Osteoarthritis Diagnosis, Treatment and Surgery Edited by Qian Chen OSTEOARTHRITIS – DIAGNOSIS, TREATMENT AND SURGERY Edited by Qian Chen INTECHOPEN.COM Osteoarthritis - Diagnosis, Treatment and Surgery http://dx.doi.org/10.5772/2400 Edited by Qian Chen Contributors Ahmet Guney, Ibrahim Kafadar, Takashi Sawai, Wataru Yoshida, Akihisa Kamataki, Miwa Uzuki, Hassan Bassiouni, Magali Cucchiarini, Henning Madry, Shaw-Ruey Lyu, De-Shin Liu, Hwai-Shi Wang, Lai-Kwan Chau, Chih-En Tseng, Tessa Christine Therkleson, Lilisbeth Perestelo-Perez, Amado Rivero-Santana, Marien Gonzalez-Lorenzo, Jeanette Perez-Ramos, Pedro Serrano-Aguilar, Dong Rak Kwon, Gi Young Park, Viorica Marin, Olga Surdu, Daniela Profir, Sibel Demirgian, Michele Abate, Vincenzo Salini, Richard Carey Smith, Shu-Fen Sun, Maria Rosaria Gatto, Ida Marini, Gellért Sohár, Violeta Vasilevska, Ulrike Szeimies, Milan Vancho Samardziski, Axel Stäbler, Mihaela Micu, Craig Rodner, Nimit Patel, Glenn Russo, Hugh MacKenzie, Oliver Boughton, Mila Etropolski, Charles Mackworth-Young, Werner Kolb, Klaus Kolb, Hanno Guhlmann, Christoph Windisch © The Editor(s) and the Author(s) 2012 The moral rights of the and the author(s) have been asserted. 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Printed in Croatia Legal deposit, Croatia: National and University Library in Zagreb Additional hard and PDF copies can be obtained from orders@intechopen.com Osteoarthritis - Diagnosis, Treatment and Surgery Edited by Qian Chen p. cm. ISBN 978-953-51-0168-0 eBook (PDF) ISBN 978-953-51-6854-6 Selection of our books indexed in the Book Citation Index in Web of Science™ Core Collection (BKCI) Interested in publishing with us? Contact book.department@intechopen.com Numbers displayed above are based on latest data collected. For more information visit www.intechopen.com 4,100+ Open access books available 151 Countries delivered to 12.2% Contributors from top 500 universities Our authors are among the Top 1% most cited scientists 116,000+ International authors and editors 120M+ Downloads We are IntechOpen, the world’s leading publisher of Open Access books Built by scientists, for scientists Meet the editor Dr Qian Chen is the Michael G. Ehrlich, MD Endowed Chair in Orthopaedic Research, Professor of Medical Science, and Vice Chair for Research in the Department of Orthopaedics at the Warren Alpert Medical School of Brown University. He is the director of Center of Biomedical Research Excellence in Skeletal Health and Repair in Rhode Island Hospital, a multi-disciplinary translational research center established by National Institute of Health. Dr Chen’s research interest includes cartilage molecular biology, mech- anotransduction, and osteoarthritis. Throughout Dr Chen’s research career, he received the Independent Scientist Award from NIH, the Sat- terfield Arthritis Investigator Award from Arthritis Foundation, and the Kappa Delta Award from American Academy of Orthopaedic Surgeons. Dr Chen served on multiple NIH study sections and advisory panels. He served as an editor of the journal Current Opinions in Orthopaedics, and the topic Chair of Cartilage, Synovium, and Meniscus for the annual meet- ing of the Orthopaedic Research Society. Contents Preface X III Part 1 General Treatment of OA 1 Chapter 1 Long-Term Treatment of Osteoarthritis Pain: Achieving a Balance Between Efficacy and Tolerability for a Successful Chronic Therapy 3 Mila Etropolski Chapter 2 Characterization of Live and Experimentally Degenerated Hyaline Cartilage with Thermal Analysis 27 Gellért Sohár, Piroska Szabó-Révész, Kálmán Tóth and Zoltán Aigner Chapter 3 Topical and Regional Treatment for Osteoarthritis 47 Leena Patel and Charles Mackworth-Young Chapter 4 Intra-Articular Injections for the Treatment of Osteoarthritis: Focus on the Clinical Use of Several Regimens 67 Dong Rak Kwon and Gi Young Park Chapter 5 Hyaluronic Acid in the Treatment of Osteoarthritis: What is New 101 Michele Abate and Vincenzo Salini Chapter 6 Gene Therapy for Human Osteoarthritis 123 Magali Cucchiarini and Henning Madry Part 2 Alternative Treatment of OA 141 Chapter 7 Peloidotherapy in Osteoarthritis-Modulation of Oxidative Stress 143 Viorica Marin, Olga Surdu, Daniela Profir and Sibel Demirgian Chapter 8 Ginger and Osteoarthritis 157 Tessa Therkleson X Contents