Treatment therapies for OA including ultrasound guided hyaluronic acid injections, platelet rich plasma therapy, physical therapy.

1. OSTEOARTHRITIS
conservative therapy:
a practical approach
Alexander R. Shikhman MD, PhD, FACR
ifsmed.com

2. PRESENTATION MATERIALS
• Slides available on slideshare.com/ifsmed
• Video available on youtube.com/ifsmed

3. OSTEOARTHRITIS
A degenerative joint disease characterized by:
• cartilage loss
• changes in the subchondral bone (bone underlying the
cartilage)
• adaptive changes in tendons and ligaments
• mechanical misalignment
• eventual loss of the joint function

4. OSTEOARTHRITIS
SYMPTOMS AND SIGNS
• pain after physical activity
• joint swelling
• joint stiffness
• loss of joint flexibility/function
• changes in the joint appearance/joint deformities

5. OSTEOARTHRITIS
PRINCIPLES OF THERAPY
Control of pain and
inflammation
• NSAIDs
• Acetaminophen
• Opioid analgesics
• Viscosupplementation
therapy
• Food supplements
• Physical therapy
(modalities)
• Bionicare device
Prevention of cartilage
degeneration
• Viscosupplementation
therapy
• Food supplements
Restoring joint function
• Food supplements
• Viscosupplementation
therapy
• Physical therapy
• Orthotics

6. VISCOSUPPLEMENTATION
THERAPY
INDICATIONS
• Joint pain
• Osteoarthritis
CONTRAINDICATIONS
• Ongoing joint inflammation (active synovitis)
• Crystal-induced arthropathy (gout/pseudogout)
• Infection

7. VISCOSUPPLEMENTATION
THERAPY
PREDICTORS OF GOOD OUTCOME
• Mild to moderate joint deformities
• Absence of large synovial effusions
• Well-preserved periarticular muscle mass
• Minimal joint instability

8. VISCOSUPPLEMENTATION
THERAPY
High Success
Rate
Knees 1st CMCs TMJs
Moderate
Success Rate
Hips Ankles
Low Success
Rate
Shoulders

9. VISCOSUPPLEMENTATION
THERAPY
OUTCOME OPTIMIZATION
• Pre-viscosupplementation intraarticular steroid injection
• Injection in a ‘dry joint’
• Selection of the right viscosupplementation agent
• Ultrasound guidance of joint injections
• Post-injection joint immobilization
• Physical therapy
• Food supplements
• Post-viscosupplementation platelet-rich plasma (PRP)
therapy

10. ULTRASOUND GUIDANCE OF
JOINT INJECTIONS
• Better assessment of joint anatomy
• Avoidance of unexpected findings
• Crystals (calcium pyrophosphate, urate,etc.)
• Active synovitis or active tendinitis
• Hidden effusions
• Guaranteed drug delivery to the joint space
• Biofeedback effect

11. MUSCULOSKELETAL ULTRASOUND
UNEXPECTED SOURCE OF KNEE PAIN

12. ULTRASOUND GUIDED KNEE
ARTHROCENTHESIS

13. ULTRASOUND GUIDED
HIP INJECTION WITH EUFLEXXA

14. FOOD SUPPLEMENTS FOR OA
CARTILAGE MATRIX OPTIMIZERS VISCOELASTICITY
Chondroitin Sulfate Celadrin
MSM Oral Hyaluronic Acid
N-Acetylglucosamine
Oral Hyaluronic Acid
Oral Collagen Type 2
INHIBITORS OF INFLAMMATION INHIBITORS OF NEOANGIOGENESIS
Boswellia/Curcumin Sea Cucumber Extract
Devil’s Claw
Yucca Schidigera Extract
Omega-3 polyunsaturated fatty acids
- fish oil
- krill oil
- green lipped muscle extract – lyprinol

15. PLATELET-RICH PLASMA THERAPY
(PRP)
• Platelet attachment to collagen fibers results in
their activation and massive release of growth
factors
• Released growth factors stimulate cartilage
matrix synthesis and suppress inflammatory
responses
• Published data indicate that PRP therapy benefits
patients with knee and hip OA

16. PHYSICAL THERAPY
TREATMENT METHODS
• Iontophoresis with acetic acid
• Class IV laser therapy
• Manual therapy
• Pilates based rehab exercises

17. IONTOPHORESIS WITH
ACETIC ACID
• Reduce calcific deposits and bone spurs
• Insoluble calcium in the form of calcium
pyrophosphate reacts with acetic acid to form
calcium acetate, which is more soluble and
therefore, more easily dissolved by our body
fluids (synovial fluid, blood)

18. CLASS IV LASER THERAPY
• Reduce pain, inflammation, and enhance
tissue healing of muscle, ligaments and bones
• Increase circulation and oxygenation of tissues
>RBC’s to area and increasing venous and
lymphatic return
• Non-invasive use of laser energy to generate a
photochemical response (helping cells
produce ATP/energy) in damaged or
dysfunctional tissue

19. LASER THERAPY

20. MANUAL THERAPY
• Reduce pain, increase joint range of motion,
increase joint proprioception and increase
muscle length
• Passive physiological and accessory
movements, manual muscle stretching and
soft tissue mobilization

21. PILATES BASED REHAB
Benefits:
o increases range of
motion
o increases flexibility
o increases strength
o increases spine
stabilization
o improves balance
o improves posture
o enhances body
awareness
o decreases joint stress
o enhances breathing
Joseph Pilates: exercise format embodying
“complete coordination of body, mind and
spirit”

22. PILATES

23. PRESENTATION MATERIALS
• Slides available on slideshare.com/ifsmed
• Video available on youtube.com/ifsmed
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