Your Joint Pain and Treatment Options Steven L. Drayer M.D. Private Practice-Lansing/Sparrow Hospital
Mar 31, 2015
Your Joint Pain and Treatment Options
Steven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital
Joint Pain and Treatment Options
About My Practice
1) Trained at Henry Ford Hospital in Detroit, Michigan.
2) Have been in private practice for 20 years
3) Have been performing joint replacements for 24 years
4) I perform approximately 150 replacements/year, not
including those done for broken hips. These are knee
and hip primarily, but also shoulder and, rarely, elbow.
Joint Pain and Treatment Options
5) I also perform revision surgery for worn out, loose or
painful joint replacements.
6) I update my knowledge on joint replacement surgery
twice a year at educational courses.
7) I’m well trained and experienced in alternative
treatments for arthritis. These include medications,
P.T., exercise, dieting, bracing, injection therapy,
arthroscopic surgery, cartilage transplant and partial
joint replacements.
Joint Pain and Treatment Options
What is arthritis?
1) It is the loss of joint surface that covers the bone. This special surface allows the bones to glide effortlessly, smoothly and pain-free. (This is the white, pearly substance on the end of the chicken bone.)
2) It is not to be confused with osteoporosis which is the loss of bone mass.
3) The loss of this surface, whether partial or complete, results in variable pain, stiffness, swelling, weakness and loss of motion.
4) With progression over time it results in the destruction of the underlying bone and adjacent ligaments.
Joint Pain and Treatment Options
How does it present?
1) It can either present in a slow gradual fashion or have a sudden appearance after a minor injury.
2) You can have “good and bad” days. Pain will be low level aching to intense pain that won’t allow walking on the leg.
3) You can be stiff and achy in the morning, comfortable during the day, then painful at the days end.
4) Oft time the pain will lessen with mild to moderate activities.
5) You may experience popping, locking or catching.
Joint Pain and Treatment Options
6) Prolonged positions will cause increase symptoms, ie. Standing in line, long car rides or sitting for a movie.
7) You avoid, or have difficulty doing, activities like kneeling, squatting, stair climbing, getting out of cars/chairs or even tying your shoes.
8) You have trouble finding a comfortable position while resting at home with a book or watching t.v.
9) You have trouble with waking up at night due to joint pain.
Joint Pain and Treatment Options
Diagnosis
Tenderness to the touch
Weakness in the muscles
Loss of passive and active range of motion
Spurs that can be felt along the bone edges
Grinding, popping or other joint noises that can be felt or heard
Fluid on the knee
Catching or locking
Physical Examination
Joint Pain and Treatment Options
Diagnosis
X-Rays (needs to be done with one view in the standing position)
Additional Tests
Joint Pain and Treatment Options
Nonsurgical Options
Diet and Exercise
Rest and Joint Care
Cane / Walker
Medications
Cortisone
Glucosamine
Visco-supplementation
Braces
Joint Pain and Treatment Options
Treatment OptionsRest
Short-term bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem.
Individual joint rest is most helpful when arthritis involves one or only a few joints.
Joint Pain and Treatment Options
Weight Loss
Average American is 20–40 lbs. overweight
Average person takes 5000-7000 steps/day
Reduces stress on weight-bearing joints
Joint Pain and Treatment Options
Balanced Diet
Helps manage weight– Extra pressure on some joints may aggravate your arthritis
Stay healthy
Joint Pain and Treatment Options
Range of Motion ExercisesStretching
Maintains normal joint movement
Increases flexibility
Relieves stiffness
Increases the ease of surgery, thus allowing better outcomes.
Joint Pain and Treatment Options
Strengthening Exercises
Increasing muscle strength helps support and protect joints affected by arthritis.
Exercise is an important part of arthritis treatment that is most effective when done properly and routinely.
Allows easier recovery and shorter rehabilitation after surgery.
Joint Pain and Treatment Options
Aerobic Exercises
Improve cardiovascular fitness
Helps control weight
May help reduce inflammation in joints
For those worried about advancement of arthritis, a Swedish study showed no progression of arthritis with moderate exercise.
Walking, Biking
Joint Pain and Treatment Options
Heat and Cold Therapies
Reduce pain and inflammation
Heat Therapy– Increases blood flow, tolerance for pain, flexibility
Cold Therapy– Cold packs, ice massage, OTC sprays and ointments
– Reduces pain by numbing the nerves around the joint
Joint Pain and Treatment Options
Physical TherapyThe goal is to get you back to the point where you can perform normal, everyday activities without difficulty.