Part 3 OA in Upper Extremity (Hand, Wrist, Shoulder, and Elbow) 169 Chapter 9 Osteoarthritis of the Wrist 171 Nimit Patel, Glenn Russo and Craig Rodner Chapter 10 Osteoarthritis of the Trapeziometacarpal Joint (TMJ): A Review of the Literature 203 Oliver Boughton and Hugh Mackenzie Chapter 11 Low Level Laser Therapy in the Treatment of Temporomandibular Joint Arthritis: Questions and Answers 211 Marini Ida and Gatto Maria Rosaria Part 4 Diagnosis of OA in Lower Extremity (Hip, Knee, and Ankle) 225 Chapter 12 Treatment Preferences in Patients with Knee or Hip Osteoarthritis: An Overview 227 Amado Rivero-Santana, Lilisbeth Perestelo-Perez, Jeanette Perez-Ramos, Marien Gonzalez-Lorenzo and Pedro Serrano-Aguilar Chapter 13 The Plica: Is a New Aetiological Factor in the Knee Osteoarthritis? 243 Ahmet Guney and Ibrahim Kafadar Chapter 14 Knee Osteoarthritis and Associated Periarticular Conditions: Iliotibial Band Friction and Baker Cyst 253 Violeta Vasilevska, Ulrike Szeimies, Milan Samardziski and Axel Stäbler Chapter 15 Evaluation of In Vivo Proteolytic Activity 265 Wataru Yoshida, Akihisa Kamataki, Miwa Uzuki and Takashi Sawai Chapter 16 Phonoarthrography: A New Technique for Recording Joint Sounds 275 Hassan M. Bassiouni Part 5 Sugery of OA in Lower Extremity (Hip, Knee, and Ankle) 289 Chapter 17 Surgery for Osteoarthritis of the Knee 291 J.R. Lewis and R.L. Carey Smith Contents X I Chapter 18 High Tibial Open-Wedge Osteotomy – New Techniques and Early Results 319 Werner Kolb, Hanno Guhlmann, Christoph Windisch and Klaus Kolb Part 6 Treatment of OA in Lower Extremity (Hip, Knee, and Ankle) 347 Chapter 19 Ultrasound Guided Hip Injection Techniques 349 Micu Mihaela Cosmina Chapter 20 Hyaluronate for the Treatment of Ankle Osteoarthritis 367 Shu-Fen Sun, Chien-Wei Hsu, Yi-Jiun Chou, Yu-Nong Wang and Mei-Chia Chou Chapter 21 Knee Health Promotion Option for Osteoarthritic Knee: Cartilage Regeneration is Possible 379 S.R. Lyu, D.S. Liu, C.E. Tseng, H.S. Wang and L.K. Chau Preface Osteoarthritis is one of the most debilitating diseases worldwide. Millions of people suffer from pain and disability associated with this disease. There are two major types of OA: primary and secondary. The primary OA is associated with aging. While people live longer and longer, the prevalence of OA becomes more prominent. It is expected that the percentage of the people who suffer from OA will continue to rise in the coming decades. The secondary OA is a consequence of injury to the joints. It is often associated with sports injury and/or other traumatic events. Thus, it often occurs in young people and adults who enjoy an active life style. Although the direct damage to the joint such as rapture of the ligaments is often repairable by surgery, the patients nevertheless would likely suffer from degeneration of the joint cartilage later in life. My connection to OA is several fold. Because of the prevalence of OA, many of us know family members and/or friends who suffer from the disease. I am no exception. My mother suffered from both rheumatoid arthritis (RA) and OA. Although she also suffered from other diseases, she complained most about arthritis. Some of the other diseases might be more life-threatening; however, none of them brought as much pain and restrained her to bed on a daily basis as arthritis. She often said that life is not worth living if there is no quality. After her RA was brought under control by new drug therapy and both her knees were replaced by surgery, her pain became manageable and her mobility was regained. She was able to perform daily routine activities by herself that many of us take for granted, such as going to the bathroom, standing up after sitting, and walking the stairs. Her outlook on her life in the old age was brightened significantly because of the new treatment and surgery. As a biomedical researcher, I was fascinated by the intricate process of cartilage development and aging since I was a young graduate student. The research was driven primarily by interest and curiosity. However, my mother’s life experience and my interactions with other arthritis patients brought urgency as well as practicality into the basic research we were conducting. The basic knowledge gained from research must be translated into new methods of