Friday, November 9, 2018

Fall Prevention Measures Can Prevent Serious Injury


Supreme Court Justice Ruth Bader Ginsburg fell in her office this week and fractured three ribs. She was hospitalized, but fortunately, is now back home now and doing well, according to news reports.

Although the details of how the 85 year-old Supreme Court Justice fell have not been released, the mishap shines a spotlight on how serious a fall can be. It fact, a fall can be devastating for older adults in particular because their bones are more fragile. They often break a hip, sustain a severe head injury... or worse.

I would like to take this opportunity to wish Justice Ginsburg well and remind everyone that measures can be taken to prevent falls indoors. In your own home, or in the home of a loved one, these strategies can help prevent an accident and keep people safe. Some of these measures can be applied to the work environment, as well:

  • Ensure that the home is free of hazards such as slippery floors, rugs that are not secured and poorly lit areas.
  • Install handrails, grab bars and other safety devices.
  • Wear properly-fitting shoes with nonskid soles.
  • Engage in regular, moderate amounts of physical activity to maintain strength, coordination, agility and balance.
  • Get an eye examination and physical each year, and wear glasses if needed.
  • Check with your doctor about side effects of all your prescription and over-the-counter medications and take proper precautions.  Medications can cause drowsiness and interfere with balance.
  • Eat a nutritionally balanced diet with adequate amounts of calcium and vitamin D.
  • Avoid excessive alcohol intake.

Stairs and steps
  • Make sure light switches are at both the top and bottom of the stairs.
  • Provide enough light to see each step and the top and bottom landings.
  • Keep flashlights nearby in case of a power outage.
  • Install handrails on both sides of the stairway and be sure to use them.
  • Do not leave objects on the stairs.
  • Consider installing motion detector lights which turn on automatically and light your stairway.
  • Put nonslip treads on each bare-wood step.
  • Do not use patterned, dark or deep-pile carpeting. Solid colors show the edges of steps more clearly.
  • Do not place loose area rugs at the bottom or top of stairs.
  • Repair loose stairway carpeting or boards immediately.

Bathroom
  • Install grab bars on the bathroom walls near the toilet and along the bathtub or shower.
  • Place a slip-resistant rug adjacent to the bathtub for safe exit and entry.
  • Mount a liquid soap dispenser on the bathtub/shower wall.
  • Place nonskid adhesive textured strips on the bathtub/shower floor.
  • Use a sturdy, plastic seat in the bathtub if you are unsteady or if you cannot lower yourself to the floor of the tub.
  • Stabilize yourself on the toilet by using either a raised seat or a special toilet seat with armrests.
  • Replace glass shower enclosures with non-shattering material.
  • Keep a night light in the bathroom.

Bedroom
  • Clear clutter from the floor.
  • Place a lamp and flashlight near your bed.
  • Install night-lights along the route between the bedroom and the bathroom.
  • Sleep on a bed that is easy to get into and out of.
  • Keep a telephone near your bed.

Living areas
  • Arrange furniture to create clear pathways between rooms.
  • Remove low coffee tables, magazine racks, footrests and plants from pathways in rooms.
  • Install easy-access light switches at entrances to rooms so you won’t have to walk into a dark room to turn on the light. Glow-in-the-dark switches may be helpful.
  • Secure loose area rugs with double-faced tape or slip-resistant backing. Recheck these rugs periodically.
  • Keep electric, appliance and telephone cords out of your pathways, but don’t put cords under a rug.
  • Eliminate wobbly chairs, ladders and tables.
  • Do not sit in a chair or on a sofa that is so low it is difficult to stand up.
  • Place carpeting over concrete, ceramic and marble floors to lessen the severity of injury if you fall.
  • Repair loose wooden floorboards immediately.

Kitchen
  • Remove throw rugs.
  • Immediately clean up any liquid, grease or food spilled on the floor.
  • Store food, dishes and cooking equipment at easy-to-reach waist-high level.
  • Don’t stand on chairs or boxes to reach upper cabinets. Use only a step stool with an attached handrail so you are supported.
  • Repair loose flooring.
  • Use nonskid floor wax.


