The document discusses osteoarthritis of the hip and knee. It notes that osteoarthritis prevalence increases significantly with age, affecting 1-4% of people aged 24-45 and 53-55% of people aged 70-80. Symptoms include pain and stiffness, and treatment may involve non-surgical or surgical methods along with rehabilitation. Rehabilitation aims to relieve pain, maintain strength and range of motion, and provides behavioral strategies and modalities like heat, cold therapy, exercise and hydrotherapy. Surgical options for treating osteoarthritis include procedures like hip and knee arthroplasty.

1. ΟΣΤΕΟΑΡΘΡΙΤΙΔΑ
ΙΣΧΙΟΥ ΚΑΙ ΓΟΝΑΤΟΣ

2. What is Arthritis?
The process by which a joint becomes useless
“Joint failure”
Cartilage destruction and other changes

5. The prevalence of osteoarthritis
 24-45 years 1% - 4%
 70-80 years 53% - 55%

6. Symptoms
 Pain
 Stiffness
Reduced functional capacity

7. Methods of Treatment
 Non-Surgical
 Surgical

8. Rehabilitation
Assists the patient in function
 Physically
 Psychologically
 Vocationally

9. Factors to consider, before rehabilitation
a. Stage and extent of arthritis
b. The pain threshold
c. Current medications
d. Patient’s compliance
e. Patient’s expectations

10. Goals to achieve
 Pain relief
 Maintaining strength
 Maintaining ROM
 Behavioral strategies

11. Modalities
 Heat
 Cold therapy
 LASER
 Electrical Stimulation
 Acupuncture
 Orthotics

12. Heat
Superficial
Wax
Warm Water
Spa
Deep
Microwave
Diathermy
Ultrasound

13. Scientific Basis
Heat has been shown to decrease pain
and muscle spasm by acting on nerve
endings.
Also, makes the tendons more
stretchable (enhances their elastic
qualities).

14. “Significant reductions in joint pain at the hip,
knee and lumbar spine with spa therapy”
Yguyen et al, 1997
Br J Rheumatology

15. “Significant reductions in joint pain at the hip,
knee and lumber spine with spa therapy”
Yguyen et al, 1997
Br J Rheumatology
Meta analysis at 293 studies with deep heat
treatment showed no difference in pain relief
Gam and Johansen, 1995

16. Effects of exercise
 Increased motion
 Decreased joint pain
 Increased aerobic capacity

17. Exercise
 Range of motion
 Stretching
 Strengthening
 Aerobic
 Recreational

18. Pool exercise
The buoyancy at the water provides
decreased joint loading and makes the
exercise less painful.
Pool programs increase aerobic
capacity.

19. Definition of Hydrotherapy
Hydrotherapy is the use of water
in the treatment of disease.
Here, the disease is arthritis
It has been used by many
cultures for various purposes

20. How it works
 Mechanical effects
 Thermal effects

21. Clinical Uses
Few clinical trials
BUT
It’s the most commonly used
modality

22. Increase in pain relief with hydrotherapy
Ahern et al, 1995
Thermal water better than tap water
Scucs et al,1989

23. Word of caution
Any type of hydrotherapy does not
prevent arthritis and does not alter
the progress of the disease.

24. Hip arthroplasty
 interpositional
 excision
 replacement

25. Interpositional arthroplasty

27. Excision arthroplasty

28. Hemiarthroplasty

29. Judet

30. Austin Moore Thompson

31. TOTAL HIP REPLACEMENT

32. 1891

33. 1938

36. The cart has been
put before the horse:
the artificial joint has
been made and used,
and now we are trying
to find out how and
why it fails
Charnley 1956

39. CEMENTED FIXATION
Mechanical interlock: static: quality
of bone, cement and consequently
fixation degrade with time
CEMENTLESS FIXATION
Biological osseo-integration:
dynamic: bone replaced and quality
of fixation maintained

48. 1969
 metal on plastic total knee
replacement Gunston
The Polycentric knee

49. 1971
 tibio-femoral “roller
in a trough” design
relying for stability
on the integrity and
tension in the
collateral ligaments
Freeman-Swanson

50. 1976
The Marmor modular knee

51. 1974
Total Condylar knee
Insall

54. Dislocated implant