ORTHO NEWS

From Hip surgery to skiing and competitive Triathlon

Clare Roche started participating in Triathlons five years ago, but feared she may have to stop training when sudden pain on a regular run heralded the start of a hip problem.

Clare, who is in her 60s and lives near Wadhurst, has enjoyed a variety of sports from childhood. More recently she started to compete in Triathlons and has represented Great Britain in international competitions in her age group. One day whilst on a usual run, she developed severe pain and was unable to weight bear on her right leg. After hobbling home, things deteriorated quickly. She was unable to walk comfortably for any length of time and the night pain that radiated down the leg into the shin and ankle made sleeping difficult. Having to cancel her plans for a walking trip to the Himalayas, Clare made an appointment with her GP.

As a physiotherapist with over 40 years of experience in the Wadhurst area, she already knew that the problem was related to her hip. X-rays showed she had no articular cartilage left in the joint, and as a physiotherapist, she knew the only option was a hip replacement. Apart from her competitive sports she has a very busy family life with three children and an increasing number of grandchildren. Clare wanted to get back to training as soon as possible. She was keen to proceed quickly to prevent her muscle strength from deteriorating too dramatically. and decided to go privately.

She had witnessed great results in patients and friends following hip surgery performed by Mr Senthil Velayudham, Orthopaedic Hip Surgeon at Nuffield Health, Tunbridge Wells.

Following consultation with Mr Velayudham, he suggested a minimally invasive total hip replacement with ceramic on ceramic bearing surfaces was the way forward and her surgery was scheduled. A ‘total replacement’ means both parts of the joint are replaced – the ball and the socket.

The operation went well with no complications. For the first ten days Clare used crutches, after which she walked with a stick. At two to three weeks post-surgery she swam regularly and used an exercise bike. Within three-four weeks she walked unaided and could do about an hour of continuous walking. She was religious with her exercises, at home and in the gym, which helped her regain muscle strength; she is still doing them almost 18 months later. At around fourteen weeks after the operation, she began running and walking began, including short intervals of alternate slow jogging combined with brisk walking. Over the following weeks and months these exercises increased in duration and intensity. Four months after the operation, Clare went skiing with no problems. Seven months after her operation she was competing in a triathlon competition and nine months after came second in her first half ironman triathlon.

Prior to her operation Clare had gained a place to compete at the Triathlon World Championships in Lausanne at the beginning of September. She was worried she wouldn’t be fit enough to compete but at the end of August was on the starting line, less than a year following surgery.

In between competitions Clare enjoys her grandchildren, hiking, bird watching and conservation all of which are only possible with the pain free mobility that her new joint brings.

Mr Velayudham said: “Minimally invasive total hip replacement is a highly successful procedure helping patients return to good active lifestyle. Understanding patients’ expectation is very important. Using appropriate prostheses, restoring hip anatomy, preserving all the muscles controlling the hip and good rehabilitation helps patients to enjoy long good outcome following hip replacement.”

Claire added: “Having a surgeon who is not only technically excellent but someone who is empathetic to your situation and provides first-rate pre and post op oversight is crucial; Mr Velayudham more than fulfilled these criteria – as I knew he would having seen several of his patients over the years. Also impressive was the care I received at the Nuffield at all levels, from porters to senior medical staff. One hears horrible stories of waiting ages for a nurse when you really need them. That was not my experience; everyone was attentive and professional yet caring. The food was something special too.

“My advice to anyone who wants to get the most out of their joint replacement is firstly don’t leave it too long before having the operation, secondly try to choose a great surgeon like Mr V, and finally be serious and committed about exercises and general fitness both before your operation and for at least 12 month afterwards. We can all do more than we think we can!”

Originally Appeared Here

Biologics Reduce Total Joint Replacements in Rheumatoid Arthritis Patients

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VANCOUVER, BC, Aug. 10, 2021 /CNW/ – New research has revealed a significant reduction in the need for total hip and knee replacement surgery among rheumatoid arthritis patients after the introduction of biologics.

“These findings reflect a marked improvement in overall rheumatoid arthritis treatment since the introduction of biologics in the early 2000s,” said Hui Xie, a scientist at Arthritis Research Canada.

