The Arthritic Knee in the Middle-aged Athlete

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Do your achy knees keep you from performing your best? Anyone with knee pain who wants to stay active and competitive will benefit from this lecture.

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The Arthritic Knee in the Middle-aged Athlete

  1. 1. Eric C. Mirsky, MD E i C Mi k
  2. 2. Individuals are more active Injuries can lead to arthritis TKR successful in older individuals Options for younger, active people
  3. 3. Wearing away of the joint cartilage Lining erodes Spurs form (osteophytes)
  4. 4. PAIN Joints stiff and swollen Lose range of motion May disrupt sleep
  5. 5. Wear and tear on joints Genetics, aging, injuries Obesity Deformity of a joint
  6. 6. Early xray changes but no symptoms Diagnosis based on symptoms, exam and radiographs
  7. 7. Cartilage wears away Joint loses its normal shape and function Osteophytes form Bone and cartilage may break off
  8. 8. Exercise and Physical therapy Bracing and Orthoses NSAIDs Steroid injections Joint fluid therapy (viscosupplementation)
  9. 9. Reduce pain and improve function Muscle strengthening and aerobic exercises Weight loss to decrease stress Compliance is a concern
  10. 10. Goal is to improve function by reducing symptoms Moderate OA Helps H l maintain active lif i i i lifestyle l Delay surgery
  11. 11. Mild analgesics Anti-inflammatory GI side effects COX-2 inhibitors
  12. 12. Ice Tylenol Narcotics
  13. 13. Corticosteroids for pain flares Hyaluronic acid therapy Synvisc, etc y ,
  14. 14. Arthroscopy High Tibial Osteotomy (HTO) Unicondylar knee replacement (UKR) Total knee replacement (TKR)
  15. 15. Role is controversial Initial benefit Placebo effect? Effective for unstable meniscal tear or mechanical complaints Careful patient selection and counseling
  16. 16. Preserves the native knee joint Postpones TKR Redirects weight-bearing axis Results deteriorate over time Less popular today
  17. 17. Younger patients with isolated disease Preserves the natural feel of the knee Recent resurgence of interest and popularity Most patients will eventually convert to TKR
  18. 18. Final option Excellent long-term results Implants unlikely to loosen with use
  19. 19. 65% able, but at lower level and with decreased frequency No evidence correlating with loosening Impact exercise not recommended I i d d
  20. 20. Treatment of OA in young, active patients remains a challenge Nonoperative management does not alter the natural history of the disease process Treatment based on symptoms and expectations

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