diagnosis, treatment, and surgery for patients. That is the most direct and effective way to improve the life quality of patients. X Preface So far, there is no FDA approved disease modified drugs for OA. Joint replacement surgery remains the last, and perhaps the most effective way to restore the functions of the joint. Due to these circumstances, a multifaceted approach is needed to improve the current treatment as well as to develop new therapy for the future. We need to emphasize the improvement not only diagnosis and treatment of OA, but also the surgery to restore the function of the joint. We need to consider not only mechanistically driven research, but also alternative medicine that has been in practice in treating OA related symptoms in different parts of the world for long time. Based on these guiding principles, we have included a variety of articles written by physicians and OA researchers from different parts of the world. The topics of the articles include general as well as alternative treatment of OA, diagnosis of OA in upper extremity (hand, wrist, shoulder, and elbow) as well as in lower extremity (hip, knee, and ankle), and common strategies for treatment as well as surgery of OA. We hope that this book serves as a comprehensive resource for professionals as well as patients who are interested in learning the state-of-the-art of OA diagnosis, treatment, and surgery. To borrow a Chinese proverb 抛 砖引玉 (cast a brick to attract jade), we hope that this compilation of a variety of articles in this book, some of which are non- traditional or even provocative, may serve as a precursor to the breakthrough in developing new therapy and treatment of OA in the future. Qian Chen, Ph.D. Alpert Medical School of Brown University, Providence, RI, USA Part 1 General Treatment of OA 1 Long-Term Treatment of Osteoarthritis Pain: Achieving a Balance Between Efficacy and Tolerability for a Successful Chronic Therapy Mila Etropolski Johnson & Johnson Pharmaceutical Research & Development, L.L.C. USA 1. Introduction Throughout the world, in both developed and developing countries, arthritis is one of the most common causes of chronic pain (Catala et al., 2002; Elliott et al., 1999; Johannes et al., 2010; Tsang et al., 2008). The National Arthritis Data Workgroup estimates that 46.4 million adults in the United States have been diagnosed with some form of arthritis based on analyses of data from the third National Health and Nutrition Examination Survey (NHANES III; 1991-1994), the 2003 to 2005 National Health Interview Survey, and 2005 US Census Bureau population estimates (Helmick et al., 2008; Lawrence et al., 2008). Within this group, approximately 27 million adults have been diagnosed with osteoarthritis, making it the most common form of arthritis in the United States (Lawrence et al., 2008). The prevalence of osteoarthritis increases with age (Kopec et al., 2007; Lawrence et al., 2008; Sakalauskiene & Jauniskiene, 2010; Shane & Loeser, 2010). Based on data from approximately 4 million patients seen over a 1-year period in British Columbia, Canada, the estimated prevalence of osteoarthritis increases from approximately 7% in patients between 40 and 44 years of age to 26% in patients between 60 and 64 years of age and to 49% in patients between 80 and 84 years of age (Kopec et al., 2007). The prevalence of knee osteoarthritis is particularly high in the elderly, and knee osteoarthritis is a major cause of disability in elderly patients (Shane & Loeser, 2010). Based on data from NHANES III and the Framingham Osteoarthritis Study, the prevalence of knee osteoarthritis in the United States is estimated to be 14% in adults 26 years of age or older, 19% in those 45 years of age or older, 37% in those 60 years of age or older, and 44% in those over 80 years of age (Dillon et al., 2006; Felson et al., 1987; Lawrence et al., 2008). Osteoarthritis can have a negative impact on health-related quality of life and psychological well-being (Axford et al., 2008; Breedveld, 2004; de Bock et al., 1995; Jinks et al., 2007; Majani et al., 2005; Salaffi et al., 2005). Patients with osteoarthritis are often limited in their ability to participate in main daily activities (eg, household duties, employment, body care, ambulation, and sleep) and to maintain their