Researchers identified 60,227 rheumatoid arthritis and 288,260 osteoarthritis cases. For individuals diagnosed before the introduction of biologics, the 8-year incidence rates of total joint replacement surgery increased over time for both types of arthritis. For people diagnosed after biologics became available, these rates decreased over time in rheumatoid arthritis but continued to increase for osteoarthritis.

“We found a 26.9 per cent and 12.6 per cent reduction in total hip and knee replacements for patients with rheumatoid arthritis diagnosed five years after the introduction of biologics, in stark contrast with 11.7 per cent and 16.6 per cent increases for those procedures in osteoarthritis over the same time period,” said Vivienne Zhou, the first author of the paper and an MSc student trainee at Arthritis Research Canada.

Osteoarthritis is another condition for which total joint replacements are often required, and for which biologics are not used. This made osteoarthritis an ideal comparator group that had not been used in previous studies.

Rheumatoid arthritis, the most common type of inflammatory arthritis, affects approximately 1.2 per cent of Canadians aged 16 years and older. Uncontrolled inflammation causes irreversible joint damage which sometimes requires total joint replacement surgery.

Total joint replacements are effective at reducing pain and improving function, but they are expensive and complications can occur. Sometimes revision surgeries are also needed.

From 2019 to 2020, 63,496 hip replacements and 75,073 knee replacements were performed in Canada, costing more than $1.4 billion, according to the Canadian Institute for Health Information.

Biologics, such as tumor necrosis factor alpha inhibitors (TNF-α), are very effective at suppressing inflammation and can halt the progression of rheumatoid arthritis and prevent joint damage.

Prior to this study, there was conflicting evidence as to whether or not biologics reduced the need for total joint replacement surgery in rheumatoid arthritis patients. This study uses large population-based cohorts of incident rheumatoid arthritis and osteoarthritis patients to document and compare the patterns of total joint replacement surgery over a 20-year period.

ABOUT ARTHRITIS RESEARCH CANADA:

Arthritis Research Canada is the largest clinical arthritis research institution in North America. Our mission is to transform the lives of people living with arthritis through research and engagement. Arthritis Research Canada’s scientific director, Dr. Diane Lacaille is leading a team of over 100 researchers, trainees and staff whose world recognized research is creating a future where people living with arthritis are empowered to triumph over pain and disability. Arthritis Research Canada is conducting research across Canada in British Columbia, Alberta and Quebec and is affiliated with five major universities: University of British Columbia, Simon Fraser University, University of Calgary, Université Laval, and McGill University. Arthritis Research Canada is leading research aimed at arthritis prevention, early diagnosis, new and better treatment, and improved quality of life.

SOURCE Arthritis Research Canada

For further information: or to arrange an interview, please contact: Heather Caulder, Marketing and Communications Officer, 604-207-4010 or [email protected], www.arthritisresearch.ca

http://www.arthritisresearch.ca/

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Originally Appeared Here

How to Recover After Hip Replacement Surgery

If you will soon need to recover after hip replacement surgery, or any major surgery involving your hip, you should carefully research what will happen, and how to cope, both before and after the operation. How should you prepare for hip surgery? What is recuperation from hip surgery look like? Will you need help after a hip operation? How soon can you return to work or resume normal daily activities?

Your orthopedic surgeon and medical team are the best authorities for specific answers related to your particular health, hip condition, work situation et cetera. The questions below, however, address some common questions and shares tips about hip replacement recovery and rehabilitation.

How can I prepare for hip replacement surgery?

A few health habits can be implemented in advance to ensure a quick and smooth recovery from hip surgery. You can help ensure a smooth and quick recovery if you are considering a hip replacement.

It is a smart idea to build your strength. Stronger upper bodies will make it easier to use crutches and a walker.

After surgery, your mobility and ability for daily activities will be severely reduced. Discuss the need for support after surgery with your loved ones, friends, and caregivers. Make practical changes to your home to ensure that you have easy access to the things that you require.

Safety is also important. Move furniture or remove rugs that make it difficult for you to use crutches/walkers.

What is the best time to return home after a hip-replacement?

Typically, hip surgery patients can walk and go home within a few days. Most people do not need to be bed-bound. Moving your joint can prevent it from becoming stiff.

