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Part III

Part III. Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota. Medical Therapy. Supplements Over-the-counter medicines Prescription medicines Injection therapy. Supplements. Little scientific evidence for/against products Not subject to FDA regulations

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Part III

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  1. Part III Amy L. McIntosh, MD Pediatric Orthopedic Surgeon Mayo Clinic Rochester, Minnesota

  2. Medical Therapy • Supplements • Over-the-counter medicines • Prescription medicines • Injection therapy

  3. Supplements • Little scientific evidence for/against products • Not subject to FDA regulations • Reasonable evidence for glucosamine / chondroitin helping with arthritic symptoms • No evidence for other compounds

  4. OTC Medicines • Tylenol • NSAIDs – Ibuprofen (Advil) and Naprosyn (Aleve) • Equally effective in all major studies • Quite safe when taken with supervision • Stomach ulcers • Kidney trouble

  5. Prescription Medicines • Prescription NSAIDs • Celebrex, Mobic, etc • No better than ibuprofen or naprosyn in comparable doses • Benefits for select patients • Primary benefit is convenience • Cardiovascular risks unknown

  6. Prescription Medicines - Opiates • Synthetic derivatives of morphine • Effective • But… tolerance building and habit forming • Frequent depression and side effects • Used very selectively and carefully under specialty supervision

  7. Physical Therapy • Important aspect of joint care in SS • Particularly important before and after any surgery

  8. Injection Therapy • Injection of cortisone or hyaluronic acid derivatives • Effective in ~2/3rds patients • Effect often fades • Safe for up to 3-4 times/year

  9. Surgical Treatment • Fusion • Arthroscopy • Realignment / reshaping • Joint replacement

  10. Fusion • Traditional treatment for arthritis in the young • “No motion, no pain” • Not for patients with multiple joint involvement • Spine, ankle, wrist possible exceptions

  11. Arthroscopy

  12. Arthroscopy • Low morbidity outpatient procedure • Doesn’t “burn” bridges • Effective against well defined targets • Focally torn cartilage • Not effective for generalized joint pain or arthritis

  13. Realignment Procedures - Knee • Surgically change alignment to “offload” worn area • Delay need for joint replacement

  14. Realignment Procedures - Hip Impinging bump on the edge of a malformed femoral head (ball)

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