Hip and Knee Arthritis

Sree Metikala, MD

April 2, 2021

Common Questions

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Do I have arthritis

Any pain pill

Can you give a Shot

Does Therapy help

I can’t exercise…I’m in pain

Loose weight ? how much ?

Can you fix without surgery

Purpose of C - O - R - E

(Community Out-Reach Education)

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• Good health starts with Good information

• Basics of Hip & Knee Arthritis and Management

(…based on scientific guidelines)

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Ty p e s o f A r t h r i t i s :

Arthritis = Disease of the Joint

https://www.medicinenet.com/arthritis/article.htm

• Osteoarthritis (OA)

• Rheumatoid Arthritis

• Septic Arthritis

• Psoriatic Arthritis

• Gouty Arthritis

• Lyme Arthritis

• Spondylytic Arthritis

• Lupus Arthritis

• Juvenile Arthritis

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Osteoarthritis (OA) = Wear-and-Tear arthritis

Car Tire Analogy

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https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/

Osteoarthritis (OA) = Wear-and-Tear arthritis (KNEE)

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https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip/

Osteoarthritis (OA) = Wear-and-Tear arthritis (HIP)

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Reasons for OA:

Injury or overuse

Age: > 50

Gender (F>M)

Obesity

Genetics

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US Bone and Joint Initiative. The Burden of Musculoskeletal Diseases in t he United States (BMUS). https://www.boneandjointburden.org/fourthedition/iiib10/osteoarthritis.

A National Public Health Agenda for Osteoarthritis: 2020 Update

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• Pain: Gradual vs Sudden

• Stiffness

• Swelling

• Clicking

• Give way

• Limping

How does OA present

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Doctor examination:

X rays:

CT Scan/ MRI scan (rarely needed)

How to confirm Arthritis

https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip

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Five Treatment Options

Lifestyle Modifications

Physical Therapy

Brace & Cane

Medications

Surgery

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1. Lifestyle Modifications

Losing Weight

Low impact exercises

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1. Lifestyle Modifications: Weight Management

https://www.cdc.gov/healthyweight/assessing/bmi/adu

lt_bmi/english_bmi_calculator/bmi_calculator.html

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1. Lifestyle Modifications: Weight Management

1 lb. weight loss

4-fold reduction in load on knee/step

Goal:

5% weight loss in 5 months

Lose just 10 lbs. if you weigh 200 lbs.

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Think before you eat

1. Lifestyle Modifications: Weight Management

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Which item in the picture could decrease life span ?

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https://www.drpennella.com/sitting-new-smoking/

Sedentary Life Style - Silent Culprit

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1. Lifestyle Modifications: Exercises

High Impact Ex

Low Impact Ex

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https://www.cdc.gov/arthritis/basics/physical-activity-overview.html

•Start low, go slow

•Modify activity

•Activities should be “joint friendly”

•Recognize safe places and ways to be active

•Talk to a health professional

S - M - A - R - T tips for exercises

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P r a c t i c e L o w I m p a c t E x e r c i s e s

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A v o i d H i g h I m p a c t E x e r c i s e s

RunningWeight-lifting

Jumping

Tennis

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Treatment Options – Physical Therapy

Lifestyle Modifications

Physical Therapy

Brace & Cane

Medications

Surgery

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2. Physical Therapy

• Manual Therapy

• Ultrasound

• Electrical Stimulation

• Heat and Cold

• Pool Therapy

• Exercise Therapy: Core → Hip → Knee

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3 . B r a c e – C a n e - O r t h o t i c s

Sleeve Brace Unloader

brace

Cane Insoles

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4 . M e d i c a t i o n s

Topical

Pills

Joint

Injections

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4 . M e d i c a t i o n s - T o p i c a l

• Minimal Systemic Absorption

• Variable effects

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OTC Rx

• Diclofenac

• Meloxicam

• Celecoxib

• Opioids (poor evidence)

4 . M e d i c a t i o n s - P i l l s

• Use lowest effective dose for shortest duration

• Side effects: GI, Kidney, CVS

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Hunter DJ. Viscosupplementation for osteoarthritis of the knee. N Engl J Med.