Preserving good range of motion is key to maintaining the ability to perform daily activities.
Physical therapists provide exercises designed to preserve the strength and use of your joints.
– Show you the best way to move from one position to another
– Teach you how to use walking aids
Joint Pain and Treatment Options
Assistive Devices
Make activities easier and less stressful for the joints and muscles.
Splint or brace when recommended by a doctor or therapist
Walking aides
Orthotics
Bath stool for use in the shower or tub
Sock grippers
Other devices are available to assist with everyday activities.
Joint Pain and Treatment Options
Walking Aides
Cane Walker
Helps keep you balanced so you don’t hurt other joints.
Joint Pain and Treatment Options
Medications: Analgesics
Analgesics, pain relievers, may provide temporary relief of arthritis pain.
Joint Pain and Treatment Options
Medications: NSAIDs
Traditional
Aspirin
Ibuprofen
Naproxen
New
Cox II
Joint Pain and Treatment Options
Medications: Topical Pain Relievers
Over-the-counter patches, rubs and ointments can provide quick pain relief for people with arthritis that is in just a few joints − such as a hand − or whose pain isn't severe.
Joint Pain and Treatment Options
Nutritional Supplements
Glucosamine and Chondroitin may relieve joint pain.
Occur in the body naturally; vital to normal cartilage function.
– Researchers are also studying chondroitin for use in making medicines more effective and helping to prevent blood clots (anticoagulant).
Not FDA approved
Warrant further in-depth studies on their safety and effectiveness, according to the Arthritis Foundation.
Source: Arthritis.org website, Aug. 2006
Joint Pain and Treatment Options
May help osteoarthritis pain and improve function.1, 2
Some studies indicate that glucosamine may help as much as ibuprofen in relieving symptoms of osteoarthritis, particularly in the knee, with fewer side effects
1. Dieppe P, et al. (2002). Osteoarthritis. Clinical Evidence (7): 1071–1090. 2. McAlindon TE, et al. (2000). Glucosamine and chondroitin for treatment of osteoarthritis. A systematic quality assessment and meta-analysis. JAMA, 283(11): 1469–1475. 3. Update on glucosamine for osteoarthritis (2001). Medical Letter on Drugs and Therapeutics, 43(1120): 111–112.
Joint Pain and Treatment Options
Side Effects of Glucosamine and Chondroitin
These arthritis supplements are generally well tolerated.
However, side effects can occur. The most commonly
reported side effects are: – Nausea
– Diarrhea or constipation
– Heartburn
– Increased intestinal gas
See your doctor for complete information.
Joint Pain and Treatment Options
Glucosamine and Chondroitin
People with osteoarthritis who have diabetes should talk with a doctor before they take glucosamine because it may influence blood sugar (glucose).
Do not take glucosamine if you are allergic to shellfish. – Glucosamine is made from shellfish covering
Source: WebMD
Joint Pain and Treatment Options
Dietary Supplements
Other than in vitamins and minerals, the long-term effects of most dietary supplements are not known.
Talk to your doctor before taking supplements.
Joint Pain and Treatment Options
Corticosteroids
Decrease inflammation– Oral
– Cream (topical)
Short-term side effects include – Swelling, increased appetite
Long-term side effects include– Stretch marks, excessive hair growth, osteoporosis, high blood
pressure, infections and high blood sugar
Joint Pain and Treatment Options
Injections: Corticosteroids
Injection
Effective
Temporary
Joint Pain and Treatment Options
Injections / Visco-supplementation
Hyaluronic Acid (Cock’s Comb)
Injection
Effective (5-13 wks)
Does Not Prevent Progression
Joint Pain and Treatment Options
Hyaluronic Acid
Natural substance that lubricates the joint
Injection – Lubricates the joint
– Provides temporary relief of pain and movement
– 80 to 85% of individuals who are treated with this series of injections have some amount of pain relief which lasts anywhere from nine to 12 months.*
– Approved for knee osteoarthritis
*http://uconnsportsmed.uchc.edu/patientinfo/whathurts/treatment/hyaluronic_acid.html
Joint Pain and Treatment Options
Knee Braces
Simple Braces “Unloader” Braces
Joint Pain and Treatment Options
When to have a Joint Replacement
Joint replacement may be a treatment option when:
Pain is chronic or more recent and disabling
Pain interferes with desired activities
Pain interferes with daily activities, recreational or work activities
Significant loss of motion (this will become permanent) occurs.
