Arthritis Relief and Joint Replacement

Bad Surgeons, Bad Communication, or Just Bad Disease?

2008-05-20T11:18:00.006-04:00

I cannot tell you how many message board and blog posts I have read over the past years concerning treatment that sounds as though it would only be offered in medieval times. I am not sure whether this is because the patients posting do not understand what is offered to them or they simply are going to the wrong doctors. It may also be a case of such bad disease that there may not be a reasonable surgical solution.

Here is the challenge for now:

If you feel you have been a victim of some type of flawed orthopedic surgery or decision-making in your case, post it here. Lay it on. I will then take all these posts, review them with a group of colleagues, and see if we can make heads or tails of them.

Dr. K.

(If you think you will post something to get ammunition for a lawsuit - forget it. We will analyze the posts to give positive, general information for everyone to learn from.)

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Technorati Tags: orthopedic surgery, joint replacement, health and wellness

Advances in Knee Replacement: Partial Knee Replacements

2008-05-09T15:42:00.001-04:00

I recently returned from observing at a course given by a device manufacturer concerning partial knee replacements. The course is given because the FDA mandates that for the company to sell the replacement to a surgeon the surgeon has to take this course. It is a 16-hour course. It does not qualify you to put in the replacement. It does not give you any skill you did not have before. It exists because of FDA rules concerning new products and their safety.

I bring this up because I saw this on a web site of an Orthopaedic Surgeon: "Dr. X is the only surgeon FDA-certified to put in the XXXXX partial knee replacement."

This, of course, is not true. It actually could be an offense punishable by the Office of Professional Medical Conduct because the FDA does not certify surgeons to put in replacements. They can only certify the sale or distribution of the implant.

What certifies a surgeon to put in a partial knee replacement? Last year I personally implanted over 125 partial knee replacements. According to the sales department of the device company whose implants I choose, this puts me at approximately number four in the nation for this particular implant. In fact, the number of partial knee replacements I personally implanted surpassed the combined number of the four largest medical centers in NY. Maybe, maybe not.

As previously noted here in this blog, surgical quality does have a connection to surgical volume. It is not direct and it is not absolute, but there is a connection. Of all the joint replacement procedures that have gained popularity in the last 25 years, a partial knee replacement demands a high level of surgical skill and experience. When I operate at a regional medical center and teach residents (surgeons in training) I commonly inform them that "the hands can only do what the mind knows." In other words, it is what you don't know that can hurt you.

Partial knee replacements have many advantages in the right patient. The recovery is faster and the results, from a patient satisfaction point of view, are consistently better than total knee replacements. It is crtical, though that the surgeon has the experience in doing the surgery. Do not be afraid to ask the following questions:

When did you perform your first partial knee replacement?
How many have you performed in the past month?
Can you show me documentation that the number you said you performed is accurate?
How many have you performed in the last year?
Can you show me documentation that the number you said you performed is accurate?
What is the most common knee procedure that you do?
Can you show me documentation that the number you said you performed is accurate?

Don't be afraid to ask the obvious.

Dr. K.

Related Topics:

Technorati Tags: partial knee replacements, unicompartmental knee replacements, knee resurfacing

He's a Jolly Good Fellow

2007-12-05T06:23:00.000-05:00

On my last blog post I talked a bit about who will do your surgery. This is a very difficult decision for anyone, as even in this country there are no rules or regulations concerning specialty training in many surgical procedures. In Orthopaedic Surgery, for example, just finishing an Orthopaedic Residency allows you to legally (and morally) perform joint replacement surgery. You are trained in it. You should be able to do it. The problem is that over the past twenty years the bar of quality has been raised. It is now a standard in the community for a surgeon to do a fellowship which is an extra year of training in joint replacement.

What does fellowship training mean for you?

It means that your surgeon has spent a FULL YEAR at an established joint replacement center studying the science and surgical art of joint replacement. This is not a six week course, a weekend course, or all the other scam-like terms used by some surgeons to hide from the public their lack of fellowship. It is a level of commitment to the skill that is impressive.

Does this mean a fellowship trained surgeon is a better surgeon?

This can never be said. Evaluation of the quality of a surgeon is in many categories. What is does say is that this particular surgeon committed himself or herself to the field of joint replacement surgery at a higher level. What can definitely be said is that the surgeon who does a fellowship is a better surgeon than he or she would have been if a he or she did not do that fellowship. How much better? WAY BETTER!

How does this help me decide on a surgeon?

It is one of the many parameters you can use. In my last post I wrote of surgical volume and clearly fifty or more procedures a year is a minimum number to go by. Therefore we now have two important parameters to consider:

Does my surgeon perform fifty or more of this procedure a year?
Did the surgeon perform an advanced fellowship in joint replacement?

Keep in mind that these are just two important guidelines. Suffice it to say that if, for example, the surgeon you go to is a sports medicine or hand surgeon it is unlikely that this is the person you would ideally choose to do your replacement.

Ask a lot of questions of your surgeon.

Dr. K.

Related Topics:

Technorati Tags: joint replacement, orthopaedic surgery, arthritis, health and wellness

Who Will Do My Surgery?

2007-06-04T13:38:00.000-04:00

Photo Credit: Gary Minnaert

On the WebMD message board on Joint Replacement there are a number of posts concerning serious problems that have occurred in each individual's surgery. One thread that ties these together is that is appears that the original surgeon that operated on the patient who posted the issue did not, would not, or could not solve the problem. What is this all about?

There are many serious problems in health care. One of the more hidden and dangerous ones is doctors performing surgeries for which they are not properly trained.

In reference to joint replacement, there is a lot of literature concerning the minimal volume of operations that separate surgeons with lower versus higher complications. I know of no US Hospital that requires surgeons to have this volume tie to their privilege to perform this surgery at that hospital.

In a report from Brigham and Women's Hospital (Harvard), for first time (primary) hip replacement, the surgeons who performed more than fifty a year had lower complications.

The same group at Harvard reported on knee replacement volume. Knee replacements done by surgeons who performed more than fifty procedures a year had lower complications an adverse outcomes. Hospitals that performed more than 200 procedures a years had lower complications as compared to hospital that did less than twenty-five procedures.

In another report, patients had higher satisfaction in hip replacement if the surgeon performed more than thirty procedures a year and the hospital performed more than one-hundred.In another report, patients has higher satisfaction in hip replacement if the surgeon performed more than thirty procedures a year and the hospital performed more than one-hundred.

In a report from the VA in Boston, surgeons who performed more than four shoulder replacements a year had lower complications than those who did less than four.

So what can we conclude here?

