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Case Presentation

Case Presentation. 65 yr, male C/O right knee pain, stiffness Can not walk more than 10 mts Can not sleep at night Walks with frame. Physical Exam. Radiograph Knee. Management of OA Knee- an Overview. Conservative treatment Surgical treatment. Weight Reduction.

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Case Presentation

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  1. Case Presentation • 65 yr, male • C/O right knee pain, stiffness • Can not walk more than 10 mts • Can not sleep at night • Walks with frame

  2. Physical Exam

  3. Radiograph Knee

  4. Management of OA Knee- an Overview

  5. Conservative treatment • Surgical treatment

  6. Weight Reduction • Wt loss of 5 kg reduces risk of OA by 50% ( Felson et al: Annals of int med, 1998) • Obese women has high risk of OA by Odds ratio of 8.57(Chungford study, Jr of Rheum,1993)

  7. Physiotherapy Cochrane database 2005 • Aerobic exercise • Quads Xr

  8. Drug Therapy AAOS, Up-to date 2005: • Paracetamol –DOC • Cochrane review,1997-No diff amoung various NSAIDS • Celecoxib • Tramadol( acute pain)

  9. Chondroprotective Agents • Glucosamine SO4 • Chondroitin SO4 NIH multi-centered trial Cochrane review 2005: WOMAC outcomes

  10. Braces • Alters biomechanical force loads • Cochrane review 2004

  11. Steroid Injections Inhibits accumulation of infl cells Reduces prostaglandin syn • Short term benefits in acute pain with effusions ( Cochrane review, AAOS, European )

  12. Hyaluronic Acid • Produced by synovium • In OA, HA is decreased • Weekly inj for 3-5 weeks Cochrane review- NO ROLE

  13. Arthroscopy Mech symp- loose bodies, locking, giving way, catching • Mosely et al, New England jr of Med, 2002

  14. Cartilage Repair • Chondrectomy • Abrasion, microfracture • ACI • Microdrill+ blood stem cells • Osteochondral graft • Grafting- periosteal - mosaicplasty

  15. High Tibial Osteotomy • Age:< 60y • Uni comp OA • Varus def < 10-15deg • ROM : 90 deg • Flex cont < 15 deg

  16. Joint Replacement • Failed conservative treatment AAOS , up-to-date 2005

  17. Overview of management of OA • Tailored treatment • Non-Pharmoc therapy is the hallmark • Exercise is always good • Pharmoc therapy is adjunctive • Paracetamol, initial Dr O Ch • NSAIDS if unresponsive • Inj Steroids for acute pain, effusions • Hyaluronic acid= ??? • Joint replacement when everything has failed

  18. Questions Osteoarthritis is… • Inflammatory condition • Septic condition • Degenerative condition • Neuropathic condition

  19. Questions Drug of Choice for initial pain relief is…. • Tramadol • Paracetamol • Ibuprofen • Steroids

  20. Questions Role of steroids…. • Systemic oral therapy • Long term maintenance therapy • Short term intra articular injec for acute pain • Don’t know…refer to clinic 6 !!!

  21. وَقُل رَّ‌بِّ زِدْنِي عِلْمًا And say, My Lord!Increase me in knowledge (20:114)

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