Join Pain Treatment & Surgery

Email: enquiry@medicyatra.
com
Your Joint Pain and Treatment Options
Copyright @ Forever Medic Online Pvt. Ltd
Joint Pain and Treatment Options Email: enquiry@medicyatra.com
About My Practice
1) Trained at Henry Ford Hospital in Detroit, Michigan. 2) Have been in private practice for 20 years 3) Have been performing joint replacements for 24 years 4) I perform approximately 150 replacements/year, not
including those done for broken hips. These are knee

and hip primarily, but also shoulder and, rarely, elbow.
Email: enquiry@medicyatra.com Joint Pain and Treatment Options
5) I also perform revision surgery for worn out, loose or painful joint replacements. 6) I update my knowledge on joint replacement surgery
twice a year at educational courses.

7) Im well trained and experienced in alternative treatments for arthritis. These include medications, P.T., exercise, dieting, bracing, injection therapy, arthroscopic surgery, cartilage transplant and partial
joint replacements.
What is arthritis?
1) It is the loss of joint surface that covers the bone. This special surface allows the bones to glide effortlessly, smoothly and pain-free. (This is the white, pearly substance on the end of the chicken bone.) 2) It is not to be confused with osteoporosis which is the loss of bone mass. 3) The loss of this surface, whether partial or complete, results in variable pain, stiffness, swelling, weakness and loss of motion. 4) With progression over time it results in the destruction of the underlying bone and adjacent ligaments.
How does it present?

1) It can either present in a slow gradual fashion or have a sudden appearance after a minor injury. 2) You can have good and bad days. Pain will be low level aching to intense pain that wont allow walking on the leg. 3) You can be stiff and achy in the morning, comfortable during the day, then painful at the days end.
4) Oft time the pain will lessen with mild to moderate activities.
5) You may experience popping, locking or catching.
6) Prolonged positions will cause increase symptoms, ie. Standing in line, long car rides or sitting for a movie.
7) You avoid, or have difficulty doing, activities like kneeling, squatting, stair climbing, getting out of cars/chairs or even tying your shoes. 8) You have trouble finding a comfortable position while resting at home with a book or watching t.v.
9) You have trouble with waking up at night due to joint pain.
Diagnosis
Physical Examination
Tenderness to the touch Weakness in the muscles Loss of passive and active range of motion
Spurs that can be felt along the bone edges

Grinding, popping or other joint noises that can be felt or heard
Fluid on the knee

Catching or locking
Diagnosis
Additional Tests
X-Rays (needs to be done with one view in the standing position)
Nonsurgical Options
Diet and Exercise
Rest and Joint Care Cane / Walker
Medications
Cortisone Glucosamine Visco-supplementation Braces
Treatment Options Rest

Short-term bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem.
Individual joint rest is most helpful when arthritis involves one or only a few joints.
Weight Loss
Average American is 2040 lbs. overweight Average person takes 5000-7000 steps/day Reduces stress on weight-bearing joints
Balanced Diet
Helps manage weight
Extra pressure on some joints may aggravate your arthritis
Stay healthy
Range of Motion Exercises Stretching

Maintains normal joint movement Increases flexibility Relieves stiffness Increases the ease of surgery, thus allowing better outcomes.
Strengthening Exercises
Increasing muscle strength helps support and protect joints affected by arthritis. Exercise is an important part of arthritis treatment that is most effective when done properly and routinely. Allows easier recovery and shorter rehabilitation after surgery.
Aerobic Exercises
Walking, Biking
Improve cardiovascular fitness Helps control weight May help reduce inflammation in joints For those worried about advancement of arthritis, a Swedish study showed no progression of arthritis with moderate exercise.
Heat and Cold Therapies

Reduce pain and inflammation Heat Therapy
Increases blood flow, tolerance for pain, flexibility
Cold Therapy

Cold packs, ice massage, OTC sprays and ointments Reduces pain by numbing the nerves around the joint
Physical Therapy
The goal is to get you back to the point where you can perform normal, everyday activities without difficulty. Preserving good range of motion is key to maintaining the ability to perform daily activities.
Physical therapists provide exercises designed to preserve the strength and use of your joints.