At the very least, the surgeon you choose should perform a minimum of thirty primary joint replacement procedures a year for you to have an optimal satisfactory result with lower complications. This means:

Thirty total knee replacements
Thirty partial knee replacements (unicompartmental)
Thirty primary total hip replacements

I know I could have gone for the fifty number but we can at least start at the minimum of thirty.

What are you to do? Ask your surgeon. He or she should be able to tell you whether or not they do at least thirty cases. It is not important as to the actual volume. There is no proof that there is a difference in quality between a surgeon who does one hundred or three hundred. In fact, more volume per surgeon after a certain number may beg the question - who is actually performing the surgery (the surgeon, an assistant, a surgeon-in-training)?

You can follow-up the answer with a letter to your surgeon:

Dear Surgeon:

I am pleased to be having surgery with you. As per our discussion you assured me that you perform at least thirty procedures a year of the procedure I am having with you. My decision to have this procedure with you was dependent on this fact. Thank you and I look forward to this procedure.

Signed,

The Patient

What would be the purpose of this letter? It may represent an implied warranty of the accuracy of the information you were given. It will certainly scare the bejesus out of any blatant liars and scoundrels.

Should hospitals should require a minimum of a certain procedure by a surgeon on staff? Absolutely. A reasonable approach is to set the volume standards and give a surgeon a reasonable amount of time to achieve these. This allows new or growing surgeons to reach these volumes. One can say, you need to reach these volumes within three years of you performing the first procedure at this hospital.

Size may not always matter, but it appears that volume does.

Dr. K.

Related Topics:

Technorati Tags: joint replacement, hip, knee, shoulder, surgery, health and wellness

Managing Arthritis Pain

2007-03-05T10:48:00.000-05:00

When to Start and When to Stop

It is interesting that I overheard two clinicians speaking recently and this is generally what I heard:

Clinician 1: I got a call from Doctor X's patient while I was on call and he was away. The patient was 2 months after arthritis surgery and was asking for a refill of pain medications.
Clinician 2: What did you do?
Clinician 1: I don't give pain medication to drug seekers.

OK. Now I am only paraphrasing but this happened somewhat like this. It brings up an interesting point. Doctors are often blamed for being on both sides of the problem. I hear that doctors are blamed for prescribing narcotics too freely and also blamed for holding back pain medications in many situations. What is the truth?

There is no right or wrong answer here. The problem is that pain is an individualized problem and while there are numerous guidelines, many patients break out of those guidelines. Additionally, most physicians are not formally trained enough in the science (and art) of pain management. Considering one of the most common complaints any patient has when walking through a doctors doors is, "I have pain," most medical schools have little to no curriculum on pain management.

In my experience as s surgeon for over 16 years I think that most patients are undertreated for their pain. For, example, I see many junior faculty prescribing Oxycodone 5 mg for postoperative pain which is fairly low dose. In general, the current approach to pain management is referred to as "multimodal." This means a combinations of narcotics, antiinflammatories, acetaminophen, ice, exercise, and possibly alternative methods. Most hospitals, though, do not have well-developed pain management services and even fewer have modern cold treatment or ice therapy machines and continue to have nurses put on ice packs at irregular intervals.

Knowing when to start aggressive pain management after surgery is easy. Knowing when and how to stop is more difficult. In a non-surgical setting in the case of arthritis even knowing when and how to start is a challenge.

What has been your experience in the management of your pain -- good and bad?

Dr. K.

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Technorati Tags: arthritis, pain management, health-and-wellness, medicine

Ten Ways to Manage Back Pain

2007-02-26T12:31:00.000-05:00

I am a joint replacement surgeon. In the operating room, in a given year I perform over 300 procedures related to joints, arthritis, and injury. In my office, half the patients I see have hip and knee arthritis; the rest have every other joint involved. The most difficult for many physicians to manage is back pain. I know that I am not alone in this.

Back pain has many sources. In general, there are so many experts out there concerning back pain that I am now wholly convinced that no one knows what the heck they are talking about in this entire specialty. One day surgery is good, the next it's bad. The alternative medicine people will extol the virtues of acupuncture to nutrition. Sometimes it works and sometimes it does not. There are more pillows and beds and commercial crap you can buy than there is room in the entire state of Rhode Island.

How can a reasonable person try to help themselves with back pain when the medical specialties are in such disagreement?

Here are a few things that may help you:

Be your own best doctor. We often are more discriminating when buying a car than when seeking medical advice. After some period of time, you will know which mix of interventions help more than others. I am often amazed when a patient comes to me and says that they have back pain and have been in physical therapy for 3 years and it does not help. What exactly were they thinking after the first year?

Understand the source of your pain. Some people have back pain from a degenerative condition, like arthritis. The joints in the back of the spine can wear and cause pain. Other sources of pain can be from a sudden injury or muscle strain. Sometimes the pain is due to a nerve being irritated by some disc material in the spine. There are even many valid theories that stress causes back pain. If you try to get a handle on the origin of the pain then this is a good place to start.

See the right doctor. There are many physicians out there -- family medicine, internal medicine, rheumatologist, orthopaedic surgeon, neurosurgeon, chiropractor, and others -- that have a keen interest in back pain. There are may more from each of these specialties that don’t care as much about back pain. Choose a physician who has back pain high on their list of diseases they want to treat.

Do not listen to lawyers. Many patient hurt their back on the job, in a motor vehicle accident, or in a slip and fall. The lawyer you choose may send you to a group of doctors who do every test under the sun and a series of bogus treatments not designed to make you better but to build your legal case. The only time a lawyer refers a case to me is when the first doctor, who was probably in their pocket, messed up the case so much, they actually need a real doctor to bail them out. While it is possible that the doctor your lawyer sends you to is good, ask around; you will probably find otherwise.

Understand that there will probably not be one single treatment method that will work on its own. I have generally seen that combinations of drugs, rest, exercise, physical therapy, chiropractic, acupuncture, and more are needed in many situations. While it is important to try a number of these modalities, set a time limit on each of them. If there is no improvement within the first two months from a specific modality, the chances of it helping in the long run are low.

Choose your physician or other health professional carefully, then listen to their advice. I can't tell how many patients want their back pain to go away but when I recommend something the patient says that they do not want to do that. For example, I may recommend taking ibuprofen. I will then get the response, "I don't take drugs." Then I may recommend epidural steroids and I hear, "I don't want any injection." Then I send the patient to a chiropractor and I hear, "I don't believe in that." The list goes on. In the end, I am not exactly sure why the patient came to me when EVERY treatment I offered was rejected. This does not mean to accept any treatment blindly and without question. On the contrary, be open to any and all suggestions and try to stay away from biases that carry over from rumors and hearsay. Evaluate each piece of advice with an open mind and then make a decision.

