osteoarthritis is a medical condition with widespread societal implications

1. OSTEOARTHRITIS-Newer Perspectives
Prof.G.S.Patnaik
Professor , Dept of Orthopaedics
IMS & SUM Hospital

2. World arthritis Day
Let us know more about
Arthritis
for
a
better tomorrow

3. Osteoarthritis, as the name implies is the inflammation
of the joint. Like the inflammation of any tissue in the
body, osteoarthritis too consists of pain, rise in local
temp, swelling and loss of function.
Osteoarthritis:

4. Osteoarthritis :
Osteoarthritis is a progressive degenerative
disease of joints characterized by……….....
• Degeneration of articular cartilage
• Hypertrophy of bone at the margins
• Changes in the Synovial membrane
• Reduction of joint space

5. Prevalence :
Osteoarthritis is a disease affecting large number
of people all over the world
• 40% of people over 70 suffer from OA globally.
• 10 % of the world’s population > 60 years is
affected by OA.
• 2.95 /1000 (women) and 1.71/1000 (men) :
women affected a little more than men

6. Arthritis: Commonest Cause of
Disability in World

7. Prevalence of Arthritis among
Adults by Age Group

8. (BMI = kg/m2
)
Prevalence of Arthritis Among
Adults by Body Mass Index (BMI)

9. What can we do for these
patients who cry for each step of
life
?

10. Complaints of a OA patient
• PAIN
• SWELLING
• RESTRICTION OF MOVEMENT
• DEFORMITY

11. PAIN
PAIN
PAIN PAIN PAIN
PAIN PAIN PAIN

12. RESTRICTION OF MOVEMENT

13. SWELLING

14. DEFORMITY

15. Risk Factors for development of OA ?
• Genetics
– Abnormal joint
– Abnormal range of motion
– Congenital anomalies
• Trauma (injury to the joint)
– Over-use syndromes (as in some athletes)
– Obesity

16. Obesity

17. Who gets Osteoarthritis
• Generally older people
• Before age 45,
(Risk) > (Risk)
• After age 45,
(Risk) < (Risk)

18. Pathogenesis of 0A

19. Normal Joint

20. Pathogenesis of 0A

21. Cartilage damage in Osteoarthritis

22. IL-1 in osteoarthritis
IL-1 is the most important chemical mediator in the
pathogenesis of Osteoarthritis
TNF-α and IL-1, IL-6, IL-8,
leukemic inhibitory factor (LIF), IL-11, IL-17.

23. Diagnosis
• Clinical Features
• X-ray
• Blood Tests
• Diagnostic Arthroscopy
• MRI (in younger patients)
Most Important

24. Clinical Features

25. X-ray

26. Feel the difference
Osteoarthritis

29. Blood Tests

30. Diagnostic Arthroscopy

31. MRI (in young patients)

32. Effects
Lifestyle effects include
• Depression
•Anxiety
•Limitations on daily activities
• Job limitations
• Difficulty participating in everyday
personal and family joys and
responsibilities.

33. Effects
Financial effects include
• the cost of treatment
• wages lost because of disability.

34. Goals of Osteoarthritis Treatment
• To control pain
• To improve joint function
• To achieve a healthy lifestyle

35. Treatment Approaches to Osteoarthritis
• Exercise
• Weight control
• Nondrug pain relief techniques, braces
• Medications to control pain
•Surgery

36. Exercise
• Stretching
•Strengthening
•Aerobic

37. AIMS OF EXERCISE / PHYSIO
• Improvement of joint function
• Protection of joint
• Improving physical fitness
• Prevention of disability

38. Develop methods to minimize and manage stress.

39. Braces
Knee Cap
Knee hinge brace
stockinet

40. A] Non pharmacological methods
• Social support
• Weight loss, if the patient is over
weight
• Muscle strengthening exercise
• Occupational therapy
• Proper footwear
Existing treatment options for Osteoarthritis

41. Current options moving for O.A
• Analgesics (NSAIDs)
• Glucosamine and Chondroitin sulphate
• Corticosteroids
B] Pharmacological management
• Diacerein

42. • No effect on disease progression
• Associated with severe G.I
toxicities
NSAIDs

43. Corticosteroids
• Control inflammation and pain
• Cannot be used for long term treatment because
of serious side effects

44. Glucosamine and Chondroitin sulphate
• Very high dosing
• Not enough data for clinical efficacy
• Only a dietary supplement

45. Diacerin
• Exhibit effective symptomatic relief
• Similar pain relief compared to NSAIDS
• Excellent long-term tolerability profile
• Slows down the progression of disease
• Safe drug for Osteoarthritis

46. What will you do for this patients
?

49. Only solution

50. Total joint; Knee, Hip Replacement

51. Total Knee Replacement
Conventional
Computer assisted
Minimal invasive computer assisted

52. What is the need of TKR ?
As the name suggest, i.e. Total knee
replacement, it is the replacing of a damaged
and malfunctioning articular end of bones
forming the knee joint .

54. Computer assisted
TKR

55. Minimal invasive TKR

61. Conclusion
Osteoarthritis in early stage needs more of physical therapy
and medication.
Among all medication Diacerin is a better alternative.
Diacerin works well in early and moderately advanced
osteoarthritis.
TKR is a last alternative.
MI TKR is the best available alternative.

62. Computer cannot replace the surgeon, rather it assist it
in its goal achievement,“as a line is more straight when
drawn with help of a ruler than that of a naked hand”
why not be in the hand of famous painter Mr. M. F.
Hussain.
Conclusion

63. Future prospect
Gene therapy and cartilage regeneration

64. •Thank you all.