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CARE OF BONES AND
JOINTS IN OLD AGE
PROF.(DR)G.S.PATNAIK
PROFESSOR , ORTHOPEDICS SURGERY
IMS & SUM Hospital,BHUBANESHWAR
SR.CONSULTANT KALINGA HOSPITAL
,
OLD AGE
•A BOON OR CURSE
• MULTITUDE OF PROBLEMS
• LOCOMOTION is BIGGEST
CONCERN
• OSTEOARTHRITIS
• BACK AND NECK PAINS
• STIFFNESS
• EMOTIONAL DISTURBANCES
• SENSE OF NEGLECT
• OTHER MEDICAL CONDITIONS
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:
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
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
Arthritis: Commonest Cause of
Disability in World
Prevalence of Arthritis among
Adults by Age Group
(BMI = kg/m2
)
Prevalence of Arthritis Among
Adults by Body Mass Index (BMI)
What can we do for these
patients who cry for each step of
life
?
Complaints of a OA patient
• PAIN
• SWELLING
• RESTRICTION OF MOVEMENT
• DEFORMITY
PAIN
PAIN
PAIN PAIN PAIN
PAIN PAIN PAIN
RESTRICTION OF MOVEMENT
SWELLING
DEFORMITY
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
Obesity
Who gets Osteoarthritis
• Generally older people
• Before age 45,
(Risk) > (Risk)
• After age 45,
(Risk) < (Risk)
Pathogenesis of 0A
Normal Joint
Pathogenesis of 0A
Cartilage damage in Osteoarthritis
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.
Diagnosis
• Clinical Features
• X-ray
• Blood Tests
• Diagnostic Arthroscopy
• MRI (in younger patients)
Most Important
X-ray
Feel the difference
Osteoarthritis
Blood Tests
Diagnostic Arthroscopy
MRI (in young patients)
Effects
Lifestyle effects include
• Depression
•Anxiety
•Limitations on daily activities
• Job limitations
• Difficulty participating in everyday
personal and family joys and
responsibilities.
Effects
Financial effects include
• the cost of treatment
• wages lost because of disability.
Goals of Osteoarthritis Treatment
• To control pain
• To improve joint function
• To achieve a healthy lifestyle
Treatment Approaches to Osteoarthritis
• Exercise
• Weight control
• Nondrug pain relief techniques, braces
• Medications to control pain
•Surgery
Exercise
• Stretching
•Strengthening
•Aerobic
AIMS OF EXERCISE / PHYSIO
• Improvement of joint function
• Protection of joint
• Improving physical fitness
• Prevention of disability
Develop methods to minimize and manage stress.
Braces
Knee Cap
Knee hinge brace
stockinet
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
Current options moving for O.A
• Analgesics (NSAIDs)
• Glucosamine and Chondroitin sulphate
• Corticosteroids
B] Pharmacological management
• Diacerein
• No effect on disease progression
• Associated with severe G.I
toxicities
NSAIDs
Corticosteroids
• Control inflammation and pain
• Cannot be used for long term treatment because
of serious side effects
Glucosamine and Chondroitin sulphate
• Very high dosing
• Not enough data for clinical efficacy
• Only a dietary supplement
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
What will you do for this patients
?
Only solution
Total joint; Knee, Hip Replacement
Total Knee Replacement
Conventional
Computer assisted
Minimal invasive computer assisted
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 .
Computer assisted
TKR
Minimal invasive TKR
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.
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 our own
Jatin Das
Conclusion
Future prospect
Gene therapy and cartilage regeneration
•Thank you all.

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