Hip and Knee Pain What are my options?

Hip and Knee Pain What are my options?

Jonathan Surdam, MD Dr. Surdam has performed nearly 1,000 joint replacements in southern Indiana Creighton University School of Medicine Residency in orthopedic surgery at Boston University Fellowship in total knee and total hip replacement, New Mexico Center for Joint Replacement Medical director of Joint Replacement Services at IU Health Bloomington Hospital 3,000+ successful joint replacement surgeries

David Licini, MD Indiana University School of Medicine Residency in orthopedic surgery at the Ochsner Clinic Foundation in New Orleans Fellowship training in hip and knee replacement surgery at the IU School of Medicine

Agenda Osteoarthritis overview Understanding non-surgical options for osteoarthritis Understanding surgical options for osteoarthritis Joint replacement program at IU Health Bloomington

What is osteoarthritis? Osteoarthritis is characterized by the breakdown of cartilage in a joint. Cartilage is tissue at the ends of bones that serve as a cushion for the joint. When this cartilage is damaged due to an injury or general wear and tear, we say you have osteoarthritis.

What causes osteoarthritis? Age Being overweight Injury Genetics Repeated stress on the joint from work or sports.

Osteoarthritis is common Osteoarthritis is the most common joint disorder in the United States. The most frequently involved joints are the weight-bearing joints (hips and knees). Forty million Americans, or 1 in 6 people, have evidence of osteoarthritis by X -ray. 29% of the US population will have osteoarthritis by the year 2020 (59 million). Twice as many women over 55 as men. 70 percent of people over the age of 70 will have X-ray evidence of osteoarthritis.

The cost of arthritis Costs billions per year in medical claims and lost productivity Biggest cost is to you quality of life: Social costs due to lack of family and community involvement. Psychological cost due to depression, anxiety and feelings of helplessness Physical cost due to chronic and acute pain

Anatomy of the hip joint The hip joint consists of the head of the femur (shaped like a ball) and the acetabulum (bowl shaped structure). The hip is a ball and socket joint and allows for a high level of mobility.

Healthy hip joint Cartilage is smooth and provides a cushion between the hip ball and socket

Arthritic hip joint The cartilage has thinned and deteriorated, allowing bone to rub against bone, causing pain.

X-ray of the hip joint Normal hip Arthritic hip

Symptoms of hip osteoarthritis PAIN!! Groin, thigh, or buttock Knee pain (symptom in 20% of population) Loss of motion, limp Change in alignment Muscle spasms

Anatomy of the knee joint Where the femur and tibia meet Acts like a hinge Allows for flexion, extension, and to a lesser degree rotation High degree of biomechanical stress

Healthy knee joint Cartilage is smooth and provides a cushion between the femur (thigh bone) and tibia (shin bone).

Arthritic knee joint The cartilage has thinned and deteriorated, allowing bone to rub against bone, causing pain.

X-ray of the knee joint Normal knee Arthritic knee

Symptoms of knee osteoarthritis Pain!! Can radiate into the thigh or shin Worse with activity Swelling Loss of motion, limp Loss of alignment Muscle spasms

Prevention Well-rounded physical activity program Stretching Strength training Aerobic exercise, non impact Maintaining a healthy weight The use of a cane, or walker May minimize many of the adverse effects of arthritis and improve overall function

Diagnosis Hip and knee arthritis is diagnosed in several ways. History and physical examination Diagnostic tests X-ray of affected joint Laboratory Tests Surgery is the LAST option

When should you see an orthopedic surgeon? Persistent pain or stiffness Swelling not relived with rest and activity modification Night Pain Avoiding activities that you love

Treatment Treatment goals for osteoarthritis of the hip and knee are designed to keep patients independent and active throughout the course of their lives. Treatment options that work for one person may not help another with the same problem.

Non-surgical treatment Non-surgical Options: Use of a cane or walker to decrease the weight on a joint Unloading brace Shoe wedges Regular physical activity helps control some of the symptoms of arthritis Keeps joints moving Strengthens muscles around the joints Maintains bone and cartilage tissue Improves overall ability to do everyday activities Improves health and fitness

Medications NSAIDs Non-steroidal antiinflammatory drugs Aleve, Motrin Work by blocking the effects of the chemical released when tissue is damaged. Analgesics Work by reducing the pain that is felt by disrupting the pain signals transmitted by the nerves. Will not treat the cause of the pain, but can provide some relief of symptoms.

Medications Corticosteroids Work by decreasing inflammation and the activity of the immune system. Injected into the affected joint. Hyaluronic Acid Orthovisc, Synvisc Works by supplementing the natural joint fluid to provide cushion in the joint. Injected in the affected joint. Pain relief can last up to six months.

When is surgery right for me? Progressive pain Inability to accomplish routine activities Night Pain Weight Gain Failure of Non-surgical Therapy Saying NO, when you used to say YES!!

Surgical options for knee arthritis Knee Arthroscopy Uni-Compartmental Knee Replacement Total Knee Replacement

Knee replacement Relieves pain, restores function Should last 15-20 years Hard work!! Therapy

Knee replacement Before After

Surgical options for hip arthritis Arthroscopy Hip Resurfacing Total Hip Replacement

Hip replacement Relieves pain, restores function Should last 15-20 years Hard work!! Therapy

Hip replacement Before After

How does the process work? Call Orthopedics of Southern Indiana for initial evaluation History, Physical Exam, X-rays and other tests Is surgery right for you? Schedule visit with primary care physician Meet with Dr. Surdam and Dr. Licini s team for Pre-op Visit 2-3 days in IU Health Bloomington Hospital following surgery Transition home or to a rehab center 4-6 weeks of therapy 96% of patients are pain free and happy one year following surgery Lifelong dedication to your new joint replacement

Contraindications for surgery Morbid obesity History of infection in the involved joint Significant medical co-morbidities

Risks factors for surgery Infection Blood Clots Loosening of the Prosthesis Leg Length Inequality Instability Bleeding Nerve Damage Anesthesia Risks Chronic Pain and Motion Problems

Joint replacement at IU Health Bloomington Hospital

Team approach

Orthopedics Unit Private rooms Dedicated to orthopedics Nurses and caregivers specially trained in caring for joint replacement patients

Quality care Continually work to ensure our care is as safe as possible. Quality indicators tracked on an ongoing basis. Surgical site infection rate: Hips: 0% Knees:.4% Average length of stay: 2.6 days Surgical indicators: 99 100% More than 92% walk at least 150 feet within 2 days after surgery

Education Information packet in the physicians office Pre-surgery education session Education during hospital stay We believe the best informed patients have the best outcomes after surgery. Education is a priority.

Dedicated surgery team

Computer navigation For difficult and unusual cases, IU Health Bloomington Hospital offers computer navigation Allows for precise placement of implants even in the most difficult cases The computer assists the surgeon making intraoperative decisions

Case example 62 year-old female presented with severe left knee pain Sustained a left femur fracture in a sledding accident in 1963 Femur fracture treated in traction Progressive pain that severely limited her activities of daily living Without Computer Assisted Navigation, her outcome following knee replacement surgery would have been guarded

Before

After

Getting back to your life Our goal is to get you as independent as possible as quickly and safely as possible After leaving the hospital, patients may: Return home and receive home/outpatient therapy Go to a skilled nursing or other facility to receive inpatient therapy

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