You might have to stay the night in hospital if you have a preexisting condition, such as a heart condition or lung condition that requires monitoring. Inpatient rehabilitation units are a good option for people who have had complicated surgeries and need support at home.

Do I have to learn how to walk again – what equipment may I need?

Your medical team – including your orthopedic surgeon, physical or occupational therapists, and primary care doctor – will assess whether you need any assistive devices. If you have fallen or that seems likely, you may need a cane, or a walker. However generally not necessary to keep weight off the hip that went through surgery.

How soon will my hip incision heal?

Modern hip replacement surgery incisions are small and closed with absorbable stitches. It takes approximately six weeks for the incision to heal. It is okay to shower during this period, but it is best to wait until the wound heals completely to bathe or swim.

What is the time frame for rehabilitation after hip surgery?

Before the hip replacement surgery, patients will receive physical therapy. Then they will work with a physical trainer right after the surgery to learn and practice muscle strengthening exercises. The rehabilitation process will continue for a few more days following the surgery. Patients will see occupational and physical therapists up to three times per week, and are given exercises to do at home as well.

The first step in rehabilitation is to get used to your daily movements. Next, you will need to practice more difficult tasks like climbing stairs or getting in and out of your car.

These and other tasks are possible only if you have strong muscles. Rehabilitation includes resistance training for the hip muscles and the knee muscles in your legs.

Elderly womans feet walking at home with aid of walker. Difficulty of life in old age

What is the “normal” level of pain following hip replacement surgery?

After hip replacement, there will be some swelling and pain in the joints. This will help to reduce the pain.

Between therapy sessions, take some time to relax. Ice the leg and the site of your incision.
Consider taking anti-inflammatory medications, with your doctor’s okay, to help with these symptoms.
When you lie down, keep your leg higher than your heart.
Pay attention to your pain levels.
If your pain levels are at 6 or above (on a 1-10 pain scale), be sure to mention this to your surgeon or primary care doctor. Your pain should gradually decrease as you continue physical therapy.

How long does it take for your hip to heal after a hip replacement surgery?

The average time for hip replacement recovery is between two and four weeks. However, everyone is different. It all depends on several factors such as how active you were prior to surgery, your age and nutrition.

Being active and in good shape before surgery can make it easier to recover faster and return to your usual activities. Prehabilitation (or prehab) is a term used by physical therapists and orthopedic surgeons to help patients become physically fit before they undergo surgery.

What is the best time to resume my regular activities following a hip replacement surgery?

Physical therapy’s goal is to help you get back to your daily life. The amount of physical activity required to complete a task will determine the time it takes to accomplish that task.

Driving: It may take up to one month for you to be able again to drive safely after having surgery on your right hip. You might be able to drive again in a matter of weeks if it was your left hip. You can start in a parking lot, then move slowly to rural roads and eventually to the highway. You might not be able to drive again if you are taking medications that can impair coordination.

Work: You can return to work in two weeks if you have a desk job that requires little activity. It is recommended that you take off six weeks for any job that requires heavy lifting, or is otherwise difficult on your hips.

Sports: You can return to sports that require little activity like golf when you feel at ease. You should wait six weeks for contact sports that have high-impact. You should wait six weeks for the incision to heal completely before you can get into a pool.

Sex: You can go back to sexual activity at any time you feel like it, as long as you can do so comfortably.

What factors slow recovery from hip surgery?

There are always complications with any surgery, even major ones like a hip replacement. These complications can include infection at the incision, bone fractures, and hip dislocations.

Contact your doctor immediately if you experience severe pain, such as fever, swelling, or difficulty moving your hips, or if your medication isn’t working.

Rehab should be done at a steady pace. Avoiding sudden movements and sharp movements may help to prevent falls and dislocations that can delay recovery.

How long can my hip replacement implant last before it needs to be replaced?

Modern hip prosthetics, unlike older metal implants, are made from a mixture of metal, plastic, and ceramic parts. They are stronger and more resistant than older ones. These implants are durable and can last for up to 30 years. There is little chance of them failing or needing to be re-done.

What is the best time to wait before I replace my other hip?

There are some cases where it is beneficial to replace both hips simultaneously (a double-hip replacement). A double hip replacement may be safer for those with severe arthritis in both of their hips.

