Tuesday, June 9, 2015

Computer-Assisted Knee Replacement Surgery Benefits Patients Who Refuse to Take Arthritis Sitting Down

Increasing numbers of younger people are opting for knee replacement, unwilling to take arthritis pain sitting down. Surgical advances such as computer-assisted surgery have made it a viable option for people in their 40s and 50s.  

The main concern in younger individuals is that the implant will wear out. Although a knee replacement can last 20 years or even longer, it doesn't last forever. However, computer-assisted knee replacement, which makes the surgery ultra-precise, may prolong the life of the artificial joint.

The highly advanced, surgeon-controlled MAKO robotic system enables an extremely precise alignment and placement of the implant in patients who are candidates for a partial knee replacement, a less invasive surgery that is possible if the arthritis is limited to just one arthritic area of the knee.  

Before surgery, CT scans are taken of each patient's knee to assist surgeons in pre-planning the procedure. During surgery, a robotic arm uses computer-guided mapping software, similar to GPS, integrated into the surgical instruments. This gives each patient a surgery tailored to his or her individual anatomy.

Three dimensional high-definition visualization and the robotic arm guide the surgeon with visual, tactile, and auditory feedback. The digital tracking system constantly monitors and updates the patient’s anatomy and enables the surgeon to make real-time adjustments to optimize implant positioning and placement and to restore biomechanical alignment and joint motion.          

It is believed the computer-assisted surgery will allow the knee replacement to be implanted more accurately and therefore enable it to last longer since the implant will experience less wear and friction. Another advantage is that the robot-assisted procedure enables more bone to be preserved, an advantage in the event another knee replacement is needed down the road.

One patient who had a partial knee replacement in her early 50s periodically sends me photos of herself hiking and even rock climbing. Several years after the procedure, she’s doing great. Her case is dramatic. For most people, just being able to be pain-free and engage in everyday activities makes their quality of life so much better.  

Tuesday, May 5, 2015

What You Need to Know About Revision Surgery

Hundreds of thousands of hip and knee replacement surgeries are performed in the United States each year, and they are highly successful in eliminating pain, restoring mobility and improving quality of life.

Joint replacement, in which an orthopedic surgeon replaces the arthritic areas of a joint with a metal, plastic or ceramic implant, has changed many lives for the better.
The implants used in joint replacement may last up to 15 or 20 years, but they generally don’t last forever. When the implant wears out, people often need a second surgery in which the existing implant or components are taken out and replaced. This is called a revision surgery.   

Sometimes, a revision surgery is needed sooner, and the main reasons include:

  • Loosening of the implant. The hip or knee replacement may become painful after many years because the components have begun to wear and loosen.
  • A fracture. A fall or severe blow can cause a fracture of the bone near the hip or knee replacement.
  • Dislocation. If the implant dislocates on repeated occasions, revision surgery is frequently needed to stop this from happening.
  • Infection. This can be a serious complication. If a deep infection develops in a hip or knee replacement, revision is often needed to eradicate the infection and to implant new non-infected components.
  • Implant recall.  On occasion, the implant used in joint replacement is found to have a problem and patients who received it are advised to be monitored by their physician to make sure it does not need replacement. Revision surgery is sometimes, but not always, necessary when an implant is recalled.
Patients should be aware of warning signs that there may be a problem, such as pain that comes on suddenly or trouble getting around. They also may have decreased range of motion. Anyone with a joint replacement experiencing these symptoms should see their doctor immediately.
A revision surgery is more complex than the initial operation, and a certain level of skill and experience are required. Many physicians who perform primary joint replacements refer their patients to an expert in revision surgery, if needed. Over the past two years, I have seen an increase in the number of patients coming to me for the procedure.
If someone needs a revision surgery because of an infection or other serious issue, it is critical to find an orthopedic surgeon who performs many of these operations, preferably at a hospital such as Hospital for Special Surgery, an orthopedic specialty hospital and joint replacement center.
Patients often ask if there are steps they can take to make their initial hip or knee replacement last longer. A number of factors are within a patient’s control to increase longevity and avoid problems requiring a revision:
  • Avoid overusing the joint.  Patients are advised to avoid high impact activities, such as running and singles tennis, which can shorten the lifespan of the joint replacement. Walking for exercise is better than running; opt for doubles instead of singles tennis.
  • Avoid sports in which jumping and landing hard can damage or weaken the joint, and engage in nonimpact activities that build muscle strength.
  • Maintain a healthy weight.  Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.
  • Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly.
  • If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your medical doctor for appropriate antibiotics.
  • Pay a visit to your orthopedic surgeon every few years after hip or knee replacement, even if the joint feels good.  The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation. 
  • Have your primary hip or knee replacement with an experienced surgeon who specializes in the procedure and at a center that performs a high number of joint replacements to ensure the best outcome and lower the risk of complications.
For more information, visit Westrichmd.com.


Thursday, February 26, 2015

Allergic to knee replacement? Uncommon, but people can be allergic to the metal in the implant.

Extremely weak and in terrible pain, a 56 year-old patient traveled from her home in the Philadelphia area to New York City to see me at Hospital for Special Surgery (HSS). Diane came in for a consultation after a nine-month ordeal that started after a double knee replacement at another hospital. Suffering from severe arthritis, she opted for the surgery after learning from her research that the procedure has a very high success rate in eliminating pain and restoring mobility.

Diane chose to have the operation on both knees at the same time.  But months later, instead of getting better, her knees still ached. And now the pain was spreading throughout her body to her shoulders, arms and legs.  She got weaker and weaker. Four months after knee replacement, she could no longer get dressed without assistance, pick up a half-gallon of milk or turn over in bed. She says she became a different person -- terribly weak, in constant pain and very unhappy.
It turned out she was allergic to the metal in the knee implants, and this was causing the severe symptoms throughout her body. 