Surgery is neither aggressive nor conservative. Surgery has a role in back pain, but not a large role. When properly indicated, surgery will always be a good choice. When not indicated, it is unnecessary and a problem for the patient. Get 2-3 opinions if surgery is recommended.

Don't be afraid to take it easy for some time period. You may not be able to return to 10 mile runs for 6-8 weeks. This is not the end of the world. Respect the pain and the injury. If you do not, your back will tell you.

Try to return to reasonable activities and work as soon as you are cleared to do this. Too many people stay out of the mainstream of work and this causes a culture of not wanting to get better. If your doctor feels it's safe to return to work in some capacity, then you should do so.

Make sure you do all you can to get a real diagnosis. If the doctor was with you for 3 minutes and never laid a hand on you, the diagnosis of back strain is probably wrong. A good history and physical examination is often correct 85-90% of the time. Tests like MRI's should be used to either confirm a diagnosis already known or to distinguish between one or two different diagnoses. Since many people over age 50 have significant findings on their MRI even if these patients do not have back pain, be careful with MRI's not connected to a comprehensive office visit. The finding in the office needs to correlate with any test.

Sometimes back pain goes away as fast as it came on. In some situations it stays longer than you want. Either way, I hope these tips can help you navigate through this problem.

Dr. K.

Related Topics:

Technorati Tags: back pain, arthritis, pain management, medicine, health and wellness

All The President's Horses: The Remarkable Hip Replacement

2007-01-10T10:42:00.000-05:00

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the King's horses and all the King's men,
Couldn't put Humpty together again.

Things have changed. Back in the days of knights, all those horses and men couldn't even put together a simple egg. Recently former President George Walker Bush had his second hip replacement. While he does not plan on falling off a wall, he probably does plan on skydiving. Eat your heart out, Humpty.

What has changed since Humpty's fall and failed surgery to the point where President Bush's hip replacement is expected to be extraordinarily successful?

The Top Ten Reasons Why Bush's Hip Replacement Will Succeed and Humpty Dumpty's Failed

10. Former President Bush probably had health insurance. While over 40 million Americans are uninsured and millions more have insurance but for a variety of reasons little access to appropriate healthcare, that still means that well over 250 million Americans are getting access to healthcare. Former President Bush has Medicare. Therefore he did not have any barriers access to a hip replacement. Humpty Dumpty didn't even have the coverage to get transported to a nearby medical facility. They tried to fix him on the spot. Poor choice.

9. Former President Bush is way healthier than Humpty ever was. Humpty was fat, out of shape- he was shaped like an egg for God's sake! His form of exercise was climbing up a wall and planting his fat butt on top. Bush is a former fighter pilot, takes care of his general health, and exercises on a regular basis.

8. Former President Bush has a supportive family network which helps in the healing process. Humpty was surrounded by a bunch of bad eggs.

7. Former President Bush had an operation that has a history of success. Humpty Dumpty basically had a bunch of horses and men trying to figure this stuff out. Hip replacement is an operation that has a successful multi-decade experience due to the work many dedicated surgeons and engineers, and device manufacturers. In the 1960's, Sir John Charnley from Writhing, England developed the most successful hip replacement of its day. Charnley's principles, based on his own work as well as work of other surgeons in the years prior to him, remain today as the foundation of hip replacement. His design of a plastic liner with a metal stem, fixed to the bone with a special type of cement ushered in the modern era of joint replacement.

6. Today we also have women involved in healthcare. I would suspect that the second stanza of the Humpty Dumpy Poem reads: Later in the day, the men decided not to be such pigs about it, took their horses, picked up some womenfolk (that is what they were called back then) returned and put him back together in no time flat.

5. There were no antibiotics in Humpty Dumpty's day. We sometimes forget that antibiotics were discovered and developed just last century. We don't really know the details of Humpty's surgery on that fateful day. Maybe he was put back together and developed an acute infection and it all fell apart. Today we use antibiotics before and after the surgery for a period of time to prevent infections.

4. Humpty Dumpty had a great fall, remember. Former President Bush had his problem isolated to the hip from arthritis. When injuries happen due to significant trauma, other parts of the body can be the cause of problems. With Humpty it could have been that his yolk ruptured or the egg whites leaked. Former President Bush did not have to worry about any injury to his spleen or liver. The surgeons were able to concentrate solely on his hip.

3. Former President Bush had anesthesia. The field of anesthesia was not in existence in Humpty's day. According to a summary of the history of anesthesia, modern anesthesia with the introduction of ether did not occur until 1946. The advances of anesthesia have been tremendous since that time to allow Former President Bush to have extremely safe anesthesia for the surgery. Also, without anesthesia, Humpty's injury must have really hurt and I am sure he was moving all over the place while the horses and men were trying to put things back together. Because of this, I am sure that not only were they not able to put him back together again. I am sure they were unable to put him back together again and again and again.

2. Former President Bush had his general medical conditions optimized by his primary care physician prior to the surgery. It is important for patients to understand the seriousness of this. Having a strong relationship with your primary care physician and optimizing any and all medical conditions prior to surgery can have significant impact of the success of the surgery. What what I can gather from Humpty's situation he was at a distinct disadvantage having Little Jack Horner, Little Bo Peep, and Jack Sprat on his preoperative medical team.

1. Doctors and teams of health professionals are now involved in the surgery and the care that follows. Don't get me wrong. I like horses but it is tough to tie sutures and hold a scalpel with those hoofs.

We wish Former President George Bush a speedy and healthy recovery.

Dr. K.

Related Topics:

Technorati Tags: George HW Bush, hip replacement

Is Arthritis Inherited?

2006-12-26T09:51:00.000-05:00

When I tell patients they have arthritis they often say that they are not surprised because their mother has it. Or they may say that their father just had a hip replacement, so it was a matter of time before they got it.

Arthritis is not inherited. Sort of.

Since arthritis is not one disease there are probably some arthritis syndromes that are inherited and others that are not.

We need to get an understanding of a few things here:
1. What is the difference between direct inheritance and genetic?
2. How does a genetic predisposition express itself as a disease?
3. If something is genetic then what hope is there of fighting it once you have it?

You inherit your eye color from your parents in a direct way. If both of your parents have blue eyes then you better have blue eyes. If you do not, then introduce yourself to your father the milkman.