A double hip replacement decreases the chance of complications associated with anesthesia. The recovery process is quicker but can take twice as long because both legs must be strengthened simultaneously. You might also find it more difficult to move around the house at first, so you may need more help at home.

To reduce the risk of blood clots, it is better to wait at most six weeks before having two hip replacements.

The hip replacement procedure is one of most successful in medicine. The effectiveness of total hip replacement surgery has increased dramatically since the 1960s thanks to improvements in joint replacement technology and surgical techniques. The American Academy of Orthopaedic Surgeons reports that more than 450,000 total hip repairs are performed annually in the United States.

How to Prepare Your Home Before Hip or Knee Surgery

If you’re worrying about how to prepare your home before hip or knee surgery, this article should help you enormously.

First important tip: set up your home BEFORE you go to the hospital. This will make it easier for you to recover and to live in comfort when you return. This should be done well in advance.

Ask your doctor or physical therapist to get your home ready.

Advance Home Preparation Makes It Easier

Make sure that everything is easily accessible and on the main floor (or wherever you spend most of your time.) Limit the amount of stairs you use per day to one.

A bed should be low enough that your feet touch the ground when you are seated on the edge.
If possible, place your bed on the main/first floor. Although you don’t necessarily need a hospital bed for your comfort, your mattress should be firm.
You should have a toilet or portable commode located on the same floor as where you spend most of your time.
You can stock up on canned and frozen food, toilet paper and shampoo.
Buy or make single meals that can be frozen then reheated.
You should be able to reach all the things you need without bending or getting on your knees.
Place food and other supplies in a cabinet that is at your waistline and shoulders.
Place glasses, teapots, and any other items that you use often on the kitchen countertop.
You must be able to reach your phone. You can use a portable phone to get around.
In the kitchen, bedroom, bathroom and any other areas you use, place a sturdy chair. You will be able to sit comfortably while you complete your daily tasks.
Attach a bag or small basket if you plan to use a walker. You can keep your phone, notepad, pen and other essential items in the bag. A fanny pack can also be used.

It is possible that you will need assistance with bathing, toilet use, cooking, shopping, going to doctor visits, exercising, and even running errands. Ask your provider to send a caregiver to your home if you don’t have anyone to help you for the first few weeks following surgery. This caregiver can help with daily activities and check on the safety of your home.

You might also be interested in these other items:

Shower sponge with a long handle
A long-handled shoehorn
A cane, crutches, or a walker
You will need a reacher to pick up items from the ground. Put on your pants and take off your socks.
Help you put on your socks with a sock aid
To help you stay steady, use the handles bars in your bathroom.

(Amazon has a Hip – Knee Replacement Kit that may be of interest.)

Bathroom Setup for Easier Use After Knee or Hip Surgery

You can reduce your knee flexion by raising the height of the toilet seat. This can be done by installing a seat cover, an elevated toilet seat, or a safety frame for the toilet. A commode chair can be used in place of a toilet.

Safety bars may be required in your bathroom. Grab bars should be attached vertically or horizontally to a wall, and not diagonally.

Towel racks should not be used as grab bars. They will not support your weight.
Two grab bars are required. The first helps you to get in and out the tub. The other assists you in standing from a sitting position.

There are many ways to make sure you’re safe when you take a shower or bath.

To prevent falls, place non-slip silicone decals or rubber suction mats in the tub.
For firm footing, use a non-skid bathmat outside the tub.
Dry the floors outside of the bathtub or shower.
You can place soap and shampoo anywhere you don’t need to stand, reach, or twist.

Take a shower in a chair or a bathtub.

Rubber tips are recommended for the bottom.
If the seat is to be placed in a tub, you can buy a chair without arms.

Avoiding Falls and Tripping In Your Home After Surgery

Avoid tripping hazards in your home.

To move from one room to the next, remove any wires and cords.
Take out any throw rugs that are not in use.
Doorways with uneven flooring should be repaired. Use good lighting.
Install night lights in darkened rooms and hallways.

You may trip if your pet is small or moves around a lot. Consider letting your pet live with a friend or in a kennel for the first few weeks of your stay.

When you’re walking, don’t carry any items. Your hands may be required to balance. To carry your phone and other items, a small backpack is a good option.

