Osteoarthritis

Dr A V Gurava ReddyDNB, M.Ch, F.R.C.S(Ed), F.R.C.S(Glas)

Chief joint replacement surgeonManaging director

Sunshine hospitals hyderabad

Osteoarthritis

• Typically affects

• Knees

• Hips

• Spine

• And small joints of fingers

• Mostly commonly affects knees in Indian

population

OSTEOARTHRITIS KNEE

• Chronic, degenerative disorder

• multifactorial aetiology

• loss of articular cartilage

• periarticular bone remodelling

• large weight-bearing joints

• Common in older patients but can occur in

younger patients ( genetic mechanism , previous

joint trauma )

• hinge joint

Incidence

• Incidence increases with age

• In india - 80-90% above 65 suffer with primary OA

• After age 55 years, the prevalence increases in women in

comparison with men

prevalence

• Equivalent prevalence occurs in men and women

aged 45-55 years (↑dramatically after the age of

50 years in women)

• Most adults older than 55 years show radiographic

evidence of osteoarthritis

• No significant correlation exists between incidence

of OA and race

Causes

Primary OA

• Idiopathic

• Defective gene

• AGE RELATED WEAR AND TEAR

Causes

Secondary OA

– Obesity

– Repetitive use (ie, jobs requiring heavy labor

and bending)

– Previous trauma (ie, posttraumatic OA)

– Infection

Causes

– Crystal deposition

– Acromegaly

– Previous rheumatoid arthritis (ie, burnt-out

rheumatoid arthritis)

– Heritable metabolic causes (eg, alkaptonuria,

hemochromatosis, Wilson disease)

Causes

– Hemoglobinopathies (eg, sickle cell disease,

thalassemia)

– Underlying orthopedic disorders (eg, congenital

hip dislocation, slipped femoral capital

epiphysis)

– Disorders of bone (eg, Paget disease,

avascular necrosis)

History

• Insidious throbbing arthralgias with activity

• Initially, resting relieves the pain

• Eventually, the pain occurs even at rest

• Morning stiffness ≥ 30 minutes

• Intermittent joint swelling

Symptoms

• Pain

• Stiffness

• swelling

• Instability

Signs

• Pain

• Tenderness

• Swelling

• Effusion

• Crepitus

• Limitation of movement and muscle

wasting

Deformities

Imaging

• Plain radiographs

• Bone scans may be helpful in early

diagnosis of OA of the hand

• The space between the bones of the upper and lower leg is smaller

• Bony spurs (osteophytes)

• Increase bone density at the margin of the joint

x-ray

findings– Joint space narrowing

– Osteophytes

– Subchondral sclerosis : ↑ bone density,

frequently found adjacent to joint space

– Subchondral cysts : fluid-filled sacs which

extrude from the joint

Radiographs

Diagnosis

• On the basis of the initial history

and examination

• X-rays

Manage

ment

Goals of

managing OA

• Pain control

• Prevent stiffness and secondary deformities

• Limiting functional impairment

Treatment

• Education and behavioural intervention

• Weight loss

• Physiotherapy

• Splints

Treatment

• Analgesics

- Acetaminophen (Tylenol®) is a mild pain

reliever with few side effects

- Anti-inflammatory medication, such as

ibuprofen and aspirin

- COX-2 inhibitors

- Glucosamine and Chondroitin sulfate

Treatment

• Intra-articular injection

- Glucocorticoids injection

- Hyaluronic Acid (HA) and similar

hyaluronan preparations (eg, Synvisc)

………. Debatable

Treatment

• Surgery

- Arthroscopy (including debridement,and lavage/irrigation)

- Proximal Tibial Osteotomy

- Total Knee Replacement

Case 1

CASE 2

Case 3

CASE 4

MOBILE BEARING KNEE- RESULT

HI-FLEX

KNEE

Young –19 /m

All four joints replaced in a young patient with ochronotic arthropathy

MOTTO

Achievements

• Established as a patient friendly hospital in 2009

• The second largest Joint replacement center in Asia

• Well equipped and biggest trauma care facility in the state of Andhra Pradesh

• Availability of all Super specialists under one roof

PATIENT FIRST

Sunshine Hospitals is South East Asia’s 2nd largest joint replacement centre to a

pioneering multi-super specialty hospital

3000+ successful joint replacements every year

A state-of-the-art healthcare destination unrivaled for its service, quality of

deliverables and empathy

Investing relentlessly in people, equipment, technology and research

PATIENT FIRST

About Sunshine Hospitals

• 400 Bed Facility

• Centrally Located at Paradise circle Secunderabad

• Exceptional Ambience

• Spacious Parking area

• Well trained Patient care Coordinators

• Choice of occupancy(Royal Suite… General ward)

