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Osteoarthritis - Singapore Orthopaedic Surgeon

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http://www.orthopaedicsurgeon.com.sg/patients-education/general/osteoarthritis/

Tel: +65 64712674
Email: kevin@orthopaedicsurgeon.com.sg

Published in: Health & Medicine
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Osteoarthritis - Singapore Orthopaedic Surgeon

  1. 1. Liberty From Aches and Pain Dr. Kevin M. H. Yip Singapore Orthopaedic Surgeon
  2. 2. <ul><li>Causes of knee osteoarthritis </li></ul><ul><li>Diagnosis </li></ul><ul><li>Prevention </li></ul><ul><li>Conservative treatment </li></ul><ul><li>Medication </li></ul><ul><li>Surgical treatment </li></ul>
  3. 3. A progressive disease
  4. 4. Natural progression Of OA <ul><li>Acute inflammation phase </li></ul><ul><ul><li>Intermittent </li></ul></ul><ul><li>Loose bodies </li></ul><ul><li>Osteophytes </li></ul><ul><li>Loss of Cartilage and Meniscus </li></ul><ul><li>Deformity-accelerated </li></ul>
  5. 5. Video
  6. 6. Video
  7. 8. Progression of OA Knee
  8. 9. Causes of early knee degeneration <ul><li>age, recurrent inflam </li></ul><ul><li>Sports is better or worse for the knee? </li></ul>
  9. 10. Inflammation damages Joints <ul><li>Rheum Arthritis, Gouty Arthritis, Haemophilia </li></ul><ul><li>ACL Deficient knee </li></ul>
  10. 11. Causes of early knee degeneration <ul><li>Cruciate ligament tear </li></ul><ul><li>Meniscus tear </li></ul><ul><li>Cartilage Damage </li></ul><ul><li>Immobilization </li></ul>
  11. 12. Other Causes of Knee Pain <ul><li>Bursitis </li></ul><ul><li>Tendinitis </li></ul><ul><li>Mal Tracking Patella </li></ul><ul><li>Gouty Arthritis </li></ul>
  12. 13. Diagnosis-Clinical and XR
  13. 14. Diagnostic Arthroscopy <ul><li>GoutyArthritis </li></ul><ul><li>Patella </li></ul><ul><li>Mal-Tracking </li></ul><ul><li>Plica </li></ul>
  14. 15. Exercise
  15. 17. Meniscus Repair <ul><li>Importance of the meniscus - an important cushioning mechanism </li></ul><ul><li>Need early repair to prevent extension of the tear </li></ul>
  16. 19. Meniscus Injuries
  17. 20. Cartilage Injury <ul><li>Osteochondral lesions - Fixation or removal of loose bodies </li></ul>
  18. 21. Do we need to treat OA Knee? <ul><li>Suffering the symptom of pain </li></ul><ul><li>Morbidity </li></ul><ul><li>Quality of life </li></ul><ul><li>Treatment depends of the symptoms and XR </li></ul><ul><li>Need to explain the pros and cons of the treatment options and to help the patient to make a correct option. </li></ul>
  19. 22. Treatment for OA knee <ul><li>Medication </li></ul><ul><li>Arthroscopic washout </li></ul><ul><li>Knee joint Injection </li></ul><ul><li>Bone realignment </li></ul><ul><li>Joint replacement </li></ul>
  20. 23. Treatment of OA knee
  21. 24. <ul><li>Acute phase - Rest, Ice, Compression, Elevation, Medication </li></ul>
  22. 25. Anti-Inflammation Medicine <ul><li>eg Vioxx, Arcoxia (MSD) </li></ul><ul><li>Celebrex, Bextra(Pfizer) </li></ul><ul><li>Cox 2 </li></ul><ul><li>Safe and effective </li></ul><ul><li>Low GI effect </li></ul>
  23. 26. <ul><li>Miacalcic Nasal 2000 </li></ul><ul><li>(Calcitonin)-Novartis </li></ul>
  24. 28. <ul><li>3 injections, one week apart </li></ul><ul><li>Multicenter </li></ul><ul><li>Prospective </li></ul><ul><li>Randomized </li></ul><ul><li>Controlled (arthrocentesis) </li></ul><ul><li>Double-blind </li></ul><ul><li>All patients received arthrocentesis </li></ul><ul><li>Intent-to-treat population </li></ul><ul><ul><li>hylan G-F 20: 31 knees </li></ul></ul><ul><ul><li>NSAID 34 knees </li></ul></ul><ul><ul><li>NSAID + hylan G-F 20 : 37 knees </li></ul></ul>Hylan G-F 20 vs. Continuous NSAID Therapy Adams et al. (1995), Osteoarth Cartil 3
  25. 30. Initial Treatment of Knee inflam <ul><li>Aspiration, Physiotherapy </li></ul><ul><li>Arthroscopic Washout of loose bodies </li></ul>
  26. 31. Arthroscopic washout <ul><li>Recovery is faster and less invasive. </li></ul>
  27. 32. <ul><li>Cartilage - Abrasive therapy </li></ul><ul><li>Soft tissue - shaving, synovectomy </li></ul>Surgical Procedures
  28. 35. High Tibial Osteotomy
  29. 40. Joint Replacement <ul><li>Remarkable pain relief </li></ul><ul><li>Range of motion is good </li></ul><ul><li>Lasts for 20-25yrs </li></ul>
  30. 41. Treatment of OA knee
  31. 42. Discussion <ul><li>Degen Arthritis is treatable. </li></ul><ul><li>Recurrent inflammation can damage cartilage </li></ul><ul><li>Arthroscopic washout and debridement for moderate OA </li></ul><ul><li>Joint replacement has good long term results </li></ul>
  32. 43. <ul><li>Thank You </li></ul>

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