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!

Friday, May 5, 2017

Study: Could IV Acetaminophen Reduce the Need for Opioid Medication After Hip Replacement?

When considering joint replacement, many patients worry about how much pain they’ll experience after surgery. It’s a valid concern. Pain control is important not only to avoid discomfort. It’s also essential to get a handle on pain early on so patients can move around and engage in a physical therapy program.  

At Hospital for Special Surgery, we’ve studied pain control at length and have excellent pain management protocols for patients who have joint replacement.  We generally strive to lower patients’ use of narcotic medications known as opioids. Although these medications do a good job at controlling pain, they can have side effects such as nausea, vomiting, dizziness, drowsiness and constipation, which are not only unpleasant, but can make physical therapy more difficult.

At Hospital for Special Surgery, we just launched a study to see if intravenous (IV) acetaminophen can reduce the amount of opioid pain medicine needed after hip replacement surgery. Currently, joint replacement patients generally receive opioids along with the pill form of acetaminophen, commonly known as Tylenol.

We decided to undertake this study because research shows that giving acetaminophen in IV form reaches a higher peak concentration in the blood much faster than oral acetaminophen. Therefore, it may be better at reducing pain than the pill form. 

All study patients will receive the standard pain control protocol, with one group getting IV acetaminophen, while the other group receives the oral pill form. Our goal is to see if intravenous acetaminophen works better than the pill form and can lead to lower doses of opioid medication and more rapid attainment of physical therapy goals.

In addition to seeing if IV acetaminophen can reduce the need for opioid medication, we will be measuring sedation effects, length of hospital stay, and the achievement of physical therapy milestones in patients given intravenous vs. oral acetaminophen.  

Because of its efficacy, general safety and lower risk of adverse effects compared to other pain medications, IV acetaminophen could be an attractive component of the overall pain management plan. If we find that the IV form safely reduces the need for opioid medication, it would be advantageous for hip replacement patients.

For more information about Dr. Westrich and hip replacement, visit: www.westrichmd.com

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Friday, March 10, 2017

Considering a Double Knee Replacement? Here’s What You Need to Know

Orthopedic surgeons perform almost 700,000 knee replacements in the United States each year. The procedure has a high success rate, alleviating pain and restoring an active lifestyle. It’s fairly common for patients to have arthritis in both knees, and they often decide to have both of them replaced. The dilemma many people face is whether to have surgery on both sides at the same time, a procedure referred to as “bilateral knee replacement,” or two separate operations.

I always advise people to carefully weigh the pros and cons of each option. Many people want to have a double knee replacement because they feel they can get it over with faster since there’s one surgery, one hospital stay and one course of rehabilitation. For the right patient, it’s a good option. However, double knee replacement is not for everyone, and people should be well-informed before making a decision.                

Studies show that bilateral knee replacement is a more risky procedure and the complication rate is higher. Rehabilitation is also much more demanding. Candidates must be in excellent physical condition, aside from the arthritis, with no underlying health problems.    

Not too long ago, people thought that if you had one knee replaced, the pain and rehab would be so taxing you wouldn’t want to come back for surgery on the other knee. But nowadays, with advances in surgical techniques, anesthesia and pain management, the recovery for a single knee replacement at a high-volume joint replacement center is much easier and faster than it was in the past. In our experience, virtually every patient comes back for the second knee replacement. Patients generally wait at least three months in between surgeries.
                                                               
Know What to Expect

Overall, the success rate is high for same-day double knee replacement, but patient selection is important. It should be out of the question for patients of any age with diabetes, heart or lung problems, or any other serious medical condition.

Patients who meet the criteria need to know exactly what to expect so they can make an informed decision about same-day double knee replacement. The recovery and rehabilitation after bilateral knee replacement are much more challenging because greater physical and emotional strain is placed on the body. The rehab is also much more difficult because patients can’t rely on a stable leg for support.

Another consideration is where an individual will receive physical therapy. Bilateral knee replacement patients almost always spend time in a rehabilitation facility after surgery, while those who have a single knee replacement often go straight home from the hospital and receive physical therapy at home.

Whether having two separate knee replacements or both sides replaced simultaneously, the orthopedic surgeon should have a detailed discussion with the patient about what to expect.

Because of the special considerations involved in double knee replacement, it's especially important to choose a highly experienced orthopedic surgeon who specializes in knee replacement. 

Patients should also choose a hospital that performs a high volume of joint replacements, such as Hospital for Special Surgery. The entire staff will be accustomed to dealing with the needs of double knee replacement patients before, during and after the surgery.©

© 2016 Geoffrey Westrich, MD. All rights reserved.