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.