Think of this though -- if everything you have that makes you your unique self was a direct result of direct inheritance then you and all your brothers and sisters would look exactly the same. We obviously don't. Ants all look the same -- even to ants. We don't. The reason is that while we each collect 23 chromosomes from each of our parents, adding up to the 46 chromosomes we carry around with us, genes have a unique behavior pattern. Genes, based on a trillion complex factors express themselves differently based on reasons even the smartest amongst us barely understand. It's sort of like when you follow a recipe in a cookbook from a restaurant and the food tastes nothing life the way the chef prepared it in the restaurant. Something gets lost in the sauce.

Therefore, if your parents had a joint replacement your chances of getting one are probably not much different than the guy next to you whose parents did not get a joint replacement.

On the other hand, there most probably is a genetic predisposition to getting arthritis. Whether this is generalized joint pain type of arthritis or actual joint destruction seen on an x-ray, if you get arthritis you were probably predestined to get it in your genes. We just don't know enough about the genetic code to predict this or figure it all out. What is also theoretically sound is that what you throw at your body during the decades before the beginning of your arthritis may do something to turn these genes on or off. Do we know what these things are? No way. These can be any or all of the following: nutrition, trauma, overuse, viruses, stress, other diseases, medications, and more.

One thing we know for sure...all those years of you being an amazing athlete did not destroy your knees unless you had a specific injury. There are too many amazing athletes around that never get arthritis. If you are overweight or obese that will not cause your joints ot wear out. The distribution of joint replacements in a surgeon's practice is not filled with fatter people.

Anyway, you get what you get and then have to deal with it. Our current model of medicine works primarily on dealing with disease when we get it. We have been fairly successful in this regard. Hip and knee replacements are generally just short of remarkable. Shoulder replacements are good. Many anti-rheumatoid medications have benefit and so do antiinflammatories.

In the area of disease prevention we are lost in space. It is not because we don't care or mainstream medicine is hiding truths from the public. It is because we just don't know. A ton of neutraceutical and herbal medicine concoctions are making claims about cartilage growth properties and disease prevention. Who knows?

I know one thing for sure -- they are not correct in their claims. I do not know if they are wrong. There is a big difference here. Because we can't prove a claim is wrong does not make it right. Billions of dollars are spent of glucosamines, bicosamines, tricoamines, and other comical variations of snake oil. The problem is that this stuff is poor ammunition against the genetic pool in action. Eventually, real answers will come with extensive research into gene therapy and understanding the gene pool and how arthritic genes get expressed. In the meantime, count your blessings if you don't have much pain and follow evidence-based advice if you do.

Dr. K.

Related Topics:

Technorati Tags: arthritis, genes, joint replacement, hip replacement, knee replacement, shoulder replacement

What is a knee replacement made of?

2006-10-23T11:43:00.000-04:00

*Excerpt from book "The MD Answer Book...on Arthritis" that I am currently writing.

Joint replacements have been around for approximately 50 years. Modern joint replacements generally were developed in the 1960's and 1970's. Over the years there have been many materials used. Currently this is the state of the art:

Knee replacements have three components to them- the part that covers the femur, the part that cover the tibia, and the part that covers the knee cap. Knee replacements are not really replacements. A knee replacement is really a resurfacing of the ends of the bone. For a good review of knee replacements go to this link.

The actual metal is made of a super metal mixture of cobalt, chromium and nickel. To give you an idea of how strong this is, it would take almost an hour to cut through a quarter of an inch with a diamond cutting wheel. To put this in perspective, another common metal used in joint replacement of the hip - titanium - would be cut in half in less than 30 seconds!

The space between the metal pieces is filled with a special polyethylene (plastic). The better products are made of what is called a cross-linked polyethylene. This gives the plastic superior wear characteristics. A review of one of the more modern plastics can be found here.

The quality of the metal and the plastics has led to increased lifespan of knee replacements. Knee replacements generally fail at a rate of 1% a year. That means in 15 years, close to 85% should still be around. Not bad.
Thanks to tremendous engineering research we have come a long way.

Dr. K.

*The excerpt above is Copyright 2006 by Ira H. Kirschenbaum, MD and used with permission.

Related Topics: Joint Replacement Surgery on the Rise, WebMD Video: Need New Knees? There's better metal in Joint Surgery

Technorati Tags: joint replacement, knee replacement

Recovery from Minimally Invasive Joint Surgery

2006-09-12T08:07:00.000-04:00

It's the same in New York, Chicago, and Tupelo, Mississippi

There has been so much press from all over the country about the speed to recover from surgery. Patient expectations are all over the map.

A former student of mine told me that his mother from New York was thinking of traveling to Chicago because she saw on the news and read on the Internet that there was a doctor there who send people home the same day of surgery after total knee replacement.

I told her to save her airfare. Last I looked, Chicago was not populated from geniuses from the planet Krypton to save mankind but rather had the same number of intelligent and concerned doctors that are present in nearly every community in this country.

So what is the deal here?

First of all, the surgery:

Absolute fact: certain types of techniques related to minimally invasive approaches to knee and hip replacement will give you decreased pain and faster return to function than a traditional method.

Absolute fact: The Orthopaedic community is in complete internal disagreement as to exactly what the term "minimally invasive surgery" means.

Absolute fact: At 6 months the results of minimally invasive and traditional techniques are the same in terms of function BUT the minimally invasive techniques CURRENTLY have higher complications.

Absolute fact: As we learn more about the successes and failures of various minimally invasive techniques, the better and safer ones will emerge and dominate the surgical landscape. Currently there is no agreement as to which is the best.

Absolute fact: If you see a surgeon from anywhere in the country- whether that is Chicago or Ocala, Florida - on the television then one of three things has occurred:

The surgeon's presence was somehow paid for a joint replacement company
The surgeon's hospital has media connections
A publicist set this up

Just in case you haven't noticed - network media is far from balanced or fair in its reporting. This does not mean the story you saw was inaccurate. It just does not necessarily come from a balanced source.

Recovery from any joint surgery is generally dependent upon:

The attitude of the patient
The pain perceived by the patient
The patient's own healing abilities
The healing support provided by the joint surgeon and team- this means proper pain management, home care services, and most importantly education on expectations.
Patient adherence to post-operative guidelines
Patient's own internal definitions of "healed."

In general- you will heal- it is the general path the body always wants to take.

Dr. K.

Related Topics: Patients Rate Knee, Hip Replacement,Joint Camp: Where Boomers Get Knees, Hips Replaced (WebMD Video)

Technorati Tags: knee replacement, hip replacement

Antibiotics After Joint Replacement

2006-08-14T08:50:00.000-04:00

The use of antibiotics after joint surgery can be divided into two time periods:

Around surgery
After surgery at particular times

It has been well known for many years that the use of antibiotics at the time of surgery prevents infections. The exact antibiotic and the length of time after surgery is left up to some discussion but in general, giving what is called a "broad spectrum" antibiotic" at least 15 minutes before the incision followed by at least 3 doses or 24 hours of antibiotics is adequate. Some surgeons use a once a day antibiotic, some use a 3 times a day type of drug and others extend the antibiotics out to 2 days. All are proper.