For Diane, it took nine months of searching for answers, of being told ‘you had knee surgery, you’re supposed to be in pain,’ and of being made to believe she was a nuisance to the doctors she pleaded with for help.
She says when her original orthopedic surgeon refused to take her complaints seriously, she called numerous orthopedists in the Philadelphia area, only to be told they would not see her before a year went by.

Diane was prescribed so many medications, she lost count. “Of course, nothing helped,” she recalled. “I became weaker and weaker and thought I would soon be in a wheel chair. I didn’t think I’d be here now. I’m a realist. I told my husband my body was shutting down and I was going to die.”
She was finally referred to me and traveled to HSS.  When blood tests confirmed Diane was highly allergic to nickel and cobalt, I replaced the implants in both her knees using prostheses that did not contain those metals.

The first revision surgery on her left knee took place in January 2014. After the surgery, week by week, her pain diminished. In May, she had the second revision surgery.  By July, she says her pain was almost gone. She says she is now doing well, has regained the use of her arms, can run errands and walk through a shopping mall. She can once again visit her mother who lives in a nursing home.

Fortunately, her severe symptoms resolved once we replaced the metal implants.  It’s important for any patient who has a problem after joint replacement to see their doctor and insist on being taken seriously.
Diane says the ordeal has taught her that you need to be your own advocate, and now she wants to help others who “may be in the same boat.”

Although severe reactions to metal implants are rare, orthopedic surgeons are advised to ask patients if they have ever had a reaction to metal, such as costume jewelry. If the answer is yes, the orthopedic surgeon can select an implant that does not contain a specific metal, most commonly cobalt and nickel. If there is any doubt, patients can be tested to see if they may have a specific metal allergy.
If the doctor dismisses the patient’s concerns, the individual should find another physician, preferably at a joint replacement center that does many, many procedures and is used to dealing with complications. And it is truly best to have the surgery done in such a joint replacement center in the first place for the best chance of a good outcome.

To see a TV report on how Dr. Westrich helped Diane, click here.

Wednesday, January 28, 2015

When the Weather and Walkways are Treacherous, Slow and Steady are the Way to Go

      The snow storm and freezing temperatures have turned many streets into obstacle courses. Piles of snow, slippery slush and patches of ice litter many streets and sidewalks, presenting hazardous conditions that could lead to a fall if people aren’t careful.
      An invisible patch of ice is an accident waiting to happen. I've seen many injuries from a fall. Sprains and broken bones land more people in the doctor’s office or the hospital this time of year.
      Everyone should exercise caution when the streets turn slippery this time of year. People often forget how dangerous a fall can be, especially when they’re in a hurry to get somewhere. Even if much of the snow and ice are removed, there are always some slippery surfaces to watch out for.
       Here are safety tips to avoid injury:
  • Wear shoes or boots that provide traction on snow and ice, such as those with rubber and neoprene composite soles. Avoid plastic and leather soles, smooth-soled shoes and, of course, high heels.
  • Walk at a safe pace. Give yourself enough time to get to your destination without rushing.
  • When given no choice but to walk on ice, take short steps or shuffle for stability. Look where you're going.
  • Watch for icy patches, especially on the north side, that remain even if the sidewalk or parking lot has been cleared of most snow and ice. Areas that do not get sufficient direct sunlight, and spaces where snow accumulates (such as near roadside curbs or between parked cars) remain icy long after the rest has melted or has been removed. 
  • Footwear should keep feet dry, warm and comfortable and provide good support. 
  • Walk in designated walkways as much as possible. Don't take shortcuts or try to jump over piles of snow. 
  • Keep your field of vision clear. Hats should not cover your eyes. You should be able to close your coat sufficiently so you can easily see where you are going. 
  • Make sure belts and scarves don't drag on or near the ground where they can cause you to trip. Use a cane or walking stick to help stabilize your balance if you need to.
  • Snow and ice accumulate on stairways. Always use hand railings. Look where you're stepping and place feet firmly on each step.
  • When you’re in your car, try to park where it is clear of snow and ice. 
  • Use special care when entering and exiting vehicles. If necessary, use the car for support.
  • Do not overload yourself with packages. Anything that throws your balance off increases the risk of falling. Make several trips to the car to unload it, rather than carrying everything at once.
  • Older people, who at particular risk of a debilitating fracture, should try to keep driving to daylight hours so that they are able to see patches of ice on streets and in parking lots. 
  • Remember that some medications, like allergy/cold medicines, certain painkillers, and others can make you groggy or dizzy, reducing your ability to maintain your balance on slippery surfaces.
  • If your vision isn’t perfect, wear your glasses so it is easier to see potential hazards.
  • Be especially watchful for "black ice" - that almost invisible sheet of ice that forms after roadways thaw and refreeze. The road, sidewalk, or parking lot may look like they are simply wet, when in fact the thin ice on the surface is extremely slick.   
  • When entering buildings, remove snow and water from footwear to prevent wet slippery conditions indoors.
          At Home:
  • Keep walkways free of obstacles, such as snow shovels, other outdoor tools, sleds and other toys. 
  • Provide sturdy handrails on all stairways to porches or doorways. 
  • Spread a layer of sand, salt, gravel, cat litter, etc. to provide extra traction on the ice, and to promote melting.
        A detailed tip sheet on fall prevention in the home, as well as outdoors, is available on my website: www.westrichmd.com.