Friday, April 24, 2015

Are Patients More Fit After Total Knee Replacement Surgery ?

Contrary to popular conception, patients generally do not experience a reduction of body mass after surgery.  A study reported by Yong Qiang Jerry Chen, MBBS analyzed 7,733 patients after total knee replacement surgery.  

After surgery 14 % had a reduction in BMI, 65 % maintained their BMI, and 21 % had a gain in BMI.     Most patients either stayed the same or gained weight.  

This studies shows the importance of optimizing BMI prior to total knee replacement surgery since 86 % of patients will not lose the weight by eating better and exercising more after surgery.  

Long term health and good outcomes after knee replacment surgery is improved in patients that have optimal BMI, have healthy eating behaviors, and exercise on a regular basis.

Friday, April 17, 2015

It Is Safe to Go Home After Total Knee Replacement

Two studies presented this week at the AAOS Annual Meeting support discharge to home after knee replacement.  One study showed that knee function (walking, bending) was not improved by inpatient rehab and the other showed that healthy patients that went home did not suffer serious complications.

One study by Douglas Padgett, MD looked at nearly 8,000 Total Knee patients and found that rehabilitation and prescribed exercises can be done just as well at home/outpatient physical therapy.  There is no evidence to support the routine use of inpatient rehab facilities or extended care facilities.  The stiffness rate (need for manipulation under anesthesia) was 4 % for each group.

Another study showed that early discharge to home did not increase the 30 day readmission rate.  This is further information to support that bad things do not happen to Total Joint replacement patients that were discharged to home as same day patients.  Same Day Total Knee Replacment appears to be a safe alternative to inpatient hospitalization for the same procedure.

Friday, April 10, 2015

Antibiotics Not Needed Before Simple Knee Arthroscopy

A poster exhibit at the AAOS Annual Meeting looked at the question:  Should Preoperative Antibiotics Be Given in Simple Knee Arthroscopy?

The answer was "NO".

The risk for allergic reaction, cost, development of resistant bacteria, and medication administration errors all can be avoided by avoiding antibiotics for this purpose.

The study looked at 40,000 + patients over 5 years.  Only 36 patients developed serious infections (less than one in a thousand).

Simple knee arthroscopy is defined as  diagnostic arthroscopy, partial menisectomy, chondroplasty, meniscal repair, lateral release or synovectomy.

Friday, April 3, 2015

Makoplasty Unicompartmental Knee Mimics Natural Knee

Front view after medial Makoplasty
Dr. Tarlow attended a course titled "Update on Unicondylar Knee Replacement" this past week at the annual meeting of the American Academy of Orthopedic Surgeons.

The best surgical outcomes are in unicompartmental knee patients. Uni patients have a higher satisfaction score,  lower chance of infection, stroke, heart attack, blood transfusion, blood clot and death rate compared to total knee replacement patients.

The appeal of the unicompartmental or partial knee replacement also known as Makoplasty can be summarized in the following thoughts.

Makoplasty replaced knees compared to Total Knee Replacement:

  • Retain more normal knee tissue - including the ACL and PCL ligaments
  • There is less bone resection
  • Smaller incisions
  • Less pain/quicker recovery
  • improved, often times normal knee motion
  • Less expensive

2014 study from Germany showed unicompartmental knee closely preserves natural knee kinematics in vitro.

2015 study from New York showed Unicompartmental knee arthroplasty is an economically attractive alternative in patients sixty-five years of age or older, and modest improvements in implant survivorship could make it a cost-effective alternative in younger patients.

Most studies comparing unicompartmental knee replacement versus total knee replacement find a slight preference in favor of unicompartmental knee.  

Friday, March 27, 2015

Opiate use in America: Time to Do Something

Pain is the cognitive, emotional and behavioral response to actual or potential damage to body tissue.
The variation of this response from one person to the other can be night and day.

After an ankle fracture surgery patients in the Netherlands usually take Tylenol while in the Unites States the same category of patient usually takes Percocet, a strong opiate.

80 % of the world's opioids are taken in the U.S..  This high level of use is associated with a high level of abuse and death related to this category of drug.

Part of this difference is mindset:  The Netherlands patient thinks "this is going to hurt" and the U.S. patient thinks "why am I hurting?".

Culture change created this U.S. epidemic.  Together we might affect culture change to solve this social issue.