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Risk Factors, Prevention, and Treatment, and the Effects on
Sensory Mechanisms Encountered by Osteoarthritic
Total Joint Replacement Patients
Osteoarthritis and Total Joint Replacement
Neil V. ShahBioNB 4210, Fall 2008
Final Project
An Introduction to OsteoarthritisOsteoarthritis (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, bringing on depression and a sense of helplessness, and finances, as treatment options can be expensive.
It is 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.
Figure 1. (Backside Body View)Courtesy of NIH NAMS
An Osteoarthritic Joint
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.
Figure 2.Courtesy of Shiel 2008, MedicineNet
Symptoms & Diagnosis of OAFrequently, 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
Common Ways to Diagnose OA
Patient’s Clinical History and Physical Exam
X-rays (Figure 3, right) or MRI images read by an Orthopedist
Figure 3.Courtesy of CentraCare
Effective Treatments for OA
SurgeryTotal 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.
Artificial joints have become increasingly long-lasting (up to 10-15 years). May require revision or re-replacements after that time.
Joint ResurfacingThe 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.
Shoulder
Ankle Knee Hip
Figure 4. Courtesy of DePuy Orthopaedics
Surgery Cont’dArthroscopy
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 ReplacementWho Can Help You Treat your OA?
In addition to major orthopedic hospitals, many community hospitals can now perform not only therapeutic treatment but surgeries.
More on Joint ReplacementThis procedure is continually improving itself,
and new methods are published frequently.Joints can now be customized to the lifestyle
and age of the patientMiddle-Aged (40-60) Athletes, Factory Workers,
Frequent Travelers, etc.Orthopaedic Centers Specializing in Joint
ReplacementHospital for Special Surgery, New York, NYNYU Hospital for Joint Diseases, New York, NYMayo Clinic, Rochester, MNCleveland Clinic, Cleveland, OHDuke 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.
Don’t Sit on OA; Approach It In the Long-Term
Don’t wait for symptoms to become debilitating to act
Studies show that surgeries performed at later stagesof 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
TherapeuticUse of Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
Aspirin, Ibuprofin (Motrin), and Naproxen (Naprosyn)Physical TherapyTreatment 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
VitalGet 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 self-management programs to help understand and cope with OA and reduce pain
Stay Active with exercise and regular activityEat Well and Control Your WeightStay Positive – OA can be successfully managed,
and research is continuing to improve the lives of OA patients on a daily basis
Intended AudienceThis 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 OAPatients younger than 60 years of age suffering from OAFamily 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. America’s 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 Cont’d
Images Cont’d 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.ama-assn.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 Cont’d
McCarvill S. (2005) Essay: Prosthetics for athletes. Lancet. 366(1): S10 – S11. http://www.sciencedirect.com.proxy.library.cornell.edu/science?_ob=ArticleURL&_udi=B6T1B-4HTK0YH-6&_user=492137&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000022719&_version=1&_urlVersion=0&_userid=492137&md5=6fc1df7a95e13d85b1eb14e4c39d7172
Zuckerman JD. (1998) Inpatient Rehabilitation After Total Joint Replacement. JAMA. 279: 880. http://jama.ama-assn.org.proxy.library.cornell.edu/cgi/content/full/279/11/880