Monday, November 5, 2018

Study Finds “Dual Mobility” Hip Replacement Implant Reduces Risk of Dislocation

Hip replacement surgery is highly successful in relieving pain, restoring mobility and improving quality of life. More than 330,000 procedures are performed each year in the United States, and that number is expected to almost double by the year 2030. 

As with all surgical procedures, the possibility of a complication exists, and dislocation is the most common problem. The risk of dislocation is higher in patients who have had a second hip replacement, known as revision surgery. Some people need a revision surgery many years after their first hip replacement when the original implant wears out. Hip instability after joint replacement is another reason a patient might need a revision surgery.    

Research conducted at Hospital for Special Surgery, where I am director of research of the Adult Reconstruction and Joint Replacement Service, and other joint replacement centers indicates that a newer type of artificial hip known as a “modular dual mobility” implant could be a good option for patients who need a revision surgery. Our study was presented at the annual meeting of the American Association of Hip and Knee Surgeons in Dallas in November. 

Although the concept of dual mobility was originally developed in France in the 1970s, the technology is relatively new in the United States. Our study found that the newer technology with modular dual mobility components offered increased stability, lowering the risk of dislocation, without compromising hip range of motion in patients having a revision surgery. 

“Dual mobility” refers to the bearing surface of the implant - where the joint surfaces come together to support one’s body weight. A hip replacement implant is a ball-in-socket mechanism, designed to simulate a human hip joint. Typical components include a stem that inserts into the femur (thigh bone), a ball that replaces the round head of the thigh bone, and a shell that lines the hip socket.  

Modular dual mobility implants provide an additional bearing surface compared to a traditional implant. With the dual mobility hip, a large polyethylene plastic head fits inside a polished metal hip socket component, and an additional smaller metal or ceramic head is snap-fit within the polyethylene head. 

Currently, there are few large-scale outcome studies on the modular dual mobility device in revision hip replacement. We set out to determine the rate of dislocation and the need for another surgery following revision hip replacement using this implant and report on the functional outcomes.

The study included 370 patients who underwent revision hip replacement with the dual mobility implant between April 2011 and April 2017. The average patient age at the time of surgery was 65.8 years. Clinical, radiographic and patient reported-outcome information was collected. 

To be included in the final report, patients needed to be seen for follow-up for at least two years after their surgery, and the average follow-up was 3.3 years. At the latest follow-up, we found that surgery with the dual mobility implant resulted in a very low rate of instability for the revision patients, namely 2.9 percent, with good functional improvement and a low rate of reoperation. While longer-term follow-up is needed to fully assess the newer device, in our study there was clearly a benefit provided by the dual mobility implant in the first few years following revision surgery.

Monday, April 30, 2018

Study Finds “Dual Mobility” Hip Replacement Attractive Option for Younger Patients


More than 330,000 hip replacement surgeries are performed in the United States each year. Overall, it is a highly successful procedure. However, as with all surgeries, a risk for complications exists. 

Dislocation is one of the most common complications after hip replacement and the number one reason for revision surgery. A study we conducted at Hospital for Special Surgery (HSS) found that patients who received a newer implant known as a “dual mobility” hip replacement had zero dislocations.  In comparison, study patients who received a traditional fixed bearing hip implant had a dislocation rate of 5 percent.

The research, which focused on patients under 55 years old, was presented last month at the American Academy of Orthopaedic Surgeons Annual Meeting in New Orleans.  

We were especially interested in seeing how the younger patient population fared because they are generally more active and put more demands and stress on their hip after joint replacement, and this increases the risk of dislocation.

Although the concept of dual mobility was originally developed in France in the 1970s, the technology is relatively new in the United States. “Dual mobility” refers to the bearing surface of the implant - where the joint surfaces come together to support one’s body weight. 

A hip replacement implant is a ball-and-socket mechanism, designed to simulate a human hip joint. Typical components include a stem that inserts into the femur (thigh bone), a ball that replaces the head of the thigh bone, and a shell that lines the hip socket. 

Dual-mobility hip components provide an additional bearing surface. A large polyethylene plastic head fits inside a polished metal hip socket component, and an additional smaller metal or ceramic head is snap-fit within the polyethylene head. "Dual-mobility" means that there are two areas of motion, improving the patient's range of movement and reducing the risk of dislocation.