independence (de Bock et al., 1995; Hunter et al., 2008; Jinks et al., 2007; Segal et al., 2004). Patients’ mental health has been shown to decrease progressively over time, and patients with more severe osteoarthritis pain are most likely to experience depression and to have difficulty coping with their disease (Axford et Osteoarthritis – Diagnosis, Treatment and Surgery 4 al., 2008). In addition, patients with osteoarthritis have an increased risk of developing metabolic syndrome and cardiovascular disease (Breedveld, 2004; Puenpatom & Victor, 2009). Osteoarthritis is also associated with a substantial economic cost (Kotlarz et al., 2009; Wagner, 2011; White et al., 2007). According to an analysis of a medical claims database of 32,043 privately insured patients from 1999 to 2004, the average annual direct cost of osteoarthritis was $11,543 per patient, including $8,602 in direct medical costs and $2,941 in drug costs (White et al., 2007). Based on results of the data from the Medical Expenditure Panel Survey, which was conducted over a 10-year period from 1996 to 2005, osteoarthritis was estimated to have increased aggregate annual healthcare expenditures by $185.5 billion per year (in 2007 dollars; Kotlarz et al., 2009). Osteoarthritis can occur in any joint; however, it occurs most frequently in the knees, hips, and hands. Other commonly affected joints include those in the feet and the cervical or lumbar regions of the spine (Martel-Pelletier & Pelletier, 2010). Osteoarthritis is characterized by progressive degeneration of articular cartilage, bone remodeling and sclerosis, formation of osteophytes, synovial hypertrophy, and meniscal damage (Abramson & Attur, 2009; Felson, 2009; Hunter & Felson, 2006). The loss of articular cartilage, which is generally recognized as a defining characteristic of osteoarthritis, results from an imbalance in the dynamic equilibrium between the synthesis and degradation of the cartilaginous extracellular matrix (Abramson & Attur, 2009; Hinton et al., 2002; Michael et al., 2010). In normal articular cartilage, chondrocytes are responsible for the production and maintenance of the cartilaginous extracellular matrix; chondrocytes also act as mechano- and osmo- sensors, altering the rate of matrix synthesis or degradation in response to local physiochemical changes (Loeser, 2008; Martel-Pelletier & Pelletier, 2010; Shane & Loeser, 2010). However, in osteoarthritis, inflammatory and catabolic signals stimulate chondrocytes to synthesize proteolytic enzymes that actively degrade the articular cartilage matrix (Abramson & Attur, 2009; Shane & Loeser, 2010). In response to this increased degradation of cartilage matrix, chondrocytes trigger increased synthesis of the proteoglycan components of the matrix, but these newly synthesized proteoglycans are structurally altered and may have a reduced capacity to form new cartilage (Martel-Pelletier & Pelletier, 2010; Rizkalla et al., 1992). As osteoarthritis progresses, eventually chondrocytes are unable to synthesize enough proteoglycans to offset the degradation of the cartilage matrix. Irreversible matrix degradation and cartilage loss is followed by the development of synovitis, joint incongruence, and formation of subchondral cysts (Martel-Pelletier & Pelletier, 2010; Michael et al., 2010). Although the loss of articular cartilage is considered to be the physiological hallmark of osteoarthritis, the destruction of cartilage is not directly responsible for the joint pain that is considered to be the clinical hallmark of the disease (Felson, 2009). The most likely sources of osteoarthritis pain are the bone, muscle, ligaments, periosteum, and synovium of the affected joints. Bone-related changes associated with osteoarthritis joint pain may include bone marrow lesions, sub-articular bone attrition, periostitis associated with osteophyte formation, subchondral microfractures, and bone angina. Osteoarthritis joint pain has also been linked to synovitis and joint effusions. In cases where osteoarthritis is secondary to joint injury with rupture of the ligaments, the nerves themselves may be a source of pain. Nerve fiber regrowth is typically abnormal and disorganized, comparable to that observed in animal models of nerve injury (Felson, 2009; Hunter et al., 2008).