the arthritic knee in the middle-aged athlete
DESCRIPTION
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.TRANSCRIPT
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E i C Mi k MDEric C. Mirsky, MD
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Individuals are more activeInjuries can lead to arthritisTKR successful in older individualsOptions for younger, active people
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Wearing away of the joint cartilageLining erodesSpurs form (osteophytes)
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PAINJoints stiff and swollenLose range of motionMay disrupt sleep
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Wear and tear on jointsGenetics, aging, injuriesObesityDeformity of a joint
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Early xray changes but no symptomsDiagnosis based on symptoms, exam and radiographs
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Cartilage wears awayJoint loses its normal shape and functionOsteophytes formBone and cartilage may break off
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Exercise and Physical therapyBracing and OrthosesNSAIDsSteroid injectionsJoint fluid therapy (viscosupplementation)
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Reduce pain and improve functionMuscle strengthening and aerobic exercisesWeight loss to decrease stressCompliance is a concern
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Goal is to improve function by reducing symptomsModerate OAH l i i i lif lHelps maintain active lifestyleDelay surgery
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Mild analgesicsAnti-inflammatory GI side effectsCOX-2 inhibitors
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IceIceTylenolNarcoticsNarcotics
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Corticosteroids for pain flaresCorticosteroids for pain flaresHyaluronic acid therapySynvisc, etcy ,
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ArthroscopyHigh Tibial Osteotomy (HTO)Unicondylar knee replacement (UKR)Total knee replacement (TKR)
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Role is controversialInitial benefitPlacebo effect?Effective for unstable meniscal tear or mechanicalEffective for unstable meniscal tear or mechanical complaintsCareful patient selection and counseling
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Preserves the native knee jointPostpones TKRRedirects weight-bearing axisResults deteriorate over timeLess popular today
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Younger patients with isolated disease Preserves the natural feel of the kneeRecent resurgence of interest and popularityMost patients will eventually convert to TKR
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Final optionExcellent long-term resultsImplants unlikely to loosen with use
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65% able, but at lower level and with decreased frequencyNo evidence correlating with looseningI i d dImpact exercise not recommended
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Treatment of OA in young, active patients remains a challengeNonoperative management does not alter the natural history of the disease processnatural history of the disease processTreatment based on symptoms and expectationsexpectations