ortho news - Google

“There’s great momentum across the AAOS family of registries,” said William J. Maloney, MD, FAAOS, chair of the AAOS Registry Oversight Committee. “The number of anatomical areas and procedures covered continues to grow and the data being submitted by participating sites is paving the way for improved orthopaedic outcomes in the United States. We are pleased to publish these clinical insights from the AJRR and the SER and look forward to seeing continued growth and increasingly impactful analyses in the years ahead.”

AJRR 2020 Annual Report Supplement
Data presented in the 2020 AJRR Annual Report Supplement were submitted to the AJRR by 1,110 institutions through June 2020, covering procedures from 2012 to 2019. For the second consecutive year, the supplement includes reporting of device-specific cumulative percent revision estimates, drawn from the registry’s unique linkage with Centers for Medicare and Medicaid Services (CMS) claims data. In addition, analyses in the 2020 supplement were expanded to include many more devices than the 2019. This year’s analysis also examines cumulative, all-cause revision at target timepoints with further stratification of devices based on fixation and bearing descriptions.

This report found all hip device constructs included in analysis had a cumulative percent revision of less than 2.7% at one year and less than 4.6% at final follow-up for each respective device. Knee device constructs included in analysis were found to have less than 2.5% cumulative percent revision at three years and less than 3.7% at final follow-up for each respective device

To read and download the 2020 AJRR Annual Report Supplement, visit the AAOS’ website.

Shoulder & Elbow Registry Second Annual Report
The SER includes representatives from the American Shoulder and Elbow Surgeons (ASES), the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA), and the American Society for Surgery of the Hand (ASSH). The SER collects shoulder and elbow procedural data in the United States to establish survivor curves, track revisions, and support orthopaedic care and best practices. The program’s latest annual report represents submitted shoulder and elbow procedures dating from 2015 through 2020.

“The AAOS Shoulder and Elbow Registry is one of the most important endeavors being undertaken in shoulder and elbow surgery,” said SER Steering Committee member Stephen F. Brockmeier, MD, FAAOS. “This data will drive future clinical care, answer critical questions and contribute to research in the field, and dramatically enhance our ability to provide optimal outcomes for our patients. As can be seen in the 2020 SER Annual Report, the Registry data continues to accumulate at a rapid pace, and new procedures are added for study each year.”

To date, there are more than 112 SER participating facilities including hospitals, private practices, and ambulatory surgical centers spanning 35 states across the United States. To read and download the complete 2020 SER Annual Report, visit the AAOS’ website.

# # #

AAOS Registry Program
The AAOS Registry Program’s mission is to improve orthopaedic care through the collection, analysis, and reporting of actionable data. The American Joint Replacement Registry (AJRR), the Academy’s hip and knee replacement registry, is the cornerstone of the AAOS’s Registry Program, and the world’s largest national registry of hip and knee joint replacement data by annual procedural count, with more than 2.4 million procedures contained within its database. Additional registries include the Fracture & Trauma Registry, the Musculoskeletal Tumor Registry (MsTR), the Shoulder & Elbow Registry (SER), and the American Spine Registry (ASR), a collaborative effort between the American Association of Neurological Surgeons (AANS) and the AAOS.

About the AAOS
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments, and related musculoskeletal health care issues, and it leads the health care discussion on advancing quality.

https://www.aaos.org/

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.

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.

 

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.

Sixty-five-year-old Ian Lovatt is waiting for a hip replacement, but cannot be operated on. As a result, he has been tied to the house for two years.

“Can you imagine a broken glass in your hip? That’s what it feels like every time you take a step or move.”

Hawke’s Bay DHB admits he needs surgery, but told him others had priority. He has been denied time and time again.

“Annoying, sad. It’s actually very depressing. I feel like a prisoner because I’m just trapped. I can’t get out.”

Lovatt carries morphine for 18 months and is worried about his addiction, so he manages the amount he takes.

“I try to reduce morphine, so I don’t trust it all the time, but you depend on it because the pain gets worse.”

The DHB says there is a greater demand for elective surgeries and is working hard to meet it by building an eighth operating room and collaborating with a private hospital.

But Dr. Darran Lowes, a local GP, worries that DHB is out of date.

“Over time it has gotten worse and now the threshold for entering the surgical waiting list is extremely high,” he says.

“We just don’t have enough beds, enough theaters, enough services to do that.”

It is a similar situation in Northland. Margaret Pohl is the clinical director of orthopedic surgery at Northland DHB and has seen a growing wave of people in need of joint surgery.

She says there isn’t enough operating room space for elective surgeries, and a lot of people don’t even get on the waiting list.

“We’re setting aside about 50 percent of people referred to joint replacement surgery,” he says.

“Year after year it has gotten worse and the hardest thing for all surgeons are the patients they have rejected.”

The number of people operated on for joint surgery has increased. Figures from the Ministry of Health show that during the nine months to March 2019, 7524 people underwent joint replacement surgery. And in the nine months to March 2021, there were 8007 people.

But the number of people on waiting lists has also grown: from 3,881 people in March 2019 to 5,407 people in March this year.

The ministry attributes some of this to the backlog of COVID-19, but Dr. Lowes argues it has long been a problem.

“The population here is aging and with it the demand for surgery is increasing.”

As a result, he sees that more morphine is prescribed to relieve pain.

The amount of publicly funded morphine prescription dispensed between 2016 and 2020 increased by approximately 22,500, from 511,896 to 534,389.

Most are for young people aged 60 to 69, an increase of 12,473.

Dr. Lowes is worried about people getting addicted to it.

“We certainly see tolerance and dependence a few days after starting it, so it’s a big problem.”

Stu Desmond of Kaitaia is another who takes morphine to deal with pain.

“You try not to cry, it gets pretty exciting,” he says.

He is awaiting hip surgery and is aware that the drug is addictive.

“I’m lucky to be able to limit myself to two or three a day.”

But not everyone is lucky that Desmond and some end up being addicted.

“We’re seeing an increasing amount of pain and an increasing use of drugs to control their pain,” Dr. Pohl says.

In last year’s budget, the Government injected $ 282 million into DHBs to help eliminate a backlog of elective surgeries, caused in part by COVID-19.

Health Minister Andrew Little is aware of the problem.

“We know there are long waiting lists and we know people are struggling to get on the waiting lists,” he says.

“It bothers me that people are being given morphine to relieve pain because there is no end. That’s not good enough.”

He hopes the health care reform, which scratches the structure of DHB, will also help.

“We should be able to divert people to where the capacity is available.”

He can’t get there soon enough for Lovatt.

“All I want is to get it, get back to normal.”

We return to a life without constant pain and without morphine.