You can practice using a walker, crutches or a wheelchair. It is important to learn how to:

You can get in and out of a seat easily
After using the toilet, sit down and then stand up.
Shower in the morning and get out at night
The shower chair can be used
Stairs can be used to ascend and descend

Is it possible to prevent hip surgery or replacement altogether?

Exercising after Joint Replacement Surgery

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Hip and knee replacements can get you back to an active life in a jiffy. Keep this in mind: You are an important factor in determining the end result of surgery. A new hip or knee joint does not work on its own.

To get the most out of your new parts you need to commit to an exercise program. This work begins immediately after surgery with a personalized rehabilitation plan created by a physiotherapist.

But a critical part of the recovery process begins after finishing the last physiotherapy appointment. “You’re already involved in an exercise program,” says physiotherapist Michele Hribar, PT. “Now you have to continue the rest of your life.”

The Importance of Exercising After Joint Replacement Surgery

It is essential to build muscles around the new hip or knee to keep the joint in tip shape. Hribar recommends continuing the specific exercise routine that you have already established with your physiotherapist.

“You really have to optimize the exercises to strengthen the supporting muscles,” Hribar says.

Fitness in general is also important, especially because knee or hip pain before surgery may have prevented you from doing enough activity. This may have caused weakness or limitations in areas other than the affected joint.

“Now that the joint is in better shape, you have a chance to improve and maintain overall fitness,” Hribar says.

You also need to exercise for balance, which can be affected after surgery.

The best exercises after joint replacement

Your workout routine should be a combination of aerobic activity and strength, flexibility and balance exercises. With a walking or cycling program it is not enough for any of the muscles needed for mobility and balance.

Some good news too: when this new hip or knee is put into operation, the activities may seem easier to do. “After surgery, these exercises should be better tolerated because of the relief of joint pain,” Hribar says.

Below are recommendations for sweating in two categories:

Aerobic activities

Aerobic activities make the heart beat faster. To get the ticker to pump, try walking, cycling, or using an elliptical machine. By variety, alternate the different activities. Consider using trekking poles to walk outdoors if you have difficulty maintaining balance and stability.

Once you have fully recovered from joint replacement, you should be able to do virtually any activity you have done before surgery. However, most surgeons do not recommend running.

Before giving up any activity you enjoy, Hribar suggests that you talk to your doctor or physiotherapist. You may be able to return to some higher impact activities or find ways to modify them.

“We’re able to get people back to playing pickle or doubles tennis, even though individual tennis is harder,” Hribar says.

Aim to try to achieve at least 30 minutes of aerobic activity most days of the week.

Exercises of strength, flexibility and balance

Muscle mass and bone density naturally decrease with age. To slow down this process, it is important to have a complete exercise routine.

Strengthening exercises after a hip or knee replacement should include exercises aimed at the quadriceps (four muscles in the front of the thigh), gluteals (three muscles that form the buttocks), and hip abductors (responsible muscles). to move the thigh to the side)).

Try to do focused strength and balance exercises two or three times a week. To build and maintain flexibility, exercises such as hamstring stretches and heel cord stretches should be part of your daily routine.

Find joy in exercise

Hribar points out that there are activities that combine aerobics, balance, strengthening and flexibility. Examples are dance, yoga, tai chi and pool exercises, which can also be social, with face-to-face classes opening once again after the pandemic and online options also available.

“You can make it fun,” Hribar says.

Click here for more info on how to recover after joint replacement surgery.

Less Pain After Orthopedic Surgery with Nerve Stimulation

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April 15 (UPI) – Nerve stimulation treatments are effective in reducing pain in patients recovering from orthopedic surgery and limiting the need for potentially addictive opioid drugs, according to a study published Thursday in the journal Anesthesiology.

The data show that a treatment called percutaneous peripheral nerve stimulation reduced patients ’postoperative pain scores after routine procedures.

The treatment provides small amounts of electricity to the surgically affected nerves and interrupts the transmission of pain signals to the brain, the researchers said.

In addition, the use of opioid-based pain medications in patients decreased by 80% during the first week after treatments, according to the researchers, who described the findings as “impressive.”

The benefits of postoperative nerve stimulation were “much greater than we had anticipated,” researchers at the University of California-San Diego wrote.