After the first 48 hours there generally is no need for further antibiotics. If your wound is draining, some surgeons restart antibiotics with the idea that the drainage should be sterilized and an infection may be prevented. There is no real proof that this works or not. It is common practice though. it is not wrong to do it and it is not wrong to not do it.

After joint surgery, a wide range of procedures can happen to patients. This includes colonoscopy, cystoscopy, dental work, etc. Every joint surgeon I know has a list of the procedures that need antibiotics before and after. You must contact your own surgeon for this list as it is always changing. In general- dental cleaning and any dental work is the most dangerous.

General guidelines form the Orthopaedic Academy and the Dental Academy is that you need these antibiotics around certain procedures for up to two years after surgery.

Dr. K.

Related Topics: Need New Knees? There's Better Metal in Joint Surgery (WebMD Video), Arthritis and Knee Surgery: A New Twist

Technorati Tags: joint surgery, antibiotics, post-surgery antibiotics

Hip Resurfacing: BEWARE!

2006-07-24T09:48:00.000-04:00

Only in Research Stages with Known Failures and Unknown Long-Term Success

Hip resurfacing is a surgery getting a lot of press lately. If you do a Google search on the word hip resurfacing, the first sponsored advertisement is from a respected device manufacturer who proceeds to tell you all the "good" things about this operation.

They do not tell you the truth, though. They suspiciously compare the operation to hip replacement using older plastic techniques and cover over any of the serious complication that may loom. They tell you nothing of the range of research or potential negative aspects of the procedure.

This operation could be very dangerous for you. This operation could be very successful for you. Here is the problem: we really just don't know right now. The respected surgeons working on the implant should be applauded in that they are rigorously studying an alternative to hip replacement. The early advertising and "physician locator" features found on some advertisers' websites should be outright condemned.

Here are some of the projected problems associated with "hip resurfacing:"

This information is summarized from a superb review article in "Orthopaedic Clinics of North America." The article was written by a group from Melbourne, Australia. According to the data supplied by this respected journal, none of the authors were either investigators of the implant, reserved royalties for the development, or had any financial interest in the outcome of hip resurfacing.

There were serious problems with the older designs of hip resurfacing which has prompted this development of a new generation of hip resurfacing (the one in the above mentioned advertisement is an example of this new generation).
There are NO LONG TERM results available on this new generation of hip resurfacing.
The more of these hip resurfacing procedures that are being put in, especially by non-developers, the more the complications appear.
Fracture of the femur (the top of the hip bone) is a real and serious complication.
The fracture rate is 1-2 people every one hundred cases. That is high.
The ideal candidate to receive a hip resurfacing at all is unknown by any real data and is conjecture at best.
The metal-on-metal surface of hip resurfacing produces circulating metal in the bloodstream. These are cobalt and chromium levels. It is yet to be known what the negative effects of these circulating metals are. [My Note: given the choice of metal circulating through my liver, kidneys, lungs, and brain or not- I choose NOT]
The problem with metal ions can be removed if ceramic surfaces were used [My Note: Like in successful ceramic bearing in total hip replacement!]
There is a need for INDEPENDENT research to allow better guidance on this procedure.

That pretty much sums it up. When choosing hip replacement procedures, ask your surgeon real and serious questions.

In 2006 through 2007 the data supports a cementlesss titanium hip replacement of a ceramic head and modern cross-linked plastic cup, a ceramic head and a ceramic cup, or a metal head and a modern cross-linked plastic cup.

When hip resurfacing is compared for 10 years against all three of those models then it should be considered. It is not an operation for the general public now.

Dr. K.

Related Topics: WebMD Video: Joint Camp: Where Boomers Go , Is Less-Invasive Hip Replacement Best for You?

Technorati Tags: hip resurfacing, arthritis, hip replacement, Arthritis Center

Basic Knee Anatomy

2006-07-12T10:57:00.000-04:00

On the WebMD message board the following post caught my eye:

"I have been hearing a scraping sound in my right knee every time I sit down or climb or go down stairs.... A couple years ago, I had alot of pain in that knee and had special x-rays done, and was told the meniscus was starting to wear down."

Here are a few anatomical tid-bits:

The knee joint is made up of 2 bones that ALWAYS touch each other: the femur (thigh bone) and the tibia (leg bone). The femur and tibia both have their ends covered with a 3/8" of cushion called cartilage. Cartilage is part of the femur and tibia so technically since the cartilage surface always rub against each other then the femur bone and the tibia bone technically rub against each other.

If this surface cartilage rubs away then the bone ends rub against each other. This sometimes causes pain, but not all the time.

The knee is unique in that there is a second type of cartilage that is there (just when you thought you knew it all...) This cartilage is called the meniscus cartilage. I tell my patients that it is called the "meniscus" cartilage. I do not call it a pancake cartilage as I have heard other refer to it because I cannot eat it and it tastes like crap with maple syrup. Also it does not look like a pancake, it looks like the letter C.

The meniscus cartilage sits on top of the tibia and is actually attached to the tibia. YOU DO NOT WALK ON THE MENISCUS CARTILAGE. There is a meniscus cartilage on the inside of your knee (the medial meniscus) and another on the outside (the lateral meniscus). Looking down on the tibia, one meniscus looks like a C and the other looks like a reverse C. When they come together they may an oval and effectively appears like a ring.

The meniscus cartilage therefore is more like a ring around the knee. It can be likened to a rubber gasket on a faucet. When you are sitting or standing with your knee straight the meniscus cartilages are hanging out around the edges of the ring, minding their own business. As you either bend your knee or twist it while walking the meniscus cartilages (the ring) engages and acts as a secondary support - just as you would expect from a ring support.

Sometime that meniscus ring can tear, just like a gasket on a faucet can tear. Since meniscus cartilage has NO NERVE ENDINGS it should not be painful. The problem is that when a meniscus tears in the center while there are no nerve endings there are many nerve endings at its attachment.

Think of it like a skin tag or earring. If you have a skin tag and look at it, it does not hurt. If you pull on it, ouch! Same with an earring. It looks nice, but pull on it -- WOW!. Based on this, the meniscus tears with a little tag of cartilage and when you walk or twist the tags gets caught between the femur and the tibia and pulls on the attachment. This causes pain and swelling.

