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.  


Wednesday, March 1, 2017

Arthritis "Treatments" to Avoid

Advertisements for treatments claiming to cure or slow down arthritis can be found on the Internet, on television and in print ads. They include drinks, certain supplements and rubs. Most are a a waste of money. 
The ads target people in pain who want to avoid surgery. The problem is, the longer people wait, the worse their arthritis can get. In the beginning, even if these bogus remedies provide a false sense of security, people are actually worse off because they are not receiving the proper care.
The bottom line is that patients should be wary of any advertisement for a product claiming to cure arthritis.
Supplements such as glucasomine and chondroitin, more in the mainstream, are also purported to slow the progression of arthritis. However, in 2013, the American Academy of Orthopaedic Surgeons added these supplements to the list of treatments that provide little benefit.

Knee lavage or “washing out the knee” has also received a thumbs down from the American Academy of Orthopaedic Surgeons. The procedure has not demonstrated any benefit and should not be performed to relieve arthritis. People should be wary if a doctor recommends it.
Another useless “treatment” for arthritis is arthroscopic surgery, with tiny incisions and supposedly a quick recovery.  Although certainly much easier than joint replacement for both the patient -- and the surgeon performing the procedure -- studies show, and we know from experience, that arthroscopic surgery is of no benefit for arthritis and can actually make the pain worse. 
Arthroscopic surgery may be considered to fix a torn meniscus cartilage that is causing symptoms, such as locking or catching in the joint, that physical therapy has not helped. But for someone with arthritis, an arthroscopic procedure is of no benefit.
And not only is it useless, it often makes the condition worse. Every surgery carries some element of risk, so don’t be fooled by the words “minimally invasive.” Countless arthritis patients have come to me after arthroscopic surgery exacerbated their knee pain. One patient developed severe swelling and fluid in her knee after arthroscopy and needed to go back to the doctor every week to have it taken out with a needle, a very uncomfortable procedure.
Surgery is surgery, and all operations have risks and benefits. If an orthopedic surgeon tells you arthroscopic surgery will relieve arthritis pain or buy you time, find another doctor. In fact, if you’re ever unhappy with a doctor, go elsewhere. And it never hurts to get a second opinion, especially when surgery is being considered.
The only tried and true treatment for advanced bone-on-bone arthritis that's causing severe pain is joint replacement. Sometimes, if the arthritis is limited to just one area of the knee, we can do a partial joint replacement, and this is usually easier on the patient. The recovery is generally faster; plus, we preserve more bone.
It’s important to get the proper diagnosis sooner, rather than later. If people wait too long, the joint continues to deteriorate, and a partial knee replacement may no longer be an option. At that point, a total joint replacement will be necessary to relieve pain and restore mobility.©
© 2016 Geoffrey Westrich, MD. All rights reserved.