Geoffrey Westrich, MD

Blood loss and the need for a blood transfusion are concerns in joint replacement surgery, but a new use for an old drug is proving effective in reducing blood loss and transfusion rates, according to a study we conducted at Hospital for Special Surgery. The drug, tranexamic acid, or TXA, has been used for decades in heart surgery, to treat hemophilia and to stop excessive uterine bleeding. After reviewing thousands of patient records, we found that TXA was safe and effective, reducing the need for a blood transfusion by more than 50 percent. The research was just presented at the annual meeting of the American Academy of Orthopaedic Surgeons. TXA is classified as an “anti-fibrinolytic,” or blood clot stabilizer, whose mechanism of action reduces bleeding. TXA should not be used in patients who have a cardiac stent or in those who have had a previous blood clot. We reviewed the records of 4,449 patients who had hip or knee replacement over a six-month period. ...

Knee pain is a very common problem. If your knee has been bothering you for a while or keeping you from activities you enjoy, the new year is a good time to take action. I encourage you to resolve to get the right diagnosis; resolve to take action to relieve the pain ; resolve to live life to the fullest, life pain-free. For some people, strategies such as physical therapy and weight loss may bring so much improvement, they will feel like they have a "new" knee. For others with severe arthritis and constant pain, a "new knee" in the form of a joint replacement may be the best option to eliminate the pain once and for all. Basically, there are two types of knee pain. "Acute" pain is what we experience after a sudden knee injury. When this happens, people are advised to follow the regimen known as RICE:   Rest, Ice, Compression and Elevation. They should rest their knee, apply ice on and off, and keep the joint elevated over the level of their hear...

Increasing numbers of younger people are opting for knee replacement, unwilling to take arthritis pain sitting down. S urgical 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 su...

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 fractu...

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 ...