PATIENT FIRST

About Sunshine Hospitals

• 40 critical care beds with central monitoring systems

• Dedicated floor and In House critical care team to handle all Emergencies

• 1:1 Nursing ratio in critical care areas

• Treatment and patient care protocols as per international standards and

guidelines

• Specialized equipment and expertise Consultant team to handle complex

procedures

PATIENT FIRST

About Sunshine Hospitals

• 14 World class operating Theatres having global quality standards with laminar

airflow, Hepa Filters, High end microscope and other latest surgical equipments.

• Well equipped patient centered central monitoring systems ICCU’s with special

trained staff and consultants 1:1 Nursing staff

• 2 Flat panel digital catheterization lab

• 150 seat Auditorium with latest AV system

• 2 Digital 7900 flurostar C-Arm

• 1.5 Tesla MRI and Spiral CT

• Dedicated floor for OT with pre and post operative ICU care

PATIENT FIRST

• State of art Radiology services( MRI, CT, ECHO, Ultrasound, Doppler, TMT,

digital x-ray etc)

• Fully automated laboratory services( Pathology, Microbiology, Biochemistry,

Genetics)

• Special Health checkup packages

• Continuous learning programs for doctors and paramedical staff( internal and

external)

PATIENT FIRST

CT / MRI 1.5 Tesla

PATIENT FIRST

PATIENT FIRST

PATIENT FIRST

20

09

Our VisionTo create a world-class medical facility where patients are treated with compassion.

Our MissionTo create a world-class medical facility where patients are treated with compassion .To offer qualitative and comprehensive services in a patient-friendly environment focused on clinical excellence, safety, dignity and transparency, while staying affordable and accessible to every patient in need.

Our Values• Compassion• Teamwork• Transparency• Process-driven

PATIENT FIRST

AUGUST,

SUNSHINE HOSPITALS: The beginning

Arthroplasty surgeries

PATIENT FIRST

96 3

1

2010: A promising start..

5 Beds

321

0

210

5 Shoulder, Arthroscopy & Shoulder

surgeries 500

Trauma surgeries

Arthroplasty surgeries

PATIENT FIRST

27 7

1

2013: The Journey till now..

0 Beds

603

1

040

5 Shoulder, Arthroscopy & Shoulder

surgeries 500

Trauma surgeries

2014: Well placed to grow..

PATIENT FIRST

2ASIA’s LARGEST

Joint replacement Centre

nd

2014: Well placed to grow..

PATIENT FIRST

1stRanked

Worldwide Achievers & Headlines Today

HEALTHCARE EXCELLENCE AWARD 2013

Other specialities

• Trauma

• Arthroscopy and sports medicine

• Orthopedic oncology

• Spine

• Hand surgery

• Pediatric orthopedics

• Ilizarov and reconstructive surgery

Trauma team

Spine unit

Hand surgery

Arthroscopy and sports medicine

Orthopedic oncology

Pediatric orthopedics

Reconstructive and ilizarov

surgery

Our Anaesthesia Team

Our Physiotherapy Team

Our Support Team

PATIENT FIRST

PATIENT FIRST

THE SUNSHINE ADVANTAGE Sunshine Big hospitals without Specialty focus

Single Specialty hospitals

Volumes3000 joint replacements in a year

✔

Round the clock availability of Specialists, Resident in

the campus 24 X 7

DM Cardiologists ✔

MS Orthopedics doctors ✔MD Anaesthesiologist ✔MD General Medicine ✔Intensive care Specialists ✔

Infrastructure

Cardiac cath labs ✔CT Scan ✔MRI ✔Dialysis Machines ✔Modular theatres Laminar airflow with HEPA filters

✔

Support Services

Dedicated Pain Control Nurses working under a Consultant Anaesthesiologist

✔

Exclusive Infection control team headed by Consultant Microbiologist

✔

Is the time out?