We compared the dual mobility system with the traditional fixed bearing system in two age-matched groups of patients who had a primary total hip replacement over the same time period. There were 136 patients in each group with a mean age of 48.

At three-year follow-up, the researchers found that the patients who received the dual mobility implant had no dislocations. In the group receiving the standard fixed bearing implant, seven patients, or 5.1 percent, had a dislocation and needed a revision surgery.

Total hip replacement is increasingly being performed in younger patients. The results of our study are encouraging for this active, high demand group of patients and may lessen concerns for dislocation. More research is needed to see how dual mobility implants perform over the long term.


Thursday, November 30, 2017

Hip Pain: Diagnosis and Treatments

Many people experience hip pain from time to time, especially if they lead an active lifestyle. A good deal of walking and hiking while on vacation or rushing to finish chores over the holidays can lead to a sore hip. People experience pain from overdoing it. Known as an “overuse injury,” it results from repetitive stress on the muscles, joints and tendons.

Usually, the best way to deal with pain from overuse is to take it easy for a while. We advise patients to rest their hip, take an over-the-counter anti-inflammatory medication as long as they don't have gastrointestinal issues, and apply ice or heat. If an aching hip doesn’t feel better in a week or so, a visit to a doctor for an orthopedic evaluation is usually in order.     

Sometimes hip pain is a result of a something more serious than overuse, and the following symptoms should prompt you to see a doctor quickly or go to the emergency room:      

·         Intense pain that comes on suddenly
·         Severe pain from a fall or other injury to the hip
·         The inability to put weight on the joint or move your hip or leg
·         A joint that looks deformed or is bleeding
·         Hip pain accompanied by fever and a general feeling of malaise       

For ongoing hip pain, people are advised to see a specialist. Since there can be any number of causes, the doctor should take a detailed medical history, asking plenty of questions. The physician should also perform a thorough physical exam to pinpoint the location and cause of the pain. X-rays often aid in the diagnosis, and an MRI may be ordered down the road.

Bursitis is a common cause of hip pain that usually results from repetitive stress on the joint. The bursae, which are small, fluid-filled sacs that help your joints move smoothly, become inflamed. Pain is usually felt on the outside of the hip. Treatment includes rest, anti-inflammatory medication and sometimes a steroid injection or physical therapy.

Some patients are surprised to learn that their hip pain is actually coming from another part of their body, such as their lower back or knee. 

Arthritis is the most common cause of hip pain in adults over 60, resulting from years of activity and wear and tear on the joint. It’s not uncommon for the arthritis to be accompanied by a labral tear in the hip, which can be likened to a torn cartilage in the knee.  If a doctor recommends arthroscopic , or minimally invasive, hip surgery to repair a torn labrum, patients should get a second opinion. Studies show that arthroscopic surgery for a labral tear has no benefit for older patients with hip arthritis.

Conservative treatments to help relieve arthritis pain include prescribe anti-inflammatory medication, rest and physical therapy. Patients are advised to listen to their bodies and avoid activities that make their arthritis worse. If an individual has excess weight, losing weight may help by taking some stress off the joint.
    
If arthritis is severe and conservative treatments fail to provide relief, people often consider hip replacement surgery to eliminate pain once and for all and get back to activities they’ve been forced to give up.  More than 300,000 hip replacements are performed in the United States each year.

Major advances in joint replacement techniques and in the implants themselves have revolutionized the field. One such advance is less invasive hip replacement. The newer technique achieves the same goal as the standard procedure, but with a three- or four-inch incision, as opposed to 12 or 14 inches. The surgery entails replacing the painful, arthritic joint with a fully functioning hip implant. Aside from the better cosmetic result, the smaller incision can result in less pain, a quicker recovery and easier physical therapy.  Advances in anesthesia and pain management after surgery have also benefited patients.

This blog should not be construed as medical advice. All questions regarding your health or possible health problems should be directed to your physician.

