Knee Replacement Can Lead to Longer Life

Post provided by Medscape Medical News

Patients with severe osteoarthritis of the knee who undergo knee replacement have a 7-year mortality rate that is half that of those who don't undergo the procedure, researchers reported at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.

"This is more good evidence for the benefits of knee arthroplasty," lead researcher Scott Lovald, PhD, told Medscape Medical News.

Dr. Lovald and his colleagues from Exponenet, a private consulting firm in San Francisco, California, were hired by Biomet, which makes products for knee arthroplasty, to analyze the costs and benefits of the procedure.

They looked at a 5% sample of patients insured by Medicare to identify those with osteoarthritis of the knee. They divided these patients into those who did not undergo total knee arthroplasty and those who did from 1997-2009.

They looked at the patients' data for up to 7 years to compare their health statistics and to measure how much they spent on healthcare.

Over the 7 years, they found that the Medicare payments for patients who did not get knee replacments totaled $63,940; for those who did get knee replacements, they were $83,783- a difference of $19,843.

What did that money buy? The most dramatic difference between the 2 groups was in mortality.

Those with knee replacement had half the 3.1% 7-year mortality rate of those who did not.

Also, those with knee replacements had a slightly lower rate of heart failure at 3 years.

"Many would consider that a cost-effective treatment," said Dr. Lovald.

However, both groups had roughly the same rate of diabetes.

In addition, those with knee replaced knees had a higher rate of depression in the first year after the procedure, although this difference faded in the subsequent years.

The study does not prove that knee replacement reduces mortality or heart failure rates, Dr. Lovald acknowledged. The patients who had knee replacements might have been healthier to begin with than those who did not, he pointed out.

Marc DeHart, MD, clinical assistant professor of orthopaedic surgery at the University of Texas in Galveston and partner at Texas Orthopedics, Sports and Rehabilitation Associates, told Medscape Medical News that it makes sense that knee replacements would lead to longer lives. "You are able to walk and exercise more," he said. "That would help with the most common causes of death, which are cardiac."

He cautioned, however, that knee replacement surgery has not been shown to reduce body mass index. This could account for its failure in this study to change the rate of diabetes, he said.

The increased depression in the first year could be related to the long recovery period from the procedure, and perhaps to patients' high expectations. "It could be that they had expectations that the knee replacement would do more than ease the pain," he said.

A limitation to this type of study, which culls information from a database rather than enrolling patients who can be interviewed, is that it's hard to get answers to questions like this, he said.

Still, Dr. DeHart was impressed by the powerful benefits of knee replacement surgery, compared with its cost. In fact, knee replacement could be even more cost-effective because this study did not take into consideration the expense of prescription drugs, which could be higher in people who don't have the procedure because they likely need more pain control.

FREE Joint Replacement Seminar this Thursday

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, March 1st
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Tyler Goldberg, MD

Please RSVP by registering online or call 439-1100.This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on April 5th!

Geometry, Not Gender

Post provided by American Academy of Orthopedic Surgery.

Much orthopaedic research has been devoted to determining why women are far more susceptible to knee ligament injuries than men. According to a new study, the answer may lie in geometry – the length and shape of a patient’s knee bone – more than gender.

Research recently published in the Journal of Bone and Joint Surgery (JBJS), compared magnetic resonance imaging (MRI) scans of male and female athletes with non-contact anterior cruciate ligament (ACL) injuries with those of athletes who participated in similar, at-risk sports but without a history of ligament injury.

The ACL is a ligament that runs through, and stabilizes, the middle of the knee joint. While the ACL can be injured through contact, it is most commonly strained or torn without contact, when a person suddenly changes direction, stops abruptly or lands incorrectly after a jump, such as in soccer, basketball and skiing.

The study found that most of the women (those who had ACL injuries and those who did not) and only the ACL-injured men shared a common geometry on the outside of their knee joint: The upper part of their shin bone at the joint (tibial plateau) was much shorter and more rounded. This may help to explain why women have an ACL injury rate that is two-to-five times greater than that of men.

“A lot of people who have ACL tears have a high degree of laxity (loose ligaments) in their knee joints,” said Christopher J. Wahl, MD, the study’s lead author and an orthopaedic surgeon and team physician in the Department of Orthopaedics and Sports Medicine at the University of Washington, Seattle.

