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EMERGING TECHNOLOGIES IN THE BATTLE AGAINST KNEE OSTEOARTHRITIS: NEW ANSWERS TO OLD QUESTIONS Dr. Jason Peeler PhD, CAT(C) Department of Human Anatomy & Cell Science, U of M Pan Am Clinic Research Foundation OBJECTIVES OF PRESENTATION 1. Review Osteoarthritis ü ü ü 2. Introduce an Emerging Technology ü ü ü 3. What is it? What causes it? How is it treated? Novel application? Limitations? Enhancing Quality of Life? Question Period OSTEOARTHRITIS (OA) Degenerative disease of joints that leads to slow, progressive disruption of the structural integrity of the cartilage that lines the joint. Single most common joint disease (after 65 years of age: 60% in men / 70% in women). No Known Cure!! Most Common in weight bearing joints (knee/hip) Insidious onset of pain Joint stiffness & swelling Progressive loss of ROM Enlarged / deformed joints Loss bodies in joint / joint crepitus Narrowing of joint spaces / loss of joint integrity Clinical Diagnosis: X-RAYS Standardized classification system used to determine severity. Joint space widening (early) Subchondral bone sclerosis Subchondral bone cysts Osteophytes Joint space narrowing KNEE OSTEOARTHRITIS Most common type of OA Affects more than 10 million people in North America alone Cited as the most common cause of disability! Designated as a key condition for special attention during the World Health Organization’s Bone and Joint Decade (20002010) TYPES OF KNEE OSTEOARTHRITIS 1. Primary OA Unknown cause May be related to a defect in the articular cartilages genetic and/or cellular composition 2. Secondary OA OA with a known cause Most commonly: Acute Trauma (eg. knee ligament injury) Repetitive stress Infection Hemarthrosis Osteonecrosis ETIOLOGY OF 2º KNEE OSTEOARTHRITIS Multi - factorial !!!! Extrinsic factors Intrinsic factors 1. 2. Abnormal joint biomechanics Limb alignment Muscle weakness / imbalance Joint instability Physical Activity Too much / Too little Others???????????? LIMB ALIGNMENT MUSCLE WEAKNESS Joint Instability Surgical Repair Can it be repaired? Is patient a good candidate? Timing of surgery? (I – S time) Which procedure is best? Short & long Term Prognosis? ACL INJURY & KNEE OSTEOARTHRITIS Research demonstrates that adolescents and young adults who sustain an ACL injury are at substantially increased risk for the development of future osteoarthritis (OA): “the young patient with the old knee”. >50% of ACL injured knees demonstrate radiographic evidence of OA 5 – 15 years after initial injury diagnosis. Physical Activity What’s best? When / how / etc Keys are: Quality of Life Longevity Too Much vs. Too Little HOW DO WE AVOID THIS??? CURRENT OA TREATMENTS Treatments focus on optimizing the patient’s quality of life through the reduction of joint pain and enhancement of functional capacity ETIOLOGY OF 2º KNEE OSTEOARTHRITIS Multi - factorial !!!! Extrinsic factors Intrinsic factors 1. 2. Abnormal joint biomechanics Limb alignment Muscle weakness / imbalance Joint instability Physical Activity Too much / Too little Others???????????? #1 MODIFIABLE RISK FACTOR – Body Weight Research suggests that each one pound of weight gain results in a corresponding 4 pound increase in knee joint loads during walking. Weight Loss? Physical Activity??? Research indicates that walking 15 minutes a day three times a week may help decrease OA pain by up to 40 percent. Catch 22 - Scenario NON-WEIGHT BEARING ACTIVITIES NEW TECHNOLOGY Anti-gravity treadmill http://www.starling-fitness.com/wp-content/uploads/alterg.jpg LBPP – LOWER BODY POSITIVE PRESSURE Grabowski & Kram, 2008 ADVANTAGES ↓ Ground Reaction Forces Normal “pain free” functional movement patterns Enhanced proprioception (ie. balance) Does not affect: Muscle activation Joint Motion Limb Swing Mechanics Cardiovascular Function Facilitates regulation of body weight – ie. Artificial method of achieving instantaneous weight loss!!!! Current Research Using Alter – G Treadmill •Examining the relationship between body weight and knee pain in an OA population • Early onset • Elderly Goals of Research: •Determine the exact nature of the body weight/knee pain relationship in knee OA •Promote pain free functional activities in at risk populations Take Home Message Optimizing Function in At-Risk Populations What is OA? What causes it? #1 modifiable risk factor – Body Weight! Walking is best! Emergence of anti-gravity technologies – Alter G Treadmill Enormous application potential of this new technology with at-risk populations such as early onset OA and the elderly. ACKNOWLEDGEMENTS Dr. Peter MacDonald, Pan Am Clinic Dr. Jeff Leiter, Pan Am Research Foundation Ms. Judit Takacs, University of Manitoba Dr. Paul H.T. Thorlakson Foundation Fund Mb. Centre on Aging Question Period WEIGHT SUPPORTED SYSTEMS Harness systems1 Fixed Pulley Water-based systems http://www.madonna.org/specialized_programs/technology/bodyweight_support.html