This is why arthroscopic surgery is so successful for a meniscus tear. We have learned over the years that we only need to remove the torn "tag" part of the meniscus and we can leave the rest behind. This removes the pain almost immediately. More importantly, the more meniscus you can keep behind the less chance you have in developing arthritis at a later age. Removal of the entire meniscus leads to arthritis of that part of the joint eventually.

If you are interested in some excellent drawings about what I just explained you can go to www.walkandmove.com and click on the patient education section. This will take you to medical material produced by an excellent education company (Medical Multimedia Group). The material is called eOrthopod. You can easily access any of the material on my site for free.

Dr. K.

Related Topics: Is Chronic Knee Pain Limiting Your Life?, Common Knee Injury Strikes Women More than Men

Technorati Tags: meniscus, arthroscopic surgery, knee injury

Get Stroking Tiger

2006-07-06T10:35:00.000-04:00

Return to Golf After Total Knee

A common question, expecially in Westchester County, NY, where there are more golf courses than there are Emergency Room beds, is when can a patient return to golf after a knee replacement. It really depends on a few things:

What type of knee replacement you received- Partial (uni) or total
Your response to healing
Your definition of a return to golf

As a serious, national proponent of partial, minimally invasive knee replacements (www.walkandmove.com) return to activity is a most persuasive argument for only replacing the part of the knee that is diseased.

A partial knee replacement allows you to maintain the important knee ligaments which are totally removed in a total knee replacement. Aside from a remarkably rapid return to function, the level of function in a partial knee is superior.

The function of total knee replacement is OK- like a Toyota Corolla. The function of a partial knee is superior- like a Lexus. That an analogy I use for my patients. Surgeons who generally do not recommend partial do that because they do not have the skill or experience to implant a partial. You need to see someone who performs both- REGULARLY.

Patients do heal at different rates. In reviewing my long term results of a consecutive series of over 225 partial knee replacements I performed (50 of the patients had bilateral partial knee replacements), I found that by 3 weeks, a high percentage were able to drive a car- not a 3 wood- this took close to 6 weeks. Total knee replacements took almost 3 -6 months.

If you define returning to golf as doing 9 holes, with a cart, non-competitive- you can return early- (3 weeks). If you are looking to be club champion- look to 4-6 months.

Dr. K.

Related Topics: Is Knee Pain Limiting Your Life?, (WebMD Video) Joint Camp: Where Boomers Get Knees, Hips Replaced

Technorati Tags: golf, knee replacement

Supplements: Does the Truth Really Matter?

2006-04-27T08:26:00.000-04:00

Apparently Not!

Today - a brief blog entry. This is because a fact is a fact. Here are two facts.

1. All the glucosamine, chondroitin sulfate, MSM, joint pills, etc that you are taking are helping only one person- the person who owns the company that sells you this nonsense. Stop it now. Maybe one day, solid research will lead us to solutions in this important area of neutraceuticals but this is not that day.

I am sure that herbal medicine and nutrition is an untapped resource of tremendous help to all arthritis sufferers but what is on the market - all of it - is a waste of your money and a waste of shelf space on pharmacy stores. Just don't buy it. Just don't use it. Demand that good research is performed.

2. The joint viscosupplementation injections- hyaluronic acid which is marketed under multiple names (Synvisc, Hyalgan, Orthovisc, Euflexxa) does help some patients but not as many as whoever is injecting you is probably claiming.

If your arthritis is bone-on-bone then the injections are totally worthless. Some doctors effectively run "injection clinics". They should be shut down. Some give it and within 6 months do a knee replacement - this is a money making scam.

Don't get me wrong - there are clear "responders" to this treatment. There is extraordinarily important work in this area. Again - we are not at the day where the "joint grease" solution is anything close to a solution. In early arthritis there is probably a role. The real studies (ones not supported by industry) are sketchy on this. Just be careful about the doctors who inject people in a line that looks like new marine recruits getting their hair cut.

...more later

Dr. K.
BTW- I expect there may be just a few comments here- bring 'em on.

Related Topics: Exercise Good for Early Knee Osteoarthritis, Manage Your Osteoarthritis

Pain After Knee Replacement

2006-04-17T12:02:00.000-04:00

From The Message Board

Knee Replacement

I'm going march 30th to get my left knee replaced, can any one tell me what to expect ((((pain wise))))

Pain After Knee Replacement

No one can really predict from what patient to the next what to expect concerning pain. It is sort of like dental work. For me, dental work is so painful I feel I need general anesthesia for a teeth cleaning, other people can have their teeth drill from here to China and swer to me that they have no pain.

The topic of pain relief after any form of knee surgery, whether is it a total knee replacement of a partial knee resurfacing or partial knee replacement has three components to it:

The extent of the surgery
The perception of the patient
The methods used by the surgeon to control your pain

The Extent of the Surgery

In the first 2-3 weeks after surgery, there is no question that some form of minimally invasive surgery is less painful. This probably has more to do with the length of the incision plus the actual type of procedure performed.

While it is now well known that the results of standard vs. minimally invasive surgery are exactly the same 3 months after the surgery the early going is clearly better in minimally invasive procedures. There can be a trade-off though. Many minimally invasive hip replacement procedures like the heavily advertised 2-incision approach by Zimmer have a significantly higher complication rate than single incision MIS approaches advocated by most respected joint surgeons.

The complications seen in the increasingly less popular 2-incision approach has been dislocations, failure to put the component in properly and joint stiffness. This approach should simply be abandoned.

In knee replacement I like to look at the minimally invasive approaches in two categories. The first is limited incision total knee replacements. This is, in reality, not a true minimally invasive procedure. The reason is that in the end you are left with a total knee replacement- a lot of metal. Nothing very minimally invasive about putting heavy metal in the joint. If you need a total knee replacement - fine. Then using a limited incision or a more minimally invasive approach offers some pain relief and short-term rehabilitation advantages.

A true minimally invasive knee replacement is a partial knee resurfacing which is more commonly called a partial knee replacement or a unicompartmental knee replacement. This is true MIS knee surgery in that the ligaments of the knee are left completely intact vs. a total knee replacement where these important ligaments are hacked out (or surgically removed- semantics...)

While in my practice over 65% of knee replacement patient turn out to be xcellent and appropriate candidates for partial knee resurfacing that is not the case across the country. The decision to offer a patient this tuely less painful and higher functioning surgery is often dependent upon surgeon training and philosophy. For example, just south of me at a little known island called Manhattan, very few MIS resurfacing procedures are performed. On the other hand, if you were to be seen in the Washington, DC area, Boston, Bufallo, or Tampa you will be more appropriately given the option for this procedure.

