Tag Archive: gilbert

Anterior versus Posterior Total Hip Replacement

The surgical approach to total hip replacement (THR) may impact the surgical outcome. Total hip replacement is a common surgery, with more than 300,000 procedures performed in the United States each year. Traditionally, most total hip replacements have been done using the Hip painposterior approach, in which the surgeon accesses the hip joint through the buttocks or side. More recently, surgeons are using the anterior approach, which involves entering the hip joint through the front thigh region.

According to researchers, both direct anterior and posterior surgical approaches for THR yield excellent results as reported by patients. The surgical approach is not the singular variable that makes a difference in a 6-month post-operative outcome. Patients considering total hip replacement should ask the orthopedic surgeon about which approach is best for them. A decision will be made based on the risks and benefits of the surgical approach for the individual patient.

Clinical Studies

In a recent clinical study, involving 275 patients who had a total hip replacement between 2012 and 2014, the average age of patients was 65 years. Using certain outcomes for evaluation, researchers compared the two groups regarding pre- and post-surgical pain, function in recreation, function in daily living, and hip-related quality of life. According to results, there were no significant differences between the two groups.

In another study, researchers compared radiographic, clinical, and surgical outcomes among patients undergoing total hip arthroplasty performed via the posterior versus anterior approach. After evaluating 17 studies and 2,300 patients, researchers found that there was a significant difference in favor of the anterior approach regarding dislocations and length of stay after surgery.

canstockphoto38482995Researchers have found that the extent of muscle damage is different for each surgical approach as well. In a randomized clinical trial, researchers compared the two procedures. The main end point was the ability to walk unlimited distances and climb stairs at 6 weeks, 3 months, 6 months, and one year post-operative. At the 6-week follow-up, the direct anterior group had more patients walking limitlessly and climbing stairs compared to the direct posterior group. The differences were not as significant later on in the recovery process. However, the direct anterior approach was found to provide earlier restoration of function after total hip arthroplasty.

Another group of researchers evaluated 88 procedures (41 anterior and 47 posterior approaches for THA). The length of stay after surgery was shorter for the anterior group than the posterior group. The duration of surgery was longer, however, for the anterior approach group. Both groups performed similarly on questionnaires regarding pain and clinical outcome measures at the 6-month follow-up.

Before your surgery, the orthopedic surgeon will complete an extensive evaluation including a past medical history, physical examination, hip x-rays, and certain blood and diagnostic tests to establish fitness for surgery. Careful consideration will be given to how much pain the patient has and how often pain limits bending, walking, and resting. In addition, the surgeon will evaluate what measures have helped alleviate hip symptoms in the past.

How the Procedures Vary

During both anterior and posterior THR procedures, the head of the femur must be removed and replaced with a metal stem, as well as a ceramic or metal ball. The damaged cartilage and bone are removed from the hip socket and replaced with a metal prosthesis. Finally, a plastic spacer is placed between the new socket and ball to allow for a smooth gliding motion.

With the posterior approach, the hospital stay is usually 2-8 days, depending on the patient’s health condition, the severity of hip damage, and the surgeon’s recommendations. The incision will be 10-12 inches long, running from the outer buttock. Some muscles around the hip joint are cut and repaired, and recovery is 2-4 months. People who have this procedure have to follow specific precautions for 6-12 weeks, which include no internal rotation (turning leg inward), no crossing the leg, and no bending past 90 degrees.

With the anterior approach, the hospital stay is shorter (2-4 days), and the surgical incision is along the front aspect of the hip. The incision is shorter with this procedure (4-5 inches), and recover time is only 2-8 weeks. There are no specific precautions with the anterior approach, which makes it a more desirable procedure. With both procedures, patients must use an assistive device (walker or cane) while moving about, and physical therapy is required to improve strength, range of motion, and mobility.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top hip replacement with surgeons performing both anterior and posterior procedures. Most insurance is accepted, with some of the procedures offered as an outpatient or a one day stay. Call us now!

Resources

Barrett WP, Turner S, Leopold J (2013). Prospective randomized study of direct anterior vs posterolateral approach for total hip arthroplasty. J Arthroplasty, 28:1634–8.

Higgins BT, Barlow DR, Heagerty NE, & Lin TJ (2015). Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty, 30(3), 419-434.

Martin CT, Pugely A, Gao Y, et al. (2013). A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty, 28:849–54.

 

Cubital Tunnel Syndrome Treatment Opions

Cubital tunnel syndrome occurs when the ulnar nerve is pinched as it passes behind the elbow. If you have ever hit your funny bone, you understand what cubital tunnel syndrome is like.

Is cubital tunnel syndrome common?

According to experts, cubital tunnel syndrome is a common nerve entrapment condition with an incidence of 25 cases per 100,000 persons per canstockphoto4094506year. The condition is caused by injury or irritation to the inside aspect of the elbow. This syndrome is most common among persons who have jobs where their elbow is bent most of the day, where they could suffer repetitive injury to the elbow, or where they lean on the elbow much of the time. Also, persons who play golf, tennis, or guitar are at increased risk for ulnar nerve injury.

What are the symptoms of cubital tunnel syndrome?

Like other nerve compression syndromes, cubital tunnel syndrome causes numbness, pain, and weakness. Nerves become pinched for many reasons. The ulnar nerve is one of the nerves that supply the upper extremity. Irritation to this nerve produces elbow pain and arm weakness. When the elbow is struck, it causes a shooting sensation into the ring and small fingers. Weakