Latest Treatments for You re Not Alone Hip Arthritis ...€¦ · Latest Treatment Options for Hip Arthritis Expectations/Outcomes Your Treatment Options Hip Pain About My Practice

Latest Treatments for Hip Arthritis

Michael J. Repine MD Boulder Medical Center

Orthopedics 303-502-9404

Your Treatment OptionsYour Treatment OptionsYour Treatment OptionsHip Pain

You’re Not Alone

More 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 Hip AnatomyDiscussion of ArthritisLatest Treatment Options for Hip ArthritisExpectations/Outcomes


About My Practice

Undergraduate 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 injuries, and hand


Normal Hip

Bony Anatomy


The Hip JointMusculature

Multiple muscles enveloping the hip jointProvide additional stability to the hip joint

Posterior


The Hip JointMusculature

Multiple muscles enveloping the hip joint anteriorly as well

Anterior


The Hip JointLigaments

StabilityStabilityComplex array of ligamentsAugments stability to the ball and socket


The Hip JointCartilage

Cartilage is critical in understanding arthritis


The Hip JointCartilage

•Transmits applied loads across mobile surfaces•Lines the ends of bones •Surfaces roll or slide during motion–Hyaline cartilage is fluid-filled wear-resistant surface–It 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 Cartilage

When 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, usuallyaccompanied by pain, swelling, andstiffness.


What is What is ARTHRITIS?

Definition: The mechanical wearing of thecartilage surface resulting in painand limited function.

Importantly, this mechanical change is

accompanied by biochemical

changes

Your Treatment OptionsYour Treatment OptionsYour Treatment OptionsHip PainWhat is What is ARTHRITIS?

Normal Anatomy Normal Xrays

Your Treatment OptionsYour Treatment OptionsYour Treatment OptionsHip PainWhat is What is ARTHRITIS?

Arthritis Anatomy Arthritic Xrays


Most Common Causes of Arthritis

Degenerative – “wear and tear”

Osteoarthritic – traumatic

Rheumatoid – inflammatory

Bacterial - infectious


Diagnosing Hip Pain

Medical historyPhysical examinationX-rays, Radiographic StudiesOther tests


Symptoms

PAINWeight-bearing activitiesWhile sleeping at nightLocated over groin, lateral hip, sometimes buttock pain

*Important to evaluate for spinal source

Usually 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 hip:narrowing of the joint spacecystic changes in the boneformation of bone spurs (osteophytes)

X-ray Evaluation


DiagnosisBlood testsComputerized Tom ography(CT) scansMagnetic Resonance Imaging (MRI) scans

– Best non-surgical modality to identify focal cartilage defects

– RARELY NECESSARY FOR HIP ARTHRITIS

Arthroscopy– Small areas of traumatic

arthritis, loose bodies

Additional Tests


Non-Surgical Treatment Options for Arthritis


Nonsurgical treatment options

Physical Therapy

Almost always start with physical therapy

– Improve range of motion

– Improve strength– Decreases pain



Medications

NSAIDS– Decreases

inflammation– Decreases pain



Supplements

Lots of claims

NONE have passed FDA testing as provenPersonal trials



Cortisone injectionPROS

Relatively easy procedure under fluoroscopyExcellent diagnostic toolWell-toleratedVery predictable reduction in pain



Cortisone injectionCONS

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



Viscosupplement

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



ViscosupplementPROS

Protects remaining cartilageImproves biochemical environment of jointReliable reduction in pain



ViscosupplementCONS

“Off label use”Currently, approved for knees onlyCurrently being studied



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


Decision Variables

Physiology

Expectations

Anatomy Physiology

Expectations

Anatomy

Moderate or

extensive arthritis

Age, strength, range of motion


Surgical TreatmentModerate Cartilage Damage


Surgical treatment

Moderate cartilage damage

Must catch damage earlyBest treated before secondary changes occur within the hip

“Pothole”


Surgical treatment

Focal cartilage damage

MicrofractureLargely treated arthroscopically


Surgical treatment

Focal cartilage damageCartilageTransplantation


Surgical treatment

Focal cartilage damage

Partial replacementResurfacing


Surgical treatment

Advanced ArthritisBecause hip replacement is predictably so good in restoring function and pain relief, the choice is really replacement or not


Surgical treatment

Advanced ArthritisPatient determines the appropriate time for surgical interventionNot determined by xrayCan’t really “miss the boat” with hip arthritis



Surgical TreatmentAdvanced Arthritis

ANTERIOR ANTERIOR HIP REPLACEMENT


Anterior Hip Replacement

What is it?– The DIRECT

ANTERIOR approach



Advantage(s)– True intermuscular

approach to the hip joint

– Originally described in 1883

– Regained popularity



Advantage(s)– Patient is positioned

supine (on their back)

– Sometimes use specialized leg holder

– Easier for patient, surgeon and anesthesia



Advantage(s)– Intermuscular– Limited trauma to

muscles and tissue– Anterior capsular

incision– No disruption of the

posterior structures to the hip at all



Advantage(s)– Allows excellent

visualization– With more

limited surgical dissection

– Faster recovery– Less pain



Advantage(s)– Patients are up

walking on the hip the same day

– Most patients go home after just one night in the hospital

– No pillows between legs

– Minimal positional precautions


Surgical TreatmentAdvanced Arthritis

COMPUTER COMPUTER ASSISTED ASSISTED

HIP REPLACEMENT


Computer Assisted Hip ReplacementMakoplasty

Rationale– Allows extreme

precision when performing hip replacement surgery



Rationale– Correct

positioning of the components leads to lower wear rates and reduced risk of dislocation



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



Technique:– Robotic arm

assists with controlled resection of bone

– Real-time evaluation



Technique:– Allows single

stage reaming– Solid, stable fit of

the acetabular component


Recovery

Begins immediatelyImprovements in anesthesia also facilitate immediate mobilityStart working with therapy to get out of bedWBATAnterior hip precautions


Summary

You choose the time to intervene for hip replacementGold Standard of all joint replacementsVery predictable outcome with a painless and fully functional hip joint


Summary

Combiningtechniques of computer assistance with an anterior hip surgical approach utilize the best of current technologies to maximize your recovery and outcome

Documents

Latest Treatments for You re Not Alone Hip Arthritis ...€¦ · Latest Treatment Options for Hip Arthritis Expectations/Outcomes Your Treatment Options Hip Pain About My Practice