2015 Mar 12;372(11):1040-7. doi: 10.1056/NEJMct1215534. PMID: 25760356.

4 . M e d i c a t i o n s - I n j e c t i o n s

• Gel Injections/ Hyaluronic Acid

• Platelet Rich Plasma (PRP)

• Stem Cells• No systemic effects

• Not more than 3-4 inj. per year

• Cortisone Shot

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4 . M e d i c a t i o n s - I n j e c t i o n s

Knee Hip

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Treatment Options – Surgery

Lifestyle Modifications

Physical Therapy

Brace & Cane

Medications

Surgery

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Surgical Options

Scopy

Osteotomy

Cartilage restoration

Partial joint replacement

Total joint replacement (hip & knee)

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Knee Arthroscopy/ Key-hole surgery

https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/

Low risk procedure

Placebo effect

Temporary Benefit

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3 Surgical Options for focal knee arthritis

•Drilling•Microfracture

•Abrasion Chondroplasty•Autologous Chondrocyte Implantation

•Osteochondral Autograft Transplantation•Osteochondral Allograft Transplantation

O s t e o t omy C a r t i l a ge R e s t o r a t io n P a r t i a l

https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/

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Reliable procedure: Replace the old Tire

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https://hipknee.aahks.org/what-are-hip-and-knee-replacement-implants-made-of/

Total Knee Replacement (TKR)

Patellar button

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Total Hip Replacement (THR)

https://hipknee.aahks.org/what-are-hip-and-knee-replacement-implants-made-of/

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Complications of Total Joint Replacement

• Infection

• Clots

• Leg length issues

• Nerve injury

• Vessel injury

• Dislocation

• Loosening

• Fractures

• Revision

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Enhanced Recovery After Surgery (ERAS) protocols:

Before During After

• Nutrition

• Lung function

• Heart function

• Anemia

• DM/HTN

• Smoking

• Weight loss

• Heart issues

• Sleep apneaRegional Anes.

Nerve Blocks

Local infiltration

Early mobilization

DVT prevention

Pain Management

Home next day

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Post op Physical Therapy

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Recovery after TKR/ THR

4-6 weeks

6-8 weeks

12-14 weeks

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• Dramatic improvement in joint pain & function

• Continue light exercises & weight control

Life after TKR/ THR

• Antibiotics prior to dental procedures: 2 years- vs- life long

• Follow-ups with x-rays: every 3-5 yr

• OK for low-impact sports

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A v o i d E x t r e m e s p o r t s & H i g h Im p a c t E x e r c i se s

Life after TKR/ THR

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• Team approach

• We practice ‘Evidence Based Medicine’

How can CMH help

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• Team approach

• We practice ‘Evidence Based Medicine’

• L-E-E-D approach

(Listen-Evaluate-Explain-Discuss)

https://cheezburger.com/4009733/15-hilarious-monkey-memes

How can CMH help

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• Team approach

• We practice ‘Evidence Based Medicine’

• L-E-E-D approach

(Listen-Evaluate-Explain-Discuss)

• Realistic expectations

How can CMH help

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How YOU can help YOURSELF

W e i g h t m a n a g e m e n t i s t h e K e y

5% loss

within

5 months

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How can YOU help YOURSELF

B e w a r e o f S i t t i n g D i s e a s e

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How can YOU help YOURSELF

Smoking

Cessation

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Lifestyle Modifications

Physical Therapy

Brace & Cane

Medications

Surgery

How can YOU help YOURSELF

Tr y m u l t i p le n o n o pe r a t i v e m e a s u r es b e f o r e s u r ge r y

Study materials

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https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

https://www.cdc.gov/arthritis/docs/oaagenda2020.pdf

https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip

https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/

https://oarsi.org/sites/default/files/library/2014/pdf/patientsumfinal.pdf

https://hipknee.aahks.org/

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Dr. Madan Vallem, MD

Dr. Khalid Hasan, MD

Mari Adams, PA-C

Vicky Kennedy, NP

Acknowledgements

Angela Wright, Practice Manager

Kristy Fowler, Marketing Specialist

Margaret Hall, LPN

Melody Ashley, LPN

Teresa Williams, Care Partner

Javon Hite, Med Asst

Joanne Duffer, Patient Access Rep

Jessica Chapman, Radiology Tech

Rochelle Smith, Radiology Tech

Susan Estes, Radiology Tech

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Contact Info…

CMH Orthopaedic Services, LLC

1755 N. Mecklenburg Ave

South Hill, VA 23970

Ph: 434-584-2273