Joint Pain and Treatment Options
When to have a Joint Replacement
• When rest pain becomes prominent.
• When you have joint pain that wakes you up at night.
• When there has been a failure of medical treatment to
relieve pain.
• When there is severe bony deformity on x-ray.
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Joint Replacement
Preparing for a joint replacement procedure begins weeks before the actual day of surgery. In general, patients may need:
Routine blood tests
Urinalysis
Physical examination
Exercise
Quit smoking
Stop certain medications
Donate blood
Preoperative
Joint Pain and Treatment Options
Total Joint Replacement
Goals of total joint replacement are to help:
– Relieve pain
– Restore motion
– Improve function
– Improve fitness and health
– Restore quality of life
Joint Pain and Treatment Options
Your Hip Joint
A joint is formed by the ends of 2 or more bones.The hip must bear the full force of your weight and consists of two main parts:
A ball (femoral head) at the top of your thigh bone (femur)
A rounded socket (acetabulum) in your pelvis
Normal hip joint, showing healthy articular cartilage
Joint Pain and Treatment Options
What Causes Hip Joint Pain?
One of the most common causes of joint pain is arthritis. The most common types of arthritis are:
Osteoarthritis (OA)
Rheumatoid Arthritis (RA)
Post-traumatic Arthritis
Avascular Necrosis
Diseased hip joint, showing worn cartilage
Joint Pain and Treatment Options
Total Hip Replacement
Joint Pain and Treatment Options
Your Knee Joint
Femur – thigh bone Cartilage – tissue between bones that provides cushioning Patella – knee cap Tibia – shin bone Synovium – tissue that provides lubricating fluid to joint Ligament – flexible tissue that holds knee joint together
Joint Pain and Treatment Options
Total Knee Joint Replacement
End surface of femur replaced with metal
End surface of tibia replaced with metal
Plastic liner is inserted between femur and tibia
Patella is resurfaced with plastic
The entire knee is not removed as myth and lore would have it.
This is a resurfacing procedure.
Joint Pain and Treatment Options
Total Knee Replacement
Joint Pain and Treatment Options
Limitations After Surgery Athletic activities that place excessive stress on the joint replacement will need to be avoided. Examples of these activities include:
Skiing (snow or water)Basketball Baseball Contact sports Running Frequent jumping
Joint Pain and Treatment Options
Enhanced Performance After Surgery
1) My goal as a joint surgeon is to meet the activity demands of my patients.
2) We now have a more active “older” population.
3) The newer materials now available are more durable and longer lasting to meet these demands. (ceramics, high density polyethylene, HA coated components, metal-on metal.)
4) There are certainly higher risk activities for joint patients, yet many on the previous slide can be undertaken by experienced individuals.
Technology for Active Patients
Trident® CeramicSteven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Realistic Expectations
Age
Weight
Activity level
Bone strength
Longevity of Hip Replacement
New Technologies are Meeting the Needs of the More Active
Patient
New Technology for Active PatientsTrident Ceramic
Joint Pain and Treatment Options
Hip Implant OptionsConventional Hip Implants Ceramic Hip Implants
Metal femoral head
Femoral stem
Plastic insert
Acetabular shell
Ceramic femoral head
Ceramic insert
Acetabular shell
Joint Pain and Treatment Options
Ceramic in Hip Replacement
Superior wear performance in laboratory testing compared to metal-plastic bearings*
Excellent biocompatibility
Long clinical history
Provides smooth surface with low friction
Extremely hard material
*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th Ann. Mtg. ORS, 51, 1998.
Joint Pain and Treatment Options
Experience with Ceramics
Ceramic is used in aeronautics, bullet proof vests and golf clubs
Ceramics in hip replacement have evolved over the past 30 years
– Early use in the US revealed limitations
Joint Pain and Treatment Options
Trident® Ceramic System
Improvements in material strength, quality and design
Advanced processing, testing and quality control produces stable, extremely strong ceramic implants
Joint Pain and Treatment Options
U.S. Clinical Study
The first US clinical study of contemporary ceramic-on-ceramic hip replacements began in 1996
– Over 1,300 hip surgeries
– 16 centers in the United States
FDA approved Trident® Ceramic for sale in the US in February 2003
Joint Pain and Treatment Options
Alumina Ceramics in Hip Replacement
Alumina ceramic-on-ceramic components demonstrate significantly lower wear versus conventional metal-on-plastic components in laboratory testing.
Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th Ann. Mtg. ORS, 51, 1998.
Joint Pain and Treatment Options
Range of motion (ROM) of the Trident® Ceramic System
Although there are many factors that will influence your range of motion, the Trident® Ceramic System is designed to accommodate the range of motion as in a normal, healthy hip joint
An increased ROM may help minimize the risk of hip dislocation
Joint Pain and Treatment Options
Trident® Ceramic System
Biocompatible
Reduces friction
Extremely hard
Superior wear properties to other bearings available on the market today*
*Taylor, SK, Serekian P, Manley, M, Wear Performance of a Contemporary Alumina:Alumina Bearing Couple Under Hip Joint Simulation, Trans. 44th Ann. Mtg. ORS, 51, 1998.
Joint Pain and Treatment Options
Ceramic-on-Ceramic Hip Replacement
Additional information about ceramic hip replacement is available to you: Call 1-888-STRYKER or visit www.aboutstryker.com
Individual results may vary. There are potential risks and recovery takes time. The life of any joint replacement will depend on your weight, age, activity level and other factors. Only an orthopaedic surgeon can tell if surgery is right for you.
Joint Pain and Treatment Options
Joint Replacement Survival
1) In the 50 year old and greater age group 95% of the replaced joints are functioning well at over 20 years.
2) In the younger than 50 year old group 70% are functioning well at 10-15 years after placement.
3) This data does not include the data on the new ceramic and metal on metal hip replacements.
4) Finally, all joint replacements are now modular. Should a singular part wear out, it can be replaced with a simpler, less involved surgery.
Minimally InvasiveTotal Hip Replacement
Steven L. Drayer M.D.Private Practice-Lansing/Sparrow Hospital
Joint Pain and Treatment Options
Topics
What is hip arthritis?
What is conventional hip replacement surgery?
What is MIS hip replacement surgery?
Joint Pain and Treatment Options
Ready to Consider Hip Replacement?
Today, more than 300,000 Americans a year have hip replacement surgery
First performed in 1960, this procedure is considered one of the most important surgical advances of the past 100 years
You're Not Alone!
Joint Pain and Treatment Options
Joint Pain and Treatment Options
Replaced Hip X-ray
Joint Pain and Treatment Options
What is ‘Minimally Invasive Surgery’?
MIS is a general term used to describe a surgical procedure that often utilizes a smaller incision(s) than conventional surgery. In these cases ‘MIS’ more accurately describes “Mini Incision Surgery”
Other MIS procedures reduce the amount of soft tissue (muscles and tendons, etc) that are disrupted during surgery. In these cases ‘MIS’ more accurately describes “Minimally Invasive Surgery”
Joint Pain and Treatment Options
What are the potential benefits of MIS Hip Surgery?
Less soft tissue disruption
– Faster discharge from the hospital
– Quicker rehab and recovery
Less blood loss
Reduced pain
Smaller scar
Source: Keggi, Kristaps J., Total Hip Arthroplasty Through A Minimally Invasive Anterior Surgical Approach JBJS, Vol. 85-A.
Joint Pain and Treatment Options
What are the potential risks?
Results may vary from patient to patient
Surgery time may be extended
Risk factors relating to anatomy, weight, and prior joint replacements
Risks which are normally encountered in conventional THA remain
Joint Pain and Treatment Options
Is MIS Total Hip Arthroplasty for everyone?
No, patient limitations include:
Obese, high BMI
Muscular males
Pre-existing conditions
Joint Pain and Treatment Options
Stryker Implant Technology
Accolade® TMZF® is an MIS-friendly implant
Compatible with ceramic-on-ceramic technology for long-term results
Joint Pain and Treatment Options
What Do I Do?
1) Talk to your orthopedic surgeon.
2) Find out the best joint treatment option for you.
3) Visit the website of your surgeon, AAOS or joint manufacturer.
4) Ask questions!
Joint Pain and Treatment Options
517.371.3407