Part III

Amy L. McIntosh, MDPediatric Orthopedic Surgeon

Mayo ClinicRochester, Minnesota

Medical Therapy

• Supplements

• Over-the-counter medicines

• Prescription medicines

• Injection therapy

Supplements

• Little scientific evidence for/against products– Not subject to FDA regulations

– Reasonable evidence for glucosamine / chondroitin helping with arthritic symptoms

– No evidence for other compounds

OTC Medicines

• Tylenol

• NSAIDs – Ibuprofen (Advil) and Naprosyn (Aleve)– Equally effective in all major

studies– Quite safe when taken with

supervision• Stomach ulcers

• Kidney trouble

Prescription Medicines

• Prescription NSAIDs– Celebrex, Mobic, etc– No better than ibuprofen

or naprosyn in comparable doses

• Benefits for select patients• Primary benefit is

convenience

– Cardiovascular risks unknown

Prescription Medicines - Opiates

• Synthetic derivatives of morphine– Effective– But… tolerance building and habit

forming– Frequent depression and side

effects

– Used very selectively and carefully under specialty supervision

Physical Therapy

• Important aspect of joint care in SS

• Particularly important before and after any surgery

Injection Therapy

• Injection of cortisone or hyaluronic acid derivatives

• Effective in ~2/3rds patients

• Effect often fades

• Safe for up to 3-4 times/year

Surgical Treatment

• Fusion

• Arthroscopy

• Realignment / reshaping

• Joint replacement

Fusion

• Traditional treatment for arthritis in the young– “No motion, no pain”

• Not for patients with multiple joint involvement– Spine, ankle, wrist

possible exceptions

Arthroscopy

Arthroscopy

• Low morbidity outpatient procedure• Doesn’t “burn” bridges

– Effective against well defined targets• Focally torn cartilage

– Not effective for generalized joint pain or arthritis

Realignment Procedures - Knee

• Surgically change alignment to “offload” worn area

• Delay need for joint replacement

Realignment Procedures - Hip

Impinging bump on the edge ofa malformed femoral head (ball)