Osteoarthritis typically affects the knees, hips, spine and small joints of the fingers and is the most common form of arthritis. It is a chronic, degenerative joint disorder caused by factors like age, obesity, previous injury, genetics and repetitive stress that results in loss of cartilage and bone changes. Symptoms include joint pain, stiffness, swelling and limited movement, while treatment focuses on pain management through medications, injections, physical therapy, weight loss and potentially surgery.

1. Osteoarthritis
Dr A V Gurava Reddy
DNB, M.Ch, F.R.C.S(Ed), F.R.C.S(Glas)
Chief joint replacement surgeon
Managing director
Sunshine hospitals hyderabad

2. Osteoarthritis
• Typically affects
• Knees
• Hips
• Spine
• And small joints of fingers
• Mostly commonly affects knees in Indian
population

3. OSTEOARTHRITIS KNEE
• Chronic, degenerative disorder
• multifactorial aetiology
• loss of articular cartilage
• periarticular bone remodelling
• large weight-bearing joints
• Common in older patients but can occur in
younger patients ( genetic mechanism , previous
joint trauma )

4. • hinge joint

6. Incidence
• Incidence increases with age
• In india - 80-90% above 65 suffer with primary OA
• After age 55 years, the prevalence increases in women in
comparison with men

7. prevalence
• Equivalent prevalence occurs in men and women
aged 45-55 years (↑dramatically after the age of
50 years in women)
• Most adults older than 55 years show radiographic
evidence of osteoarthritis
• No significant correlation exists between incidence
of OA and race

8. Causes
Primary OA
• Idiopathic
• Defective gene
• AGE RELATED WEAR AND TEAR

9. Causes
Secondary OA
– Obesity
– Repetitive use (ie, jobs requiring heavy labor
and bending)
– Previous trauma (ie, posttraumatic OA)
– Infection

10. Causes
– Crystal deposition
– Acromegaly
– Previous rheumatoid arthritis (ie, burnt-out
rheumatoid arthritis)
– Heritable metabolic causes (eg, alkaptonuria,
hemochromatosis, Wilson disease)

11. Causes
– Hemoglobinopathies (eg, sickle cell disease,
thalassemia)
– Underlying orthopedic disorders (eg, congenital
hip dislocation, slipped femoral capital
epiphysis)
– Disorders of bone (eg, Paget disease,
avascular necrosis)

12. History
• Insidious throbbing arthralgias with activity
• Initially, resting relieves the pain
• Eventually, the pain occurs even at rest
• Morning stiffness ≥ 30 minutes
• Intermittent joint swelling

13. Symptoms
• Pain
• Stiffness
• swelling
• Instability

14. Signs
• Pain
• Tenderness
• Swelling
• Effusion
• Crepitus
• Limitation of movement and muscle
wasting

15. Deformities

16. Imaging
• Plain radiographs
• Bone scans may be helpful in early
diagnosis of OA of the hand

17. • The space between the
bones of the upper and
lower leg is smaller
• Bony spurs
(osteophytes)
• Increase bone density
at the margin of the
joint

18. x-ray
findings
–Joint space narrowing
–Osteophytes
–Subchondral sclerosis : ↑ bone density,
frequently found adjacent to joint space
–Subchondral cysts : fluid-filled sacs which
extrude from the joint

19. Radiographs

20. Diagnosis
• On the basis of the initial history
and examination
• X-rays

21. Manage
ment

22. Goals of
managing OA
• Pain control
• Prevent stiffness and secondary deformities
• Limiting functional impairment

23. Treatment
• Education and behavioural intervention
• Weight loss
• Physiotherapy
• Splints

26. Treatment
• Analgesics
- Acetaminophen (Tylenol®) is a mild pain
reliever with few side effects
- Anti-inflammatory medication, such as
ibuprofen and aspirin
- COX-2 inhibitors
- Glucosamine and Chondroitin sulfate

27. Treatment
• Intra-articular injection
- Glucocorticoids injection
- Hyaluronic Acid (HA) and similar
hyaluronan preparations (eg, Synvisc)
………. Debatable

28. Treatment
• Surgery
- Arthroscopy (including
debridement,and lavage/irrigation)
- Proximal Tibial Osteotomy
- Total Knee Replacement

29. Case 1

31. CASE 2

34. Case 3

37. CASE 4

39. MOBILE BEARING KNEE- RESULT

40. HI-FLEX
KNEE

41. Young –19 /m

47. All four joints replaced in a young patient with ochronotic arthropathy

49. MOTTO

50. Achievements
• Established as a patient friendly hospital in 2009
• The second largest Joint replacement center in Asia
• Well equipped and biggest trauma care facility in the state of Andhra Pradesh
• Availability of all Super specialists under one roof
PATIENT FIRST