The reason is this: One is the old adage- "When your only tool is a hammer, everything looks like a nail."

If a surgeon only performs total knee replacements, which is a salvage type procedure, then of course, that is the only procedure that surgeon would recommend. I have had many patient over the years who saw me for MIS, less painful knee resurfacing, and saw a second or third opinion with either a surgeon across the county from me or a surgeon in Manhattan. The patient has invariably called me and said, Sr. X said a knee resurfacing is not the right procedure. I asked the patient to return to that surgeon and ask him or her how many knee resurfacing they performed in their lives. I always know the answer so when the patient calls me back and says that the surgeon they went to never performed a partial knee resurfacing then it is clear that a reasnble infomermed choice was not given to the patient. As I perform total and partial knee resurfacing, as I believe all surgeons should have in their armamentarium, then the patient gets a balanced opinion.

Partial knee resurfacing is probably 10 times less painful, 6 times faster rehabilitation, and has a remarkably lower complication rate and higher level of function.

Based on this, you can see how the actual surgery chosen contributes to your pain after knee replacement.

NEXT POSTING:
The use of Multiple Methods of Pain Control to Achieve Success...

Dr. K.

Related Topics: Why Your Hips Are A Pain in the Butt, Is Less-Invasive Hip Replacement For You?

Technorati Tags: partial knee replacement, unicompartmental, knee pain

Knee Replacements and Marathon Runners

2006-03-02T15:44:00.000-05:00

Marathon Man is a seasoned marathon runner who asks:

My right knee medial meniscus is gone. I'm bone to bone. I've run many marathons and am a veteran Boston marathoner. What can I do to get running again?

To quote Baretta, the great TV philosopher, "Don't do the crime if you can't pay the time."

Patients who feel they should run marathons after joint replacement surgery and told that they can't seem to feel that medical science has let them down because their pain has been eradicated, they can walk again but due to the mechanical limitations of metal and plastic based on years of testing they are getting advice to not run 26+ miles because it will destroy the plastic.

To the person who asked this question in the first place- Here are the facts - it will wear out very early if you run or even train for a marathon. It will also fail to function well if you jump off the Empire State building. Also, if you play rugby with the New Zealand National Team you will also destroy it.

It is actually the price we sometimes have to pay to be responsible to our bodies. Try cross training with weight lifting, cycling, tennis, golf, and numerous other things.

Maybe include an intensive work-out program reading Russian novels. They have the longevity of marathons, will give your mind the important exercise it needs, and I can guarantee minimal wear of the metal and plastic of your knee replacement.

Also, the chicks seems to love it when you quote from Anna Karenina.

Dr. K

Related Topics: How Weekend Athletes Get Olympic Edge,Knee Pain Management

Technorati Tags: marathon, kneeinjury, kneereplacement

Knee Replacements and Mental Status Changes

2006-03-02T03:45:00.000-05:00

To the family of the father 2 weeks after knee replacement with mental status changes.

This is of real concern at times. Sometimes it is also a common (note I did not say "normal") response to major surgery in the elderly. Of the serious things that can happen- your father could have had a small stroke, a brief time of oxygen loss in the operating room, or may have a self-limited chemical imbalance- sodium levels, potassium levels, for example. The medical doctor should check out all of these "organic" causes of a mental status change.

In general the term "allergic to Morphine" is one I don't care for. Morphine is a kickass pain medicine with powerful side effects of nausea, dizziness, and changes in mental status. The street form of Morphine is heroin. The addicts don't take it to get them in touch with reality - but rather to remove themselves. In the same way, a common response to morphine, especially in the elderly, is confusion and mental status changes. Reversal of the morphine with a drug called naloxone would make the diagnosis immediately. If will also give your father a return of the pain, immediately. A small short-term price to pay to make an important diagnosis.

Assuming no organic cause, these mental status changes whether from the morphine or what is often called "sundowning" (the unexplained weird behavior of the elderly at night), will drift away.

Dr. K.

Related Topics: Newly Diagnosed with Osteoarthritis, How Osteoarthritis Affects Your Knee

Technorati Tags: kneereplacement, elderly, confusion, medicationreaction

Knee Replacements and Sex

2006-02-24T15:42:00.000-05:00

Question from the Message Board: Which positions are best during sexual intercourse so i dont strain my new knee implant?

Now let's look at the question of sexual positions after knee surgery. While there are a number of decent booklets out there with terribly non-erotic cartoons of patients in various "safe" positions, the definitive work on the subject has not been done. If anyone knows the adult film star Jenna Jamison have her call me and maybe we can put something together, like a DVD or Web Stream. All in the name of science, of course.

Here is what I can recommend from the experience of my patients who actually broached the topic with me.

In the realm of conventional positions, BEFORE having sex, give serious thoughts as to the types of positions and the speed of transition between these positions. Actually practice these alone (you do not have to bring yourself flowers prior this this).

It will be tough to do a figure skating triple lutz in bed with your partner if you haven't practiced it. I really am serious. Get into bed and without your partner there see the limitations of body positions before there is some pain during the actual sex.

In knee replacements, you will get into trouble if your knee is suddenly forced to bend or your partner (or partners- I make no assumptions here) sit directly on an extended knee - OUCH).

If there are specific positions you need explanations maybe I will include it in the DVD/Web Stream (note that this went from an idea to actual pre-production status in a few sentences).

Dr. K.

Related Topics: The Golden Age of Sex, When to Opt For Minimally Invasive Surgery

Technorati Tags: kneereplacement, surgicalrecovery

Knee Replacement: Stiffness and Pain

2006-02-24T12:41:00.000-05:00

Specific Q&A

One question had to do with continued stiffness after a routine total knee replacement done approximately 8 months ago.

Let's look at some of the questions about stiffness and lack of function. Eight months after a knee replacement, it can be common to have varying degrees of stiffness especially after a long day of activity. You can also expect some persistent pain/discomfort. Why is this? One of the reasons is the we need to distinguish between stiffness or pain coming from a real problem or the natural course of your unique knee replacement.

What are some of the real problems that can cause knee stiffness or persistent pain?
1. Early infection
2. A surgical error in technical aspects (not as common as you may think)
3. A fracture of the patella or tibia

What are some "natural course" issues?

Each patient perceives pain differently. One person's floor is another's ceiling. Pain to you may be mild- the same pain to another is perceived as severe. Think of the analogy of dental work. Some people have it with no local anesthesia- I for one feel I need general anesthesia just for a cleaning. So I am a wimp when it comes to dental pain. Sue me. Oops, on second thought don't sue anyone.