Show you the best way to move from one position to another Teach you how to use walking aids
Assistive Devices
Make activities easier and less stressful for the joints and muscles. Splint or brace when recommended by a doctor or therapist Walking aides
Orthotics
Bath stool for use in the shower or tub Sock grippers Other devices are available to assist with everyday activities.
Walking Aides
Cane
Walker
Copyright @ Helps keep you balanced Forever you dont hurt other joints. so Medic Online Pvt. Ltd
Medications: Analgesics
Analgesics, pain relievers, may provide temporary relief of arthritis pain.
Medications: NSAIDs
Traditional Aspirin Ibuprofen Naproxen
New
Cox II
Medications: Topical Pain Relievers

Over-the-counter patches, rubs and ointments can provide quick pain relief for people with arthritis that is in just a few joints such as a hand or whose pain isn't severe.
Nutritional Supplements
Glucosamine and Chondroitin may relieve joint pain. Occur in the body naturally; vital to normal cartilage function.
Researchers are also studying chondroitin for use in making medicines more effective and helping to prevent blood clots (anticoagulant).
Not FDA approved

Warrant further in-depth studies on their safety and effectiveness, according to the Arthritis Foundation.
Source: Arthritis.org website, Aug. 2006
May help osteoarthritis pain and improve function.1, 2 Some studies indicate that glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects
Side Effects of Glucosamine and Chondroitin

These arthritis supplements are generally well tolerated. However, side effects can occur. The most commonly reported side effects are:

Nausea Diarrhea or constipation Heartburn Increased intestinal gas
See your doctor forCopyright @ Forever Medic Online Pvt. Ltd complete information.
Glucosamine and Chondroitin

People with osteoarthritis who have diabetes should talk with a doctor before they take glucosamine because it may influence blood sugar (glucose). Do not take glucosamine if you are allergic to shellfish.
Glucosamine is made from shellfish covering
Source: WebMD
Dietary Supplements
Other than in vitamins and minerals, the long-term effects of most dietary supplements are not known. Talk to your doctor before taking supplements.
Corticosteroids
Decrease inflammation

Oral Cream (topical)
Short-term side effects include
Swelling, increased appetite
Long-term side effects include
Stretch marks, excessive hair growth, osteoporosis, high blood pressure, infections and high blood sugar
Injections: Corticosteroids
Injection Effective Temporary
Injections / Visco-supplementation
Hyaluronic Acid (Cocks Comb) Injection Effective (5-13 wks) Does Not Prevent Progression
Hyaluronic Acid
Natural substance that lubricates the joint Injection

Lubricates the joint Provides temporary relief of pain and movement 80 to 85% of individuals who are treated with this series of injections have some amount of pain relief which lasts anywhere from nine to 12 months.* Approved for knee osteoarthritis
*http://uconnsportsmed.uchc.edu/patientinfo/whathurts/treatment/hyaluronic_acid.html
Knee Braces
Simple Braces Unloader Braces
When to have a Joint Replacement

Joint replacement may be a treatment option when: Pain is chronic or more recent and disabling Pain interferes with desired activities Pain interferes with daily activities, recreational or work activities Significant loss of motion (this will become permanent) occurs.
When to have a Joint Replacement

When rest pain becomes prominent. When you have joint pain that wakes you up at night. When there has been a failure of medical treatment to
relieve pain.
When there is severe bony deformity on x-ray.