51.  Sunshine Hospitals is South East Asia’s 2nd largest joint replacement centre to a
pioneering multi-super specialty hospital
 3000+ successful joint replacements every year
 A state-of-the-art healthcare destination unrivaled for its service, quality of
deliverables and empathy
 Investing relentlessly in people, equipment, technology and research
PATIENT FIRST

52. About Sunshine Hospitals
• 400 Bed Facility
• Centrally Located at Paradise circle Secunderabad
• Exceptional Ambience
• Spacious Parking area
• Well trained Patient care Coordinators
• Choice of occupancy(Royal Suite… General ward)
PATIENT FIRST

53. About Sunshine Hospitals
• 40 critical care beds with central monitoring systems
• Dedicated floor and In House critical care team to handle all Emergencies
• 1:1 Nursing ratio in critical care areas
• Treatment and patient care protocols as per international standards and
guidelines
• Specialized equipment and expertise Consultant team to handle complex
procedures
PATIENT FIRST

54. About Sunshine Hospitals
• 14 World class operating Theatres having global quality standards with laminar
airflow, Hepa Filters, High end microscope and other latest surgical equipments.
• Well equipped patient centered central monitoring systems ICCU’s with special
trained staff and consultants 1:1 Nursing staff
• 2 Flat panel digital catheterization lab
• 150 seat Auditorium with latest AV system
• 2 Digital 7900 flurostar C-Arm
• 1.5 Tesla MRI and Spiral CT
• Dedicated floor for OT with pre and post operative ICU care
PATIENT FIRST

55. • State of art Radiology services( MRI, CT, ECHO, Ultrasound, Doppler, TMT,
digital x-ray etc)
• Fully automated laboratory services( Pathology, Microbiology, Biochemistry,
Genetics)
• Special Health checkup packages
• Continuous learning programs for doctors and paramedical staff( internal and
external)
PATIENT FIRST

60. CT / MRI 1.5 Tesla

61. PATIENT FIRST

62. PATIENT FIRST

63. PATIENT FIRST

64. 2
0
0
9
Our Vision
To create a world-class medical facility where patients are
treated with compassion.
Our Mission
To create a world-class medical facility where patients are
treated with compassion .
To offer qualitative and comprehensive services in a patient-
friendly environment focused on clinical excellence, safety,
dignity and transparency, while staying affordable and accessible
to every patient in need.
Our Values
• Compassion
• Teamwork
• Transparency
• Process-driven
PATIENT FIRST
AUGUST,
SUNSHINE HOSPITALS: The beginning

65. Arthroplasty surgeries
PATIENT FIRST
96 3
1
2010: A promising start..
5 Beds
321
0
210
5 Shoulder, Arthroscopy & Shoulder
surgeries500
Trauma surgeries

66. Arthroplasty surgeries
PATIENT FIRST
27 7
1
2013: The Journey till now..
0 Beds
603
1
040
5 Shoulder, Arthroscopy & Shoulder
surgeries500
Trauma surgeries

67. 2014: Well placed to grow..
PATIENT FIRST
2ASIA’s LARGEST
Joint replacement Centre
nd

68. 2014: Well placed to grow..
PATIENT FIRST
1st
Ranked
Worldwide Achievers & Headlines Today
HEALTHCARE EXCELLENCE AWARD 2013

69. Other specialities
• Trauma
• Arthroscopy and sports medicine
• Orthopedic oncology
• Spine
• Hand surgery
• Pediatric orthopedics
• Ilizarov and reconstructive
surgery

70. Trauma team

72. Spine unit

75. Hand surgery

76. Arthroscopy and
sports medicine

78. Orthopedic
oncology

80. Pediatric
orthopedics

81. Reconstructive
and ilizarov
surgery

83. Our Anaesthesia Team

84. Our Physiotherapy Team

85. Our Support Team

86. PATIENT FIRST

87. PATIENT FIRST
THE SUNSHINE ADVANTAGE Sunshine
Big hospitals
without
Specialty focus
Single
Specialty
hospitals
Volumes
3000 joint replacements in a
year
✔
Round the clock availability
of Specialists, Resident in
the campus 24 X 7
DM Cardiologists ✔
MS Orthopedics doctors ✔
MD Anaesthesiologist ✔
MD General Medicine ✔
Intensive care Specialists ✔
Infrastructure
Cardiac cath labs ✔
CT Scan ✔
MRI ✔
Dialysis Machines ✔
Modular theatres Laminar
airflow with HEPA filters
✔
Support Services
Dedicated Pain Control Nurses
working under a Consultant
Anaesthesiologist
✔
Exclusive Infection control team
headed by Consultant
Microbiologist
✔

89. Is the time out?