Οστεοαρθρίτιδα ισχίου - γόνατος

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Οστεοαρθρίτιδα ισχίου - γόνατος

  1. 1. ΟΣΤΕΟΑΡΘΡΙΤΙΔΑΙΣΧΙΟΥ ΚΑΙ ΓΟΝΑΤΟΣ
  2. 2. What is Arthritis?The process by which a joint becomes useless “Joint failure” Cartilage destruction and other changes
  3. 3. The prevalence of osteoarthritis 24-45 years 1% - 4% 70-80 years 53% - 55%
  4. 4. Symptoms  Pain  StiffnessReduced functional capacity
  5. 5. Methods of Treatment  Non-Surgical  Surgical
  6. 6. RehabilitationAssists the patient in function Physically Psychologically Vocationally
  7. 7. Factors to consider, before rehabilitation a. Stage and extent of arthritis b. The pain threshold c. Current medications d. Patient’s compliance e. Patient’s expectations
  8. 8. Goals to achieve Pain relief Maintaining strength Maintaining ROM Behavioral strategies
  9. 9. Modalities Heat Cold therapy LASER Electrical Stimulation Acupuncture Orthotics
  10. 10. HeatSuperficial Wax Warm Water SpaDeep Microwave Diathermy Ultrasound
  11. 11. Scientific BasisHeat has been shown to decrease painand muscle spasm by acting on nerveendings.Also, makes the tendons morestretchable (enhances their elasticqualities).
  12. 12. “Significant reductions in joint pain at the hip, knee and lumbar spine with spa therapy” Yguyen et al, 1997 Br J Rheumatology
  13. 13. “Significant reductions in joint pain at the hip, knee and lumber spine with spa therapy” Yguyen et al, 1997 Br J RheumatologyMeta analysis at 293 studies with deep heattreatment showed no difference in pain relief Gam and Johansen, 1995
  14. 14. Effects of exercise Increased motion Decreased joint pain Increased aerobic capacity
  15. 15. Exercise Range of motion Stretching Strengthening Aerobic Recreational
  16. 16. Pool exerciseThe buoyancy at the water providesdecreased joint loading and makes theexercise less painful.Pool programs increase aerobiccapacity.
  17. 17. Definition of HydrotherapyHydrotherapy is the use of water in the treatment of disease. Here, the disease is arthritis It has been used by many cultures for various purposes
  18. 18. How it works Mechanical effects Thermal effects
  19. 19. Clinical Uses Few clinical trials BUTIt’s the most commonly used modality
  20. 20. Increase in pain relief with hydrotherapy Ahern et al, 1995Thermal water better than tap water Scucs et al,1989
  21. 21. Word of cautionAny type of hydrotherapy does notprevent arthritis and does not alterthe progress of the disease.
  22. 22. Hip arthroplasty interpositional excision replacement
  23. 23. Interpositional arthroplasty
  24. 24. Excision arthroplasty
  25. 25. Hemiarthroplasty
  26. 26. Judet
  27. 27. Austin Moore Thompson
  28. 28. TOTAL HIP REPLACEMENT
  29. 29. 1891
  30. 30. 1938
  31. 31. The cart has beenput before the horse:the artificial joint hasbeen made and used,and now we are tryingto find out how andwhy it fails Charnley 1956
  32. 32. CEMENTED FIXATIONMechanical interlock: static: qualityof bone, cement and consequentlyfixation degrade with timeCEMENTLESS FIXATIONBiological osseo-integration:dynamic: bone replaced and qualityof fixation maintained
  33. 33. 1969 metal on plastic total knee replacement GunstonThe Polycentric knee
  34. 34. 1971 tibio-femoral “roller in a trough” design relying for stability on the integrity and tension in the collateral ligaments Freeman-Swanson
  35. 35. 1976The Marmor modular knee
  36. 36. 1974Total Condylar knee Insall
  37. 37. Dislocated implant

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