Orthopedics

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"}

Some doctors have been using a non-surgical treatment for Dupuytren's contracture, a common condition that causes the fingers to get pulled down into the palm of the hand. Traditionally, surgery was the only option for treatment, but more recently some alternatives have emerged.

One of these new treatments is called a needle aponeurotomy.  The needle procedure, often called NA for short, uses the tip of a needle to sever the tight bands of Dupuytren's tissue into multiple segments to restore mobility to fingers.  The study found NA was successful, but many patients had recurrences, especially younger patients.

Related: Dupuytren's Contracture | Needle Aponeurotomy

Sources: "Results of Needle Aponeurotomy for Dupuytren Contracture in Over 1,000 Fingers"

Prevention is a key to fighting symptoms of osteoarthritis--also known as wear-and-tear arthritis.  A new study has found that light exercise is one of the key ingredients to prevention of arthritis symptoms.

This study found that in individuals at risk for developing osteoarthritis, light exercise led to less cartilage destruction as measured by MRI findings.  The conclusion that should be drawn from this study is light exercise activity should be part of efforts to prevent arthritis progression in those at risk for osteoarthritis.

Related: Preventing Arthritis | Safe Exercise Activities

_{Sources: "Association of Exercise, Strength Training, and Knee-bending Activities with Knee Cartilage" RSNA 2010 Annual Meeting}

There have been problems reported with metal-on-metal hip replacements.  These problems are the result of microscopic particles of metal that accumulate around the implant, and can also enter the bloodstream and circulate throughout the body.

Some people have been concerned that perhaps these metallic particles could increase cancer risk in the body.  While there have been problem reported from these metal-on-metal implants, cancer is not one of them.  A recent study found no increased cancer risk from these implants.

Related: Metal-on-Metal Hip Concerns | All About Hip Replacement

Source: "No Added Cancer Risk From Hip Replacement Materials: Study"

People get their knees replaced fro a number of reasons, but they all boil down to the same fundamental issue: they cannot do the activities they want because of pain...

Patients who make the step to get their knees replaced are likely to expect that they can resume these activities without pain.  Why else get the surgery?  But are these expectations met?  We know the answer is: sometimes yes, and sometimes no.  But are surgeons doing enough to give their patients realistic expectations?  Probably not.

A new study found that patients, on average, we not able to do the activities they thought they would be able to do after a knee replacement.  Surgeons probably need to do a better job of helping their patients understand realistic expectations for what they'll be able to do after knee replacement surgery.

Related: Knee Replacement Surgery | Sports After Knee Replacement

_{Sources: Differences Between Actual and Expected Leisure Activities After Total Knee Arthroplasty for Osteoarthritis}

ACL surgery is becoming increasingly common in younger patients.  Decades ago, surgery was delayed as there were concerns about the reconstructive procedure possibly interfering with a child's normal growth.  Rare complications occurred in you patients having ACL surgery when there was early growth plate closure around the knee that had surgery.  This could cause abnormal or lack of growth of that extremity.

Newer techniques have been developed to limit the potential for growth plate complications associated with ACL surgery.  In addition, kids who have ACL tears often re-injure their knee if the ACL treatment is delayed.  A recent study found that kids who had delayed ACL surgery had a higher change of having meniscus tears that were not able to be repaired.

Related: ACL Tears in Kids | Meniscus Tears | ACL Reconstruction

_{Source: "In Children With ACL Injuries, Surgery Delay Can Cause Irreparable Meniscus Tears" Medical News Today, 14 Mar 2012}

_{Photo © ArtmannWitte}

Different types of knee replacement implants have been tested to determine if one is better than the other.  One of the types of implants used is a rotating knee replacement.  This type of implant is designed not only to bend, but also rotate slightly, in hopes it better replicates normal knee joint mechanics.

While replicating knee mechanics makes sense, a recent study found that rotating knee replacements performed no better than standard knee replacement implants.  The good news is, they were not found to be worse, but there does not appear to be a significant advantage to this particular implant.

Related: Knee Replacement Surgery | Knee Replacement Implants

_{Source: "Randomized Clinical Trial of Rotating-Platform and Fixed-Bearing Total Knee Arthroplasty: No Clinically Detectable Differences at Five Years"}