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Wednesday, September 20, 2017

An Unfortunate Epidemic of Falls this Year

 
In the past year, four of my close friends or relatives have fallen in their home or at work. Two of them suffered broken bones. In the first instance, a friend of mine was getting ready for a trip to California and rushing around her apartment when she tripped over a pile of papers. She broke her wrist and needed surgery. She’s on the mend and doing well, but it could have been worse.

Another friend was busy at work, and in her haste to get things done, she tripped on some steps and broke her foot. It’s been a long and difficult recovery.

A relative who had back surgery about a year ago became distracted and fell in her walk-in closet. Luckily, she was OK.

Finally, someone I know was adjusting her bath mat and slipped in the bathtub. Fortunately, she fell in such a way that she only sustained a bruise and some soreness.

They all had something in common: they were either distracted or in a hurry. I can’t stress enough how dangerous a fall can be, especially for older folks whose bones may be more fragile. As we age, our balance may not be what it used to be, so it’s more important than ever to be mindful of our movements, especially when we’re in a hurry.

Medications that cause drowsiness also put us at greater risk of falling. Check with your doctor or read the label about the side effects of all your prescription and over-the-counter medications, and be extra careful when moving around the house. 

Shoes and slippers make a difference, too. They should always fit properly, and nonskid soles are advised for people who may be susceptible to a fall.

Ever watch those home improvement shows? It never ceases to amaze me when I see a steep staircase leading to a basement with no handrail. Not only is it against building codes, it’s an accident waiting to happen. Holding on to the wall for support doesn’t cut it. Every staircase in a home should have at least one sturdy handrail. The entire area should be well-lit, with light switches at both the top and bottom of the stairs.

Here are some additional recommendations for home safety and fall prevention:
  
General tips
  • Ensure that the home is free of hazards such as slippery floors, rugs that are not secured and poorly lit areas. Do not leave piles of paper or random items on the floor. If there is a spill, clean it up immediately.
  • Keep flashlights nearby in case of a power outage.
  • Consider installing motion detector lights which turn on automatically and light your stairway.
Stairs
  • Put nonslip treads on each bare-wood step.
  • Do not use patterned, dark or deep-pile carpeting. Solid colors show the edges of steps more clearly.
  • Do not place loose area rugs at the bottom or top of stairs.
  • Repair loose stairway carpeting or boards immediately.
 Bathroom
  • Install grab bars on the bathroom walls near the toilet and along the bathtub or shower.
  • Place a slip-resistant rug adjacent to the bathtub for safe exit and entry.
  • Mount a liquid soap dispenser on the bathtub/shower wall.
  • Place nonskid adhesive textured strips on the bathtub/shower floor.
  • Use a sturdy, plastic seat in the bathtub if you are unsteady or if you cannot lower yourself to the floor of the tub.
  • Stabilize yourself on the toilet by using either a raised seat or a special toilet seat with armrests.
  • Replace glass shower enclosures with non-shattering material.
 Bedroom
  • Clear clutter from the floor.
  • Place a lamp and flashlight near your bed.
  • Install night-lights along the route between the bedroom and the bathroom.
  • Sleep on a bed that is easy to get into and out of.
  • Keep a telephone near your bed.
 Living areas
  • Arrange furniture to create clear pathways between rooms.
  • Remove low coffee tables, magazine racks, footrests and plants from pathways in rooms.
  • Install easy-access light switches at entrances to rooms so you won’t have to walk into a dark room to turn on the light. Glow-in-the-dark switches may be helpful.
  • Secure loose area rugs with double-faced tape or slip-resistant backing. Recheck these rugs periodically.
  • Keep electric, appliance and telephone cords out of your pathways, but don’t put cords under a rug.
  • Eliminate wobbly chairs, ladders and tables.
  • Do not sit in a chair or on a sofa that is so low it is difficult to stand up.
  • Place carpeting over concrete, ceramic and marble floors to lessen the severity of injury if you fall.
  • Repair loose wooden floorboards immediately.
Kitchen
  • Remove throw rugs that are not secured to the floor.
  • Immediately clean up any liquid, grease or food spilled on the floor.
  • Store food, dishes and cooking equipment at easy-to-reach waist-high level.
  • Don’t stand on chairs or boxes to reach upper cabinets. Use only a step stool with an attached handrail so you are supported.
  • Repair loose flooring.
  • Use nonskid floor wax.
Finally, check on loved ones who may be at risk of falling to make sure their homes are safe.