Joint Replacement
Preoperative Preparing for a joint replacement procedure begins weeks before the actual day of surgery. In general, patients may need:
Routine blood tests Urinalysis Physical examination Exercise Quit smoking Stop certain medications Donate blood
Total Joint Replacement

Goals of total joint replacement are to help:

Relieve pain Restore motion Improve function Improve fitness and health Restore quality of life
Your Hip Joint

A joint is formed by the ends of 2 or more bones. The hip must bear the full force of your weight and consists of two main parts: A ball (femoral head) at the top of your thigh bone (femur) A rounded socket (acetabulum) in your pelvis
Normal hip joint, showing healthy articular cartilage
What Causes Hip Joint Pain?

One of the most common causes of joint pain is arthritis. The most common types of arthritis are: Osteoarthritis (OA) Rheumatoid Arthritis (RA) Post-traumatic Arthritis
Avascular Necrosis
Diseased hip joint, showing worn cartilage
Total Hip Replacement
Your Knee Joint

Femur thigh bone Cartilage tissue between bones that provides cushioning Patella knee cap Tibia shin bone
Synovium tissue that provides lubricating fluid to joint

Ligament flexible tissue that holds knee joint together
Total Knee Joint Replacement

End surface of femur replaced with metal End surface of tibia replaced with metal Plastic liner is inserted between femur and tibia Patella is resurfaced with plastic The entire knee is not removed as myth and lore would have it. This is a resurfacing procedure.
Total Knee Replacement
Limitations After Surgery

Athletic activities that place excessive stress on the joint replacement will need to be avoided. Examples of these activities include:
Skiing (snow or water) Basketball Baseball Contact sports Running Frequent jumping
Enhanced Performance After Surgery

1) My goal as a joint surgeon is to meet the activity demands of my patients. 2) We now have a more active older population. 3) The newer materials now available are more durable and longer lasting to meet these demands. (ceramics, high density polyethylene, HA coated components, metal-on metal.) 4) There are certainly higher risk activities for joint patients, yet many on the previous slide can be undertaken by experienced individuals.
Email: enquiry@medicyatra.com
Technology for Active Patients

Trident Ceramic Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital
Realistic Expectations
Longevity of Hip Replacement
Age
Weight Activity level
Bone strength
New Technology for Active Patients
Trident Ceramic Email: enquiry@medicyatra.com
New Technologies are Meeting the Needs of the More Active Patient
Hip Implant Options

Conventional Hip Implants
Acetabular shell
Ceramic Hip Implants

Acetabular shell
Plastic insert
Ceramic insert
Metal femoral head
Ceramic femoral head
Femoral stem
Ceramic in Hip Replacement

Superior wear performance in laboratory testing compared to metal-plastic bearings* Excellent biocompatibility Long clinical history Provides smooth surface with low friction Extremely hard material
*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th Ann. Mtg. ORS, 51, 1998.
Experience with Ceramics

Ceramic is used in aeronautics, bullet proof vests and golf clubs Ceramics in hip replacement have evolved over the past 30 years
Early use in the US revealed limitations
Trident Ceramic System

Improvements in material strength, quality and design Advanced processing, testing and quality control produces stable, extremely strong ceramic implants
U.S. Clinical Study

The first US clinical study of contemporary ceramic-onceramic hip replacements began in 1996

Over 1,300 hip surgeries 16 centers in the United States
FDA approved Trident Ceramic for sale in the US in February 2003
Alumina Ceramics in Hip Replacement

Alumina ceramic-on-ceramic components demonstrate significantly lower wear versus conventional metal-on-plastic components in laboratory testing.
Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th Ann. Mtg. ORS, 51, 1998.
Range of motion (ROM) of the Trident Ceramic System

Although there are many factors that will influence your range of motion, the Trident Ceramic System is designed to accommodate the range of motion as in a normal, healthy hip joint An increased ROM may help minimize the risk of hip dislocation
Trident Ceramic System

Biocompatible Reduces friction Extremely hard Superior wear properties to other bearings available on the market today*
*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th Copyright @ Forever Medic Online Pvt. Ltd Ann. Mtg. ORS, 51, 1998.
Ceramic-on-Ceramic Hip Replacement

