A new study has looked at the rate of complications after joint replacement surgery when comparing low-volume to higher-volume hospitals. Specifically, the study investigated the rate of blood clots (DVT) after joint replacement surgery. The research found that the rate of blood clots was higher in hospitals that did a higher volume of joint replacement surgery.

This study was valuable in demonstrating a different in the potential for complications at different size hospitals. However, the study considers a high-volume hospital one that does more than 200 hip and knee replacements each year, and many small hospitals do more than 200 joint replacements per year. There is a lot that goes into preventing blood clots, and you should discuss with your doctor the measures your hospital takes to prevent this complication of joint replacement surgery.

Source: "Hospital volume and surgical outcomes after elective hip/ knee arthroplasty."

Image © Medical Mulitmedia Group

Knee replacements sometimes make noises...and most often patients were not expecting this! Therefore, many people who have had a knee replacement surgery are concerned when they start hearing noises coming from their new knee.

Are noisy knee replacements a problem? Is this a sign that something is wrong with the knee replacement? When does a noisy knee replacement need to be seen by your doctor? Learn what to think when you hear noise coming from your knee replacement.

Related: Knee Replacement Surgery | Squeaking Hip Replacements

Image © Medical Mulitmedia Group

Knee replacement surgery was once reserved for people with the most severe arthritic knees.  Only when the joint had deteriorated to a point where there were no options did surgeons offer knee replacement.

Things have changed.  Recent studies confirm several trends:

• More young patients are having knee replacements
• People with moderate arthritis are choosing to have replacement surgery

While it is good that knee replacement surgery and the implants used for replacement are getting better and lasting longer, the surgery is not without risks.  Furthermore, young patients are more likely to wear out knee replacements.  Patients with less severe arthritis are more likely to have pain and functional limitations after knee replacement.  Are surgeons doing knee replacement on too many people?  Leave your comments below...

Related: Knee Replacement Surgery | Knee Replacement in Young Patients | When is the Time Right?

_{Source: "Extent of Tibiofemoral Osteoarthritis Before Knee Arthroplasty"}

Injections are a common treatment for tendon problems.  Different types of injections including cortisone and PRP injections are commonly used to treat tendon conditions.  Cortisone is a powerful anti-inflammatory medication often used to treated acute inflammation (tendonitis) or chronic tendon problems (tendinosis).  PRP is a recent development that uses your own cells to stimulate healing in areas of chronic tendon damage.

A recent study from The Lancet, one of the leading medical journals, has tried to compile data from many other studies to determine the best use of injections for tendon problems. While the findings varied, there were a few take home points.  Of note, this type of study is called a meta-analysis, and attempts to combine the data from many studies to make the results more meaningful.  The researchers found:

For the treatment of tennis elbow, injections of cortisone helped in the short-term, but led to a worse long-term prognosis.

PRP was no more effective than placebo for treatment of Achilles tendinosis.

The effect of cortisone injection on the treatment of rotator cuff tendonitis is unclear, but it is probably not harmful.

These were several of the take-home points of the article.  I think cortisone is a useful treatment in cases of acute inflammation.  However, many tendon problems represent a chronic tendinosis, not acute inflammation, and therefore cortisone injections are likely prescribed too often.  Furthermore, short-term relief should be balanced with long-term goals--cortisone injections may not always be the best for long-term relief.  Lastly, PRP has yet to show any consistent effects of curing chronic tendon problems.

_{Sources: "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials"}