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Wednesday, July 26, 2017

A Letter from a Patient and Some Advice When Choosing a Doctor

This month, I received a letter from a patient that just made me feel good. Most people have excellent outcomes after hip or knee replacement surgery, but it’s not every day that they write a letter to tell you about their experience. Nancy, a teacher from Westchester, wrote a letter thanking me and the staff at Hospital for Special Surgery (HSS) for “a most successful and amazing experience.”  

She had decided to have hip replacement due to intense pain that kept her up at night and made it difficult for her to do the job she loved. Nancy had tried physical therapy, but after 25 sessions and little pain relief, she thought it was time to make an appointment with an orthopedic surgeon. She said three previous joint replacement patients had recommended me, so she felt very comfortable making an appointment. She was also aware of the excellent reputation of Hospital for Special Surgery. Her x-rays, medical history and exam showed that advanced arthritis was causing her pain. She felt confident in her decision to have hip replacement surgery. 

In her letter, she said it was reassuring to know exactly what to expect before surgery, and she was impressed with the attention she received from everyone at HSS. “The hospital experience was everything I could have hoped for and more – from check-in to the recovery room staff and PT personnel as well as the most kind and supportive nurses on the 10th floor…every single person made me feel like they were there to make my experience successful and comfortable.”  

Her letter confirmed that she went into surgery with a positive attitude and without hesitation: “I can’t even imagine a better surgery experience… you were so calm and confident and reassuring before and after surgery. You truly deserve the reputation that precedes you… It’s now almost my 11th week post surgery and I still can’t believe how well I’m walking and moving around in general.  The outpatient PT person is really impressed with my recovery.”

It’s really gratifying to receive a letter like this from a patient. We strive to provide patient care of the highest caliber, to understand each individual’s needs, and to allay any concerns a patient may have. A letter like Nancy’s shows us that we’re doing our job and achieving our goals.

I firmly believe that every patient has the right to expect high quality and compassionate care for whatever medical problem they may be facing and no matter where they are treated. This is especially important for anyone considering surgery. In her letter, Nancy outlined the factors that made her experience so successful, and if you’re considering surgery, I would like to offer the following recommendations to help you choose the right doctor: 

One of the first considerations is whether or not the doctor takes your insurance, and if not, could you go out of network? If you see a physician who is out of network, find out how much of the procedure will be covered and if other professionals involved in your care, such as an anesthesiologist, will be covered. 
     
Get recommendations for a physician from friends, relatives or from a family doctor. 

Check credentials. See where the physician received his or her education and training. Make sure a doctor is board certified, and don't hesitate to ask.

Be mindful of whether the physician approaches you with professionalism and confidence. You want a confident physician who respects you and appears genuinely concerned for your well-being.  

Don’t rely solely on an advertisement or a physician’s website when choosing a doctor. Advertisements and information displayed on the Internet are not regulated. Ads and websites can often provide useful information, but remember to check the doctor's experience and credentials.

Choose a doctor with whom you feel comfortable and who inspires confidence. Make sure the physician is willing to take the time to answer all of your questions in non-technical terms. If you feel rushed or believe your questions have not been answered in a satisfactory manner, look for another physician.

Make sure the doctor explains what you can expect in terms of the surgery itself, the final outcome and recovery time. The physician should discuss possible risks as well as benefits.

What about the doctor’s staff? Are they gracious and respectful? When you set up pre-surgical testing or receive information about the surgery, is everything explained thoroughly? 

If the doctor dismisses any concerns you may have, dismiss the doctor.

Having a good rapport with your physician will give you a better chance for a successful surgery

© 2016 Geoffrey Westrich, MD. All rights reserved.  


Friday, July 21, 2017

Named Top Knee Replacement Blog by Feedspot

Wow, we've been named a top blog about knee replacement by Feedspot, which lets users read all their favorite blogs in one place: http://blog.feedspot.com/knee_blogs/


Thank you for the honor, Feedspot!