Additional information about ceramic hip replacement is available to you:
Call 1-888-STRYKER or
visit www.aboutstryker.com
Individual results may vary. There are potential risks and recovery takes time. The life of any joint replacement will depend on your weight, age, activity Copyright @ Forever Medic level and other factors. Only an orthopaedic surgeon can tell if surgery is right for you. Online Pvt. Ltd
Joint Replacement Survival

1) In the 50 year old and greater age group 95% of the replaced joints are functioning well at over 20 years. 2) In the younger than 50 year old group 70% are functioning well at 10-15 years after placement. 3) This data does not include the data on the new ceramic and metal on metal hip replacements.
4) Finally, all joint replacements are now modular. Should a singular part wear out, it can be replaced with a simpler, less involved surgery.
Email: enquiry@medicyatra.com
Minimally Invasive Total Hip Replacement

Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital
Topics
What is hip arthritis? What is conventional hip replacement surgery? What is MIS hip replacement surgery?
Ready to Consider Hip Replacement?

You're Not Alone! Today, more than 300,000 Americans a year have hip replacement surgery
First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years
Replaced Hip X-ray
What is Minimally Invasive Surgery?

MIS is a general term used to describe a surgical procedure that often utilizes a smaller incision(s) than conventional surgery. In these cases MIS more accurately describes Mini Incision Surgery Other MIS procedures reduce the amount of soft tissue (muscles and tendons, etc) that are disrupted during surgery. In these cases MIS more accurately describes Minimally Invasive Surgery
What are the potential benefits of MIS Hip Surgery?

Less soft tissue disruption

Faster discharge from the hospital Quicker rehab and recovery
Less blood loss
Reduced pain
Smaller scar
Source: Keggi, Kristaps J., Total Hip Arthroplasty Through Copyright @ Forever Medic Online Pvt. Ltd Invasive Anterior Surgical Approach JBJS, A Minimally Vol. 85-A.
What are the potential risks?

Results may vary from patient to patient
Surgery time may be extended

Risk factors relating to anatomy, weight, and prior joint replacements
Risks which are normally encountered in conventional THA remain
Is MIS Total Hip Arthroplasty for everyone?

No, patient limitations include: Obese, high BMI Muscular males Pre-existing conditions
Stryker Implant Technology

Accolade TMZF is an MIS-friendly implant
Compatible with ceramic-on-ceramic technology for long-term results
What Do I Do?
1) Talk to your orthopedic surgeon.
2) Find out the best joint treatment option for you.

3) Visit the website of your surgeon, AAOS or joint manufacturer. 4) Ask questions!

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Email: enquiry@medicyatra.

Your Joint Pain and Treatment Options

Copyright @ Forever Medic Online Pvt. Ltd

Joint Pain and Treatment Options Email: enquiry@medicyatra.com

including those done for broken hips. These are knee

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

twice a year at educational courses.

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

How does it present?

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

9) You have trouble with waking up at night due to joint pain.

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Spurs that can be felt along the bone edges

Fluid on the knee

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

X-Rays (needs to be done with one view in the standing position)

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Treatment Options Rest

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Extra pressure on some joints may aggravate your arthritis

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Range of Motion Exercises Stretching

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Heat and Cold Therapies

Increases blood flow, tolerance for pain, flexibility

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Medications: Topical Pain Relievers

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Not FDA approved

Source: Arthritis.org website, Aug. 2006

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Side Effects of Glucosamine and Chondroitin

Nausea Diarrhea or constipation Heartburn Increased intestinal gas

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Glucosamine and Chondroitin

Glucosamine is made from shellfish covering

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Copyright @ Forever Medic Online Pvt. Ltd

Email: enquiry@medicyatra.com Joint Pain and Treatment Options

Join Pain Treatment & Surgery

Join Pain Treatment & Surgery