Friday, July 31, 2015

Outpatient Total Knee Replacement Proves Popular With Patients

So far, 2015 is proving to be the year that the long held concept that hospitalization is required after total knee replacement has changed.

Half of our patients are choosing to go home on the day of surgery.  All have expressed a high satisfaction with their choice.  Nobody has had to be admitted to the hospital and the complications seen are not different than the hospital group.

How can this be ?

Advancements in multimodal pain management and anesthetic technique are the main drivers of this delivery model.  Perioperative nursing care is a close second.  Modifications in surgical technique also play a role.

Multimodal pain management refers to using opiods, neurontin, Zofran and IV Tylenol to keep our patients pain in check.

Anesthesia techniques include adductor canal nerve block and short acting spinal to stop pain before it happens.  Using medications like Zofran and minimizing opiod doses nearly eliminates nausea/vomiting.  People come out of the general anesthetic quickly, alert, with manageable pain.

Nursing before and after surgery guide the patient safely to a same day discharge.

Surgical techniques including less traumatic techniques, bleeding control with tranexemic acid and capsular injection with an anesthetic agent combine to make recovery faster.  

Healthcare delivery continues to evolve for the better.  Advanced Knee Care is leading the way into a better future for our patients.

Thursday, July 2, 2015

Male and Female Differences in Knee Injuries and Disease

Gender variances exist due to anatomic differences, hormones, and genetic factors.

ACL knee injuries occur at a higher frequency in female athletes - on the order of 3:1 vs age and sport matched males.

Osteoarthritis in the knee develops more frequently in women.  One explanation is that women lose healthy joint surface cells (articular cartilage) at 4 times the rate as men.  Obesity afflicts women more than men and this is one link to the greater incidence of knee OA.  Estrogen may play a role.

Thursday, June 25, 2015

Will Biologics Revolutionize Knee Treatments ?

PRP (platelet rich plasma) and BMAC (bone marrow aspirate concentrate is a source for mesenchymal stem cells)  are two examples of orthobiologics.  Both are offered as a new and unproven cellular treatment for knee conditions such as osteoarthritis, cartilage restoration, and patellar tendonitis.  Both are costly out of pocket services not covered by health insurers.  PRP is in the $600 range per treatment and BMAC is several thousand dollars.

The science is inconclusive with respect to both of these treatments.  PRP studies for treatment of tendon problems are the most suggestive that success can be acheived and PRP for knee OA strategies are still evolving (but stay tuned).

BMAC may help with meniscal regeneration and articular cartilage regeneration when combined with other growth factors.  Know that BMAC is a new treatment and results are likely to be variable.

Monday, June 15, 2015

Home DVT Prevention - Preventing Serious Complications After Knee Replacement Surgery

Advanced Knee Care, PC and Stefan D. Tarlow, M.D. strive to attain the best outcomes for our patients after major knee surgery such as Total Knee Replacement and Makoplasty (robotic partial knee replacement).   VenaPro home sequential compression device lowers the DVT risk during our patient's first 2 weeks at home.  Additionally, patients are treated with Aspirin at home for 14 days.    These devices wrap around both lower legs and use rapid air inflation to move the blood out of the lower leg, minimizing blood clots. The VenaPro device is used at rest (in bed or sitting on chair or couch) for 2 weeks.  No device is needed when walking normally. Utilizing both medication and mechanical compression, we now have a two pronged attack against DVT formation.

Today, we can lower DVT rates and save lives.  We call this high quality patient care in action.

Federal Safety Guidelines since 2008 have mandated that patients undergoing total hip or knee arthroplasty receive at least one of a list of prophylactic regimens for at least 10 days following surgery.

Options for Elective total knee or total hip replacement 
  • Aspirin
  • Low molecular weight heparin (Lovenox-injection)
  • Factor Xa inhibitor - (Xarelto-pill form)
  • Vitamin K antagonist (Warfarin-pill form)
  • Intermittent pneumatic compression devices (Venoflow Elite-Home device)
  • Low-dose unfractionated heparin (injection heparin)

Monday, June 8, 2015

ACL Torn Again After Surgery - Consider This

Research presented shows that 9 % of athletes can and do retear their surgical repaired anterior cruciate ligament.  

The overall rate of another injury within 2 years to the ACL—on the same or the opposite knee—is six times greater among athletes who undergo ACL reconstruction surgery and return to sport than among those who have never had an ACL tear. 

So if you are one of those 9 % consider your options.  Evolving research suggests that at the time of your second surgery you might need to have an AnteroLateral Ligament (A.L.L.) reconstruction in addition to a revision ACL.  Additionally, for some patients the position of the ACL graft needs to be repositioned slightly at the time of the repeat surgery to protect your knee from additional re-injury.  An orthopedic surgeon with experience in revision ACL surgery can help you 

* A few more facts ---- A study by Dr. Paterno in 2013 found the following.  Within the group of athletes who had undergone ACL reconstruction, researchers noted a trend for female athletes to be two times more likely to sustain an injury on the knee opposite the injured knee. Overall, 29.5 percent of athletes sustained a second ACL injury within 24 months of returning to activity, with 20.5 percent sustaining an opposite leg injury and 9 percent incurring a graft re-tear injury on the same leg. A higher proportion of females (23.7 percent) sustained an opposite leg injury than males (10.5 percent).