensory impairment in hip-fracture

patients 65 years or older and effects of hearing/vision interventions on fall frequency. J. Multidiscip. Healthcare. 2: 1-11. http://www.dovepress.com/articles.php?article_id=2549

References and Resources Contd


McCarvill S. (2005) Essay: Prosthetics for athletes. Lancet.

366(1): S10 S11. http://www.sciencedirect.com.proxy.library.cornell.edu/science?_o b=ArticleURL&_udi=B6T1B-4HTK0YH6&_user=492137&_rdoc=1&_fmt=&_orig=search&_sort=d&view= c&_acct=C000022719&_version=1&_urlVersion=0&_userid=4921 37&md5=6fc1df7a95e13d85b1eb14e4c39d7172 Replacement. JAMA. 279: 880. http://jama.amaassn.org.proxy.library.cornell.edu/cgi/content/full/279/11/880

Zuckerman JD. (1998) Inpatient Rehabilitation After Total Joint