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Degenerative disease of the joints
The Bone and Joint Decade 2000 – 2010
Contents
1. Bone and Joint Decade 2000 – 2010
2. Degenerative disease of the joints (osteoarthritis)Ø Etiology
Ø Pathogenesis
Ø Signs and symptoms
Ø Diagnostic possibilities
3. Treatment of osteoarthritis
The Bone and Joint Decade 2000 – 2010
The Bone and Joint Decade 2000 – 2010
aims to improve the health-related
quality of life for people with
musculosceletal disorders worldwide.
The Bone and Joint Decade 2000 – 2010
The Bone and Joint Decade 2000 – 2010 was officially launched in Geneva on 13 January, 2000.
One out of every four American suffers from musculoskeletalconditions.
You are bringing hope to countless people around the world and helping to create a brighter, healthier future for us all.
The Bone and Joint Decade 2000 – 2010
UNWHO
World Bank
51 Goverments
Decade endorsement
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Facts
• Across the world, musculo-skeletal
conditions affect hundreds of millions of
people, at a huge cost to society (estimated at
$240 billion per year in the USA alone)
• Joint diseases account for half of all chronic
conditions in people aged 50 and over
•The number of individuals over the age
of 50 is expected to double between1990-
2020. In Europe by 2010, for the first
time, there will be more people over 60
years of age than people less than 20
years of age, resulting in a huge
escalation of treatment costs
Osteoarthritis is recognised as acivilisation disease
- is one of the
world’s largest
health care
problems
(WHO)
OsteoarthritisChronic degenerative non-inflamatory
joint disorder in which there is
progressive loss of articular cartilage
accompanied by new bone formation
and capsular fibrosis.
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OsteoarthritisClassification
Primary
(Osteoarthrosis idiopathica)
Secondary
(Osteoarthrosis secundaria)
EpidemiologyOsteoarthritis
18-34 years4%
35-74 years11%
75-79 years85%
Etiology
Secondary osteoarthrosis
• post-traumatic• congenital musculo-sceletal anomalies• post-inflamatory• epiphyseal diseases
Secondary osteoarthritis
Secondary osteoarthritis Etiology
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Patello-femoral pathology
P
L
TLP:LTInsall i Salvati
Osteoarthritismechanical
loadää
tissue resistance
Physiological inter-dependance
Articular cartilage
Synovium Subchondral bone
Cartilage & bonecartilage fibrillation
ääsurface abrasion
ääsubchondral bone thickening
ääcyst formation
Partial thickness damage
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Partial thickness damage Full thickness damage
Joint capsuleand synovial membrane
synovial hypertrophy
capsule fibrosis
capsule thickening
Symptoms
• pain
• stiffness
• restriction of movement
• flexion contracture
Signs
• joint swelling
• muscle wasting
• restriction of passive patellar tracking
• crepitation during movements
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Signs
• joint line
tenderness
• joint effusion
ValgusVarus
Diagnostic methods Diagnostic methods
Osteoarthritis Diagnostic methods
increased transmisionof forces to the
subchondral bone
ääincreased local blood
flow and deposition on existing trabeculae
ääsubchondral sclerosis
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Diagnostic methods
Osteophytes
Cartilage-bone outgrowths that occur most commonly at the margins of OA joints, by the process of enchondral ossification at the junction of hyaline cartilage and synovium/periosteum.
Arthrosis of the hip
Imaging
Normal articular cartilage in MR
SE T1 FL 2D FL 2D FL 2D
Imaging
Damaged articular cartilage
SE T1 SE T1
Arthroscopy
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Treatment of osteoarthritis
Pharmacological treatment Pharmacological treatment CostCost (PLN)(PLN)
0100020003000400050006000700080009000
10000
M D O V C E
MajamilDiclacOlfenVioxxCelebrexArthroplasty
Pharmacological treatmentPharmacological treatment
• Even short-term NSAID treatment may causegastropathy or entheropathy.
• Pathology may be visible within 7 days from the start of NSAID treatment.
• After some NSAID 19% frequency of stomach ulcer is observed in 6 days from the start of treatment.
• The cost of 9-months of sick-leave exceeds the cost of total knee arthroplasty
» ARCANA
Pharmacological treatmentPharmacological treatment
• Hyaluronic acid
• Glikozoaminoglicans/
• chondroityn
expensive, safe, may-be effective
cheaper, safe,
effective
•Hungerford D. S. 2002
Abrasion arthroplastyBone marrow stimulation technique
Mosaicplasty
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MicrofracturesBone marrow stimulation technique varus valgus
High tibial osteotomy
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Cemented arthroplasty
Cementless arthroplastyHip
prosthesis
Cementless hip arthroplastyOsteoarthritis
uni- and tricompartmental involvement
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Total knee arthroplasty
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Social and economic aspects of total knee arthroplasty
• Joint replacement is one of the most cost effective procedures in the whole medicine and surgery.
• When comparisons are made on the basis of the cost of quality adjusted life years, THR has a similar cost effectiveness to coronary artery bypass surgery.
»Laupacis 1994
Quality of life before and after arthroplasty• Preoperative hip and knee patient
groups were compared with similar groups who underwent arthroplasty 2 or 5 years previously.
• Major improvements were observed for pain, sleep, range of motion, and physical ability.
• The health status of patients operated 2 or 5 years ago was similar, suggesting a long-term health quality improvement .
• Rissanen P. and coathors 1995
Cardiovascular fitnessCardiovascular fitness
Inactivity secondary to more severe
osteoarthritis symptoms can result in
cardiovascular deconditioning.
» Ries M. D. and coauthors 1995
Cardiovascular fitnessCardiovascular fitness
Resumption of routine physical
activities after TKR is associated
with a corresponding
improvement in cardiovascular
fitness. In nonoperated patients
deterioration is observed.
» Ries M. D. and coauthors
1996
Arthrodesis
xxxxxxxxxxx
Hip prosthesis
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Complications
» Robertsson and coauthors 2000
Complications
• Infection rate after total knee arthroplasty
1 – 2 %
• Approximate per case cost
(USA)
50 – 60 thous. $
0
1
2
3
4
p a i
primasept.inf.
Sculco T. P. 1993 Hebert C. K. and coauthor 1996» »
Social and economic aspects of total knee arthroplasty
• Joint replacement is one of the most cost effective procedures in the whole medicine and surgery.
• When comparisons are made on the basis of the cost of quality adjusted life years, THR has a similar cost effectiveness to coronary artery bypass surgery.
»Laupacis 1994
Social and economic aspects of total knee arthroplasty
In over 90% of patients good result of
treatment may still be expected 10 years
after surgery.
» Molhani A. L. i Rand J. A. 1993-1994 r.
» Mason M. D. 1993-1994 r.
» Ranawat C. S., Boachie-Adjej O. 1988 r.
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Goals for the Decade
• Tissue engineering
• Gene therapy
Total knee arthroplastyGoals for the Decade
• Implants with better wear characteristics and improved fixation need to be developed.
Total knee arthroplastyGoals for the Decade
• Computer navigation
during surgery
Total knee arthroplastyGoals for the Decade
• Less invasive
unicompartmental
arthroplasty
?=
Advanced age is not
necessarily connected
with pain and disability.
Department of OrthopaedicsK. Marcinkowski University of Medical Sciences
in Poznan
Thank you