Common Questions
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Do I have arthritis
Any pain pill
Can you give a Shot
Does Therapy help
I can’t exercise…I’m in pain
Loose weight ? how much ?
Can you fix without surgery
Purpose of C - O - R - E
(Community Out-Reach Education)
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• Good health starts with Good information
• Basics of Hip & Knee Arthritis and Management
(…based on scientific guidelines)
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Ty p e s o f A r t h r i t i s :
Arthritis = Disease of the Joint
https://www.medicinenet.com/arthritis/article.htm
• Osteoarthritis (OA)
• Rheumatoid Arthritis
• Septic Arthritis
• Psoriatic Arthritis
• Gouty Arthritis
• Lyme Arthritis
• Spondylytic Arthritis
• Lupus Arthritis
• Juvenile Arthritis
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https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/
Osteoarthritis (OA) = Wear-and-Tear arthritis (KNEE)
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https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip/
Osteoarthritis (OA) = Wear-and-Tear arthritis (HIP)
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US Bone and Joint Initiative. The Burden of Musculoskeletal Diseases in t he United States (BMUS). https://www.boneandjointburden.org/fourthedition/iiib10/osteoarthritis.
A National Public Health Agenda for Osteoarthritis: 2020 Update
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• Pain: Gradual vs Sudden
• Stiffness
• Swelling
• Clicking
• Give way
• Limping
How does OA present
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Doctor examination:
X rays:
CT Scan/ MRI scan (rarely needed)
How to confirm Arthritis
https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip
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1. Lifestyle Modifications: Weight Management
https://www.cdc.gov/healthyweight/assessing/bmi/adu
lt_bmi/english_bmi_calculator/bmi_calculator.html
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1. Lifestyle Modifications: Weight Management
1 lb. weight loss
4-fold reduction in load on knee/step
Goal:
5% weight loss in 5 months
Lose just 10 lbs. if you weigh 200 lbs.
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https://www.drpennella.com/sitting-new-smoking/
Sedentary Life Style - Silent Culprit
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https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
•Start low, go slow
•Modify activity
•Activities should be “joint friendly”
•Recognize safe places and ways to be active
•Talk to a health professional
S - M - A - R - T tips for exercises
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Treatment Options – Physical Therapy
Lifestyle Modifications
Physical Therapy
Brace & Cane
Medications
Surgery
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2. Physical Therapy
• Manual Therapy
• Ultrasound
• Electrical Stimulation
• Heat and Cold
• Pool Therapy
• Exercise Therapy: Core → Hip → Knee
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OTC Rx
• Diclofenac
• Meloxicam
• Celecoxib
• Opioids (poor evidence)
4 . M e d i c a t i o n s - P i l l s
• Use lowest effective dose for shortest duration
• Side effects: GI, Kidney, CVS
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Hunter DJ. Viscosupplementation for osteoarthritis of the knee. N Engl J Med.
2015 Mar 12;372(11):1040-7. doi: 10.1056/NEJMct1215534. PMID: 25760356.
4 . M e d i c a t i o n s - I n j e c t i o n s
• Gel Injections/ Hyaluronic Acid
• Platelet Rich Plasma (PRP)
• Stem Cells• No systemic effects
• Not more than 3-4 inj. per year
• Cortisone Shot
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Treatment Options – Surgery
Lifestyle Modifications
Physical Therapy
Brace & Cane
Medications
Surgery
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Surgical Options
Scopy
Osteotomy
Cartilage restoration
Partial joint replacement
Total joint replacement (hip & knee)
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Knee Arthroscopy/ Key-hole surgery
https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/
Low risk procedure
Placebo effect
Temporary Benefit
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3 Surgical Options for focal knee arthritis
•Drilling•Microfracture
•Abrasion Chondroplasty•Autologous Chondrocyte Implantation
•Osteochondral Autograft Transplantation•Osteochondral Allograft Transplantation
O s t e o t omy C a r t i l a ge R e s t o r a t io n P a r t i a l
https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/
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https://hipknee.aahks.org/what-are-hip-and-knee-replacement-implants-made-of/
Total Knee Replacement (TKR)
Patellar button
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Total Hip Replacement (THR)
https://hipknee.aahks.org/what-are-hip-and-knee-replacement-implants-made-of/
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Complications of Total Joint Replacement
• Infection
• Clots
• Leg length issues
• Nerve injury
• Vessel injury
• Dislocation
• Loosening
• Fractures
• Revision
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Enhanced Recovery After Surgery (ERAS) protocols:
Before During After
• Nutrition
• Lung function
• Heart function
• Anemia
• DM/HTN
• Smoking
• Weight loss
• Heart issues
• Sleep apneaRegional Anes.
Nerve Blocks
Local infiltration
Early mobilization
DVT prevention
Pain Management
Home next day
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• Dramatic improvement in joint pain & function
• Continue light exercises & weight control
Life after TKR/ THR
• Antibiotics prior to dental procedures: 2 years- vs- life long
• Follow-ups with x-rays: every 3-5 yr
• OK for low-impact sports
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• Team approach
• We practice ‘Evidence Based Medicine’
• L-E-E-D approach
(Listen-Evaluate-Explain-Discuss)
https://cheezburger.com/4009733/15-hilarious-monkey-memes
How can CMH help
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• Team approach
• We practice ‘Evidence Based Medicine’
• L-E-E-D approach
(Listen-Evaluate-Explain-Discuss)
• Realistic expectations
How can CMH help
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How YOU can help YOURSELF
W e i g h t m a n a g e m e n t i s t h e K e y
5% loss
within
5 months
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Lifestyle Modifications
Physical Therapy
Brace & Cane
Medications
Surgery
How can YOU help YOURSELF
Tr y m u l t i p le n o n o pe r a t i v e m e a s u r es b e f o r e s u r ge r y
Study materials
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https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
https://www.cdc.gov/arthritis/docs/oaagenda2020.pdf
https://orthoinfo.aaos.org/en/diseases--conditions/osteoarthritis-of-the-hip
https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/
https://oarsi.org/sites/default/files/library/2014/pdf/patientsumfinal.pdf
https://hipknee.aahks.org/
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Dr. Madan Vallem, MD
Dr. Khalid Hasan, MD
Mari Adams, PA-C
Vicky Kennedy, NP
Acknowledgements
Angela Wright, Practice Manager
Kristy Fowler, Marketing Specialist
Margaret Hall, LPN
Melody Ashley, LPN
Teresa Williams, Care Partner
Javon Hite, Med Asst
Joanne Duffer, Patient Access Rep
Jessica Chapman, Radiology Tech
Rochelle Smith, Radiology Tech
Susan Estes, Radiology Tech