“When I started looking closely at the MRI images of the ‘lax’ individuals, the tibial plateau seemed very rounded and very short compared to those patients with stable knees,” said Dr. Wahl. “The outside of the knee joint almost doesn’t make sense—it is a round surface resting on a round surface—like a ball on a ball. This would seem to be inherently unstable.

“We were surprised to find that statistically, most of the women in the study share that geometry, even if they hadn’t been injured. However, only some men have this geometry, and they were the ones who got ACL tears,” said Dr. Wahl. “Put a different way, instead of asking why all females are more prone to ACL injuries, we might consider why only some men are. The male geometry is more variable than the female’s in this respect.”

The findings also may explain why women have a higher rate of ACL injuries, and yet the rate of re-injury is the same among men and women.

Patient Stories Needed!

The American Academy of Orthopaedic Surgery is launching a new public awareness campaign called "A Nation in Motion: One Patient at a Time." The campaign will tell the stories of patients across the country whose lives have been saved or restored by orthopaedic care.

The physicians of Texas Orthopedics would love for our patients to submit their story! To submit a story, visit www.anationinmotion.org before Friday, March 23, 2012. You can even submit a video or picture of you doing what you love!

If you would also like to share your story and photo on our Facebook page, like our page today and post on our wall "Because of my orthoapedic care, I can _________."

New Year's Resolution Camp

Texas Orthopedics has a new seminar to help patients with the #1 New Year's Resolution! Join us the fourth Tuesday of every month from 6-7pm at our Northwest Austion location to learn more about weight management, healthy eating and exercise from orthopedic surgeon Dr. Barbara Bergin and personal trainer and dietician Tom McLernon at NYR Camp!

NYR Camp is a FREE seminar to help you learn how to live a healthy lifestyle. Bring your family and friends.

RSVP TODAY 439-1100

Date: Tuesday, February 28th

Time: 6-7 pm

Location: 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759

Welcome South Austin Orthopaedic Clinic to our Team!

Texas Orthopedics is proud to welcome South Austin Orthopaedic Clinic to our team effective January 1, 2012.

Doctors J. Clark Race, David Savage, Robert Blais and Greg Westmoreland will see patients at our South Austin office located at 3755 South Capital of Texas Hwy., Ste. 160. Their current location on Westgate Blvd. will close.

Shoulder Pain

Post provided by Dr. John McDonald

Many active patients are disappointed that while trying to stay fit by working out, exercising with a trainer, or playing weekend sports, they actually can develop pain in the shoulder. This type of pain can be a debilitating problem for many recreational athletes. There are several common causes that force even fit people to cut back on their activities. The most common cause of pain in these patients is a combination of rotator cuff tendinitis and impingement syndrome.

There is a small fluid filled sack called a bursa above the ball and socket shoulder joint but underneath the acromion (bone you can feel at the top of the shoulder). Everyone has these bursa sacks almost anywhere in the body where there is a bony prominence, but they do not get inflamed unless a trauma is sustained. The rotator cuff is a group of tendons that attach the small muscles in the shoulder to the humerus (upper arm bone). When active people constantly do things above shoulder level (weight lifting, aerobics, throwing a ball) often this bursa and these tendons can be pinched between the acromion and the humerus. This phenomenon can be worsened by a narrowed space for the bursa due to the shape of the acromion. Repetitive overhead activities cause the bursa to fill with fluid and become inflamed and painful. The pain is typically in the front and side of the shoulder and can radiate to the upper arm. Often, patients have difficulty even with daily activities including washing their hair, reaching for something in the cupboard, or reaching behind their backs.

There are many effective treatments which include physical therapy for rotator cuff strengthening, icing, and anti-inflammatory medicines. Occasionally, a steroid injection can calm down the inflammation in the bursa which can improve the outcomes of physical therapy. Arthroscopic surgery is sometimes necessary if the symptoms fail to resolve. It can be done through several small incisions with the use of a camera. The inflamed bursa is removed and the underside of the acromion is removed to create more space for the rotator cuff. The rehabilitation from surgery typically allows for return to full activities by 6-8 weeks.

The key for recreational athletes is not to ignore shoulder pain. Impingement can become a nagging problem and can significantly affect not only your recreational sports but also your daily life.