The results “stand alone and indicate that percutaneous peripheral nerve stimulation is highly effective for acute pain,” they said.

The reduction in the need for opioid-based pain medications after surgical procedures has become a point of emphasis in recent years because of the risk that patients may become addicted to drugs.

Prescription opiate-based pain medications have helped fuel an “epidemic” of abuse and misuse of these drugs, which have intoxicating effects similar to illegal drugs such as “heroin,” according to the National Institute on Drug Abuse.

For this study, researchers enrolled 65 adults who underwent joint outpatient surgery, such as removing the bunion from the foot and repairing the fist of the shoulder rotator.

All study participants had electrical wires located near the nerve or nerves that serve the surgical joints, and half of them received active electrical stimulation adjusted to achieve the desired sensory change that is sometimes described as a ” nice massage, ”the researchers said.

The rest of the participants received inactive treatment, with a pulse generator that appeared to work normally but did not provide electricity, according to the researchers.

After one week, participants who received active percutaneous peripheral nerve stimulation showed significantly lower pain scores, with mean scores on a scale of zero to 10 of approximately 1, compared with just over 3 in the simulated treatment group, showed the data.

Participants in the active treatment group used, on average, approximately 5 milligrams of opioid analgesics during the first week after surgery, or about one-tenth of the amount used by those in the simulated treatment group. say the researchers.

“Percutaneous stimulation of the peripheral nerve is likely to demonstrate optimal treatment after painful surgical procedures,” they wrote.

Figuring Out If – and When – You Need a Knee or Hip Replacement

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If you have experienced joint pain due to arthritis, you may be wondering if you need a knee or hip replacement. When considering a joint replacement surgery, there are some ways to determine if you are ready to talk to your orthopedic provider.

Chad E. Smith, MD, orthopedic surgeon at the Norton Orthopedic Institute, suggests thinking about the following three factors:

Pain

Does hip or knee pain come and go? Does it occur only during intense activity? Or is it constant and interferes with everyday life?

If the pain comes and goes, you may not be ready for surgery. The good news: There are some non-surgical ways to get relief. These may include taking nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, or physical therapy.

Age and activity

Then think about your age and activity level. If you are active and would like to stay active for many years, a hip or knee replacement may be possible. Surgeons perform joint replacements on younger patients than in the past, however, surgery will not normally be considered until age 50. In addition, unless X-rays show moderate to advanced arthritis in the knee or hip, non-surgical treatment will be recommended.

Weight and health in general

Finally, how is the rest of your health, including your weight? Carrying extra weight is an important factor in knee or hip pain. Surgeons typically do not perform knee replacements in patients with a body mass index greater than 40, as they increase complications during and after surgery.

However, there are physiotherapy programs designed to help you lose weight, while also supporting and aiming to improve painful joint. Your healthcare provider can help you find a physical therapy or weight loss program that fits your needs.

Do you have heart disease or diabetes? Is your diabetes controlled with an adequate level of hemoglobin A1C? Chronic medical conditions need to be optimized before surgery.

You will also want to make sure you are mentally prepared for a couple of difficult weeks after surgery.

Can pain be overcome during physiotherapy while working to strengthen and move the new joint.

For Severe Arthritis Pain, Are Multiple Joint Replacements a Good Idea?

After several joint replacement surgeries, Lorry Graham jokingly calls herself a “bionic woman.” Friendly and optimistic, the 75-year-old Delaware resident always enjoyed an active lifestyle. And she always felt younger than her chronological age. Therefore, when arthritis caused by wear and tear began to cause an unpleasant weight on the knees and hips, she refused to take it sitting. Over the past six years, she has had four joint replacements at New York City’s Special Surgery Hospital (HSS), both her knees and her two hips, so she can enjoy life without pain.

