膝关节骨关节炎—培训课件.pptVIP

TREATMENT Viscosupplemention Hyaluronic acid One of the major glycosaminoglycans in the extracellular matrix ,binding proteoglycans Important in maintaining articular cartilage integrity TREATMENT High molecular weight and concentration hyaluronic acid:hylan G-F 20 Providing and maintaining intraarticular lubrication Optimising the viscoelastic properties of synovial fluid The treatment effect with hylan G-F 20 was statistically significantly superior to placebo for the primary endpoint, change in WOMAC A (pain) over 26 weeks TREATMENT Exercise Weight loss Physical therapy Medicine Surgery TREATMENT Arthroscopic lavage and debridement Washing out the joint Repairing damaged cartilage No lasting benefit in most cases of osteoarthritis TREATMENT Osteotomy (high tibial osteotomy) An important adjunct to cartilage repair rocedures that rely on a normalized biomechanical environmentpatients Indications: patients presenting with unicompartmental disease (eg, after prior meniscectomy) who are at an age and functional level that is not ideally suited for joint arthroplasty Advantage: allowing 70% to 85% of patients to delay arthroplasty for ≥ 5 to 10 years and 50% to 60% for ≥ 15 years Method of planning the magnitude of the opening wedge . H hip, K knee, A ankle, VA virtual ankle, FP Fujisawa point TREATMENT Note:Varus or valgus deformity often has a ligamentous component as well as osseous and cartilaginous TREATMENT Complications Intra-articular fracture Compartment syndrome Hardware failure Correction failure Contracture Neuroma Infection Hardware pain Delayed union Hematoma Anterior knee pain Pes anserinus pain TREATMENT Cartilage Repair Techniques Bone Marrow Stimulating Techniques Osteochondral Transplantation Techniques Autologous Chondrocyte Implantation (ACI) Schematic drawing of autologous cartilage implantation (ACI). The procedure consists of the following steps: (1) cartilage harvest generally performed during arthroscopic surge