Your disease prior to surgery was so severe that the results actually are a bit worse after knee replacement in these patients. We know that motion after surgery is correlated to your motion before surgery. Also, if your ligaments prior to surgery were so stretched out then it will probably be loose after surgery. A surgeon can't make gold from lead.

My advice to the persistently painful and or stiff - make sure there is no mechanical or real disease cause for the problem with evaluations, second opinions, and objective testing. If it is all negative, schedule an extended appointment with your surgeon to discuss your feelings (wow - what an amazing concept) about where you are and where you expect to be.

Related Topics: How Bad Is Your Knee Pain?, Arthritis Supplements in Question

Knee Replacement 101

2006-02-23T15:35:00.000-05:00

Let's talk about knee replacements - partial and total.

This is a major operation. I don't care how many are done in the US, I don't care what the results that your Aunt Mildred had, and I don't care that someone told you something on some idle Tuesday while you were waiting for an elevator - THIS IS MAJOR SURGERY. A scalpel cuts into your body. The knee is essentially cut out with a high speed saw. Metal and plastic are inserted into a previously elegantly constructed body space. Then the surgery is over and people expect to run marathons, bungee cord jump, or dance in Havana in X amount of time.

Here is the 411 on knee replacement surgery. There are many factors that affect your outcome of the surgery. What do I mean by "outcome?" I mean everything - your time to heal the wound, how much motion you receive and how fast, stiffness after 2 weeks to 2 decades, the kind of sports and activities you can return to, and everything else.

I would like you to look at a knee replacement as the absolute custom fitting of anything you will ever have in your life. The work and elegance in this brutal experience makes the most beautiful custom dress that any Hollywood star wears at the Oscars look like an off the shelf schmatta (definition: rag) from the thrift store.

Your surgery is unique, your x-rays are unique, and your experience is unique.

Fortunately, though, looking at large numbers of patients we can see trends and statistically give you good ideas on what to expect - what the milestones are and where many people can be at a certain times.

Dr. K.

Oh, one more thing- cement vs. cementless- does not matter in joint replacement. There is more information on that issue but surgeons argue this all the time. There are real arguments on both sides.

Related Topics: Common Knee Injury Linked to Knee Arthritis, Arthritis: Therapy in Motion

Technorati Tags: knee, surgery, jointreplacement

Blogs and Boards

2006-02-23T13:14:00.000-05:00

The New Frontier for Us All

On the Joint Replacement Message Board, there are many wonderful questions. There are also ridiculously stupid questions. Yes there is such a thing as a stupid question. When you ask it the following way "This may be a stupid question but..." and the doctor says "Don't worry, there is no such thing as a stupid question.", the doctor is really probably saying, of course it is stupid but I have heard this same stupid question for years so go ahead.

If you disagree, try this stupid question:

When I bungee-cord jumped 450 feet with the cords strapped to my ankles my total hip replacements popped out. Can I sue the doctor for not putting it in right?

Stupid question.

Consistently, of course, all the questions on the board have important issues raised, some more elegantly than others, but all right on target. In the 3 years of moderating the board there have been people who come and go, and questions tend to repeat.

Repeating questions are good and bad. They are good because medicine is an ever-evolving field (medicine was not designed intelligently - the knowledge base evolves) and the answer to a question 2 years ago may be different now. The bad part is that it sometimes gets a bit wearying to answer the same questions on a message board. I have realized that many of the answers are not catalogued so who can blame the repeaters.

In answer to this and the humorous slurs on my recent absence for some time on the Board (you guys have been nice- I have thicker skin than that), I am instituting this new experiment (not FDA approved by the way). I will summarize all the questions and try to put together a unified Blog post that answers what I think was asked and what I think could have been asked.

Try the following:

Read this Blog and my other Blog Mad About Medicine for two reasons:

Your answers may be embedded
I want you to

Add comments to the Blog instead of back to the message board if you think the public at large is interested in your answer.

Add comments to the message board if you think the answer pertains to the specific person who asked the question only.

Let's see how this works.

Dr. K.

Technorati Tags: blogs, community, messageboards

Surgery a Second Time

2006-02-06T00:52:00.000-05:00

The Problems with Revision Surgery

Not all surgery goes well. That is a fact. Some operations fail. Sometimes we know why and sometimes we do not. When we do not patients sometimes think information is being hidden from them. I assume this does occur. But sometimes we just don't know why.

I perform a large amount of revision joint replacement surgery. Like most joint replacement specialists I actually do not revise many of my own. A joint surgeon's failure rate is generally quite low. I do a lot of revisions because I was trained in specifically doing them and many surgeons choose not to take these complex cases on. I am now well into my second decade of revision joint replacement surgery here are some pieces of advice I can share from experience.

If you are having a problem with a joint replacement it is extremely important to know exactly why. In other words- what is the cause of the failure? Is it infection? Is there a fracture? Did the metal crack? Did the plastic wear? Making a diagnosis is the most important step. This may include a series of many tests. Do them. Get a diagnosis.

What are your options? This is the next is to understand all the options- surgical and non-surgical. While I rarely recommend non-surgical treatment for a joint replacement failure, there have been occasion for this. A good example is a failure of a hip replacement in a bed-ridden patient. Another example is a patient with a severe medical history that will put them at grave danger in any operating room.

Who will do your surgery? Revision joint replacement surgery is not for the untrained, uninitiated, or general Orthopaedic Surgeon. There are a range of skills, techniques, and tools that are the domain of the specialist in this.

What result can you expect? In general, here is the bad news. Everything is worse after a revision. There is a higher infection rate, a higher limp rate, a higher limb length discrepancy rate, and so one. This does not mean that you will not get an extremely satisfying revision joint, it just means your risk of a worse result are higher.

I hope this helps some of the questions posted on my Arthritis message board with regard to this topic.

Dr. K.

Related Topics: Illnesses Hamper Joint Replacement Recovery, Is Less Invasive Hip Replacement Surgery Best For You?

Another interesting arthritis blog

Brief Note...

2006-01-31T22:58:00.000-05:00

A patient came into the office today with severe arthritis of both knees. After some discussion, we both decided that she was not a candidate for surgery despite not being fully controlled with medications. Arthritis pain is a very frustrating symptom to treat. In this I envy my colleagues in Cardiology and Primary Care. If someone has high blood pressure, they rarely even know it. You tell them they have it. The patient believes you. You give them a diet and a pill and the pressure gets to normal. You are a hero. The medical treatment of joint pain is painfully incomplete.

Dr. K.

Related Topics: Stem Cells May Mend Arthritis Damage, Is Chronic Knee Pain Limiting Your Life?

Technorati Tags: arthritis, kneepain