“The pain was very, very limiting. It was affecting my quality of life and I didn’t want to live like that, ” she says. She decided to do something about it and researched a lot. “There were three main factors I considered before surgery,” she explains. “The first was the best hospital I could find, which was HSS. The second was the best surgeon I could find. And the third component was my mental attitude and my willingness to do the work after surgery to get the best result. ”

For each joint replacement surgery, Ms. Graham, a former high school teacher and advisor, made the trip from her home in Delaware to HSS in New York City. “I always knew I had to do it. I love walking, I love shopping, I love playing with my grandchildren, ” she explains. “And arthritis made me limp, it hurt, it affected my sleep. This type of pain is shown on the face. You are not a happy person. I didn’t want to delay the surgery any longer than I had to. ”

Her doctor, Geoffrey Westrich, MD, who specializes in knee and hip replacements in HSS, says it’s not uncommon for patients to have advanced arthritis in two joints. Having four joint substitutions is less common, but it does happen. He recommends that patients considering various joint replacement surgeries do their research to find a high-volume joint replacement center and an experienced orthopedic surgeon who takes the time to answer all their questions and who they are comfortable with. .

“When someone has more than one joint replacement, timing and recovery are important and no two patients are alike,” says Dr. Westrich. “If someone has painful arthritis in both knees, for example, and conservative treatments like physiotherapy and over-the-counter medications offer no relief, we usually wait about three months between surgeries. It’s the time it takes the body to heal. and the time it takes to do physical therapy and make the muscles strong again. Patients will support their weight with the side that underwent the first surgery. ”

Dr. Westrich adds that a critical factor is the surgeon’s experience in knowing when it is safe to proceed with the next joint replacement. That’s why, after the first postoperative visits, Dr. Westrich sees the patients again after six weeks to make sure they are doing well, and sometimes after three months, before proceeding with a second joint replacement.

These days, on the same day, double replacements of the joints are performed less frequently, as Dr. Westrich and other HSS researchers have found that it is best for most patients to have “in-phase” procedures, that is, to have the surgeries performed at least months apart. “In studies, we have found that bilateral knee replacement surgery on the same day can present more challenges for the patient from a medical point of view, more pain medications are needed after surgery and physiotherapy is much more difficult because they don’t have a good standing leg, so to speak, ”he says.

Dr. Westrich points out that sometimes there is a good reason to perform a bilateral joint replacement on the same day. For example, both arthritic knees may have a severe flexion contracture, meaning they are in a bent position and the patient cannot straighten them. “In these cases, it may be appropriate to do a double joint replacement, as physiotherapy can be much more difficult if the unoperated knee is bent.” He adds that if the contracture is not too severe, a shoe lift can equalize the length of the legs and allow the patient to do physical therapy after two different procedures.

Mrs. Graham had four different surgeries and, less than two months after her final hip replacement in May, said she was feeling very well. “I am shaking this, I am totally shaking it. I went to play mahjong with my friends and when I came in, they couldn’t believe how good I looked and how good I was doing.”

She believes her mental attitude and willingness to work hard in rehabilitation after surgery played an important role in optimizing the outcome of each joint replacement. Dr. Westrich agrees that going in with a positive attitude and dedicating yourself to work can improve outcomes.

“Clearly, Lorry Graham was very interested in his recovery and worked very hard after the surgery to get a good result,” he notes. “There is no doubt that patients who work hard and spend a lot of time on physiotherapy tend to progress faster and have a better overall recovery.”

Just two months after her last hip replacement, Mrs. Graham visited a new New York City park with her friend and walked for more than an hour without pain. “I walk everywhere,” she says. “I am doing better than in the last six years. It feels great. ”

No Knee Replacement Necessary? Perhaps, with High-Tech Knee Brace

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A California robotics company is about to launch a high-tech knee brace that can alleviate the suffering of millions of Americans facing knee osteoarthritis. It can be especially appealing to patients who want to avoid knee replacement surgery.

San Francisco-based Roam Robotics said its $ 7,000 Ascend orthosis should begin shipping this winter. Certified by the FDA as a Class 1 medical device, Roam provides for reimbursement for both Medicare and private insurance. Medicare could cover 50% or more, and private insurance could cover the entire cost in some cases, Roam says.

Roam Robotics CEO Tim Swift

Roam is located in San Francisco’s Mission district, across the street from Oltrelab, an engineering company that has awarded tens of millions of dollars in government research contracts, primarily for robotics and energy projects. Roam is one of several emerging companies emerging from Altrelab. Its founder and CEO Tim Swift is a veteran of Ekso Bionics, a pioneer in the field of the exoskeleton. After working on heavy, super-expensive exoskeletons, Swift concluded that a radical move away from conventional designs was needed if exoskeleton technology became accessible and affordable.

