Two types of regional anesthesia do not make patients more prone to falls in the first days after having knee replacement surgery as some have previously suggested, according to a study based on nearly 200,000 patient records. Regional forms of anesthesia – spinal or epidural (neuraxial) anesthesia and peripheral nerve blocks (PNB) – which only numb the area of the body that requires surgery, provide better pain control and faster rehabilitation and fewer complications than general anesthesia, research shows. But some surgeons avoid using them due to concerns regional anesthesia may cause motor weakness, making patients more likely to fall when they are walking in the first days after knee replacement surgery.
Same-day bilateral knee replacement surgery is safe for select patients with rheumatoid arthritis, researchers from Hospital for Special Surgery in New York have found.
Generally, patients with an inflammatory systemic disease such as rheumatoid arthritis (RA) are sicker than patients with the degenerative condition osteoarthritis (OA), says senior study author Mark Figgie, M.D., chief of the Surgical Arthritis Service at Hospital for Special Surgery, and the hospital's first Allan E. Inglis, MD, Chair in Surgical Arthritis.
The number of total knee replacement (TKR) procedures continues to climb, as does the number of revision total knee replacement (RTKR) surgeries.
Elderly and female patients with a moderate number of comorbidities represented the largest proportion of the revision population. The authors suggest that optimizing patient health before surgery and paying meticulous attention to efforts by the surgical team to minimize the risk of periprosthetic joint infection may decrease the number of knee replacement revisions.
Each year, approximately 600,000 total knee replacement procedures are performed in the United States, a number that is expected to rise in the next decade as the population ages. For the first time in the United States, an iASSIST system is now in use. iASSIST is a computer navigation system with Bluetooth-like technology that improves surgical precision and accuracy in total knee replacements, decreasing the need for revision surgery.
Certain types of bone fractures have the potential to put you at risk for further bone fractures — even on a different part of your body. Wrist and hip fractures are one of these combinations. A recent study found that patients who have suffered a Colles' wrist fracture are at a significantly higher risk of experiencing a hip fracture, compared to people who have not had a Colles' fracture. The researchers found that osteoporosis (bone disease) is a risk factor associated with hip fracture, especially if a patient has had a Colles' fracture and has osteoporosis.
Chemical compounds synthesized in the laboratory, similar to those found in cannabis, could be developed as potential drugs to reduce the pain of osteoarthritis.
These compounds could also reduce joint inflammation, according to new research carried out at the Arthritis Research UK Pain Centre at The University of Nottingham.
Multidisciplinary pain treatment has been shown in a recent study to one way to aid patients following total knee arthroplasty and total hip arthroplasty procedures.
In the study, investigators found that multidisciplinary pain treatment (MPT) “has beneficial short-term and mid-term effects on subjective pain intensity, physical capability and depression levels in patients with persistent pain after joint arthroplasty,” lead author Christian Merle, MD, MSc, and colleagues, wrote.
Merle and colleagues conducted a retrospective study that followed 40 patients (mean age 62 years) with persistent unexplained pain following total knee arthroplasty (TKA) or total hip arthroplasty (THA) that previous treatments were unable to rectify. The procedures were performed between April 2007 and April 2010.
The evaluations, which were done before MPT, after 3 weeks of MPT and at 32 months mean follow-up, focused on the patients’ pain intensity, physical capability and psychological status, according to the study.
All the scores used showed a significant improvement at the completion of MPT over the baseline pain scores. At 32 months’ follow-up, pain intensity, physical capability and depression levels deteriorated slightly, but were significantly better than at baseline.
The results showed 79% of the 34 patients available for final follow-up reported a reduction in pain on the Numeric Rating Scale of 0.5 to 5.0 points. All patients reported pre-MPT NSAID use, 41% of patients continued to use NSAIDs and15% of them reported using opioids after 32 months.
Because MPT helps to alleviate unexplained pain following TKA and THA, Merle and colleagues noted in the study it may help patients avoid exploratory revision surgery.
Hip instability can be successfully managed using a six-part algorithm that helps surgeons identify and treat variations in instability, according to a presenter at the Current Concepts in Joint Replacement Winter Meeting, here.
“Our conclusion, then, is this demonstrates a six-part algorithm for treating an unstable hip,” Wayne G. Paprosky, MD, said. “We think it is probably one of the most successful series of its size. We are now advocating the use of tripolar constrained liners where possible, especially in these type III abductor deficiencies.”
Paprosky and colleagues performed a retrospective analysis of 77 consecutive hip arthroplasties that were revised due to instability, according to the abstract. They identified six variations of instability and placed patients in numbered from one to six based on the etiology of the instability, which included acetabular component malposition, femoral component malposition, abductor deficiency, impingement, late wear, or “unclear etiology.”
Once the instability was identified, type I and II instabilities were treated with component revision, type III and VI instabilities were treated with a constrained liner, type IV instabilities were treated by removing the impingement and type V was treated with a liner change.
The success rate was 84.4% for all treatments of instability. When treatment for type III abductor insufficiencies were removed, which accounted for 8 of 12 revisions in the study, the success rate was 92%, according to the abstract.
Obese patients have high risk of complications after TJR, but high BMI does not contraindicate surgery
Obese patients who undergo total joint replacement have a higher risk of complications, but there is no body mass index level where the surgery would be contraindicated, according to a recent presentation, here.
“We understand that notable obesity increases most complications,” Daniel J. Berry, MD, said at the Current Concepts in Joint Replacement Winter Meeting. “There is no [body mass index] BMI threshold, but we should use good judgment in whether we operate on patients at a high BMI, and remember the rate of complications seems to rise fast above a BMI of 40.”
For patients who undergo total hip arthroplasty, complications such as nerve injury, infection and wound healing are increased, according to the abstract. Berry noted that although obese patients have lower functional and activity scores compared to nonobese patients, obese patients start with lower functional and activity scores so pain relief and postoperative change is comparable.
Berry said strategies for patients to lose weight before joint replacement surgery include diet and bariatric surgery. However, he noted weight loss through surgery may result in a patient who is malnourished. If a surgeon decides to perform total joint replacement surgery on an obese patient, Berry recommended optimizing metabolic, wound and anticoagulant management to reduce postoperative complications. Overall, he said it is important to include the patient in the decision-making process.
“Use good surgical judgment, consider carefully in each patient [whether] the risks are greater than the benefits and engage the patient in the shared decision-making process,” he said. “They understand they have a high body mass index. It is helpful for them to be engaged in the discussion so whatever the outcome of surgery they feel like they participated in the decision.”
While knee replacement surgery can help to improve mobility, there can be complications connected to this procedure. And some patients may be at a higher risk for experiencing these complications than others. A recent study found that being older, having diabetes and being obese were significant risk factors for death or experiencing complications like wound infections in the 30 days after knee replacement surgery. The authors of this study noted that patients and physicians should be mindful of any new symptoms or pain that occurs after having knee replacement surgery.