“Our goal is not to build cyborgs. It’s to make people more human than they ever were.”

“I think we have the ability to change the relationship that people have with robots on a scale that has never been considered before,” Swift says. “I don’t want people to see robots as something beyond human beings. Our goal is not to build cyborgs. It’s about making people more humane than they ever were. ”

Ascend is made of lightweight carbon fiber and high-strength fabric. The pneumatically powered device is connected to a rechargeable battery that is carried in the backpack. Custom knee arm sensors provide real-time data to Ascend microprocessors, where proprietary algorithms detect the user’s intent and then extend and flex the knee. Ideally, this relieves pain and increases patients ’ability to navigate stairs and master simple daily activities.

Rowan Paul, a sports medicine doctor who has consulted with Ascend, says he may like those who are reluctant to use a cane because of the stigma of disability it entails. Knee strengthening makes them look like an athlete with an injury, he says. Ascend can also reduce or eliminate the need for opioid pain medications or cortisone injections, which offer temporary relief from osteoarthritis, but are at risk for side effects.

“I’ve seen several patients, where if we can just give them a little help in a very specific and precise way, they don’t need to do a knee replacement,” Paul says.

Roam market research places the number of patients living with severe pain and limited mobility due to knee osteoarthritis at 10 million or more.

The company has opened a storefront in San Francisco where patients can try Ascend driving. Reid Weaver came down from Tacoma, Washington, in June to try one and it was sold with the product. “It’s so comfortable and so light, that you don’t even feel like it’s there,” says Weaver, who spent 19 years as a SWAT police officer in Washington state and now works as a court officer protecting the judges of Tacoma.

The weaver had surgery on his legs after a hiking accident, but surgery exacerbated his osteoarthritis. Weaver, 60, is an avid outdoor enthusiast who played football in college and manages to ride a motorcycle to work. With the Ascend knee put on, Weaver finds that he can go up and down the stairs with ease and was surprised that it was no longer a struggle to get up from a chair, a challenge for many with osteoarthritis in the knees.

“That was a lot more powerful than I thought it would be,” Weaver says. “It basically got me out of the sitting position without using my hands, without moving forward. I think it will change the game.

Angelique Newman-Malone, 52, of San Jose, California, says she felt trapped in her own body from osteoarthritis. After coming across an Ascend ad on Facebook, Newman-Malone wore his knee on several occasions and declared it a gift from God.

“I felt like someone was supporting me, like a partner walking beside me,” he says. “That feeling is amazing.”

But the best advantage for Newman-Malone is that the knee strap allows him to kneel and then stand up. A devoutly religious Christian, she said the ability to kneel when praying is key.

98-year-old Woman Walking Smoothly One Day After Knee Replacement

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A 98-year-old woman with severe osteoarthritis of the knee has recently undergone total knee replacement surgery. She was discharged 24 hours after the surgery which was performed using the minimally invasive surgery (MIS) technique at Manipal Hospital.

Dr. Rohan Desai, a hip and knee replacement surgeon, said the patient had seen them a couple of years ago with left knee problems. The need for surgery was not felt then. “About a couple of weeks ago he visited us and, after the examination, it was found that his knee was very deformed. He could not stop or walk and was confined to a wheelchair,” Desai said.

After doing the necessary tests and medical advice, it was decided to do the knee replacement surgery. He suffered from comorbidities such as hypertension, heart problems: pacemakers for 15 years, nephropathy and anemia. Diseases were controlled long before and after surgery. “Medical management of comorbidities is very important for successful surgery. We did it with the MIS technique and, in a few hours, he was able to stop and walk to everyone’s surprise. This is the first time that a 98-year-old boy with comorbidities has undergone such surgery in Goa,” he said.

Manish Trivedi, director of the hospital, said people do not usually undergo these procedures once they reach a certain age, for example, after 60 or 70 years. “It is never too late to undergo any type of medical procedure, after consulting a doctor. The patient in question was able to stand up and walk smoothly only one day after the surgery, ”said Trivedi.

“Rapid mobilization was possible in a few hours, thanks to multimodal analgesia and advances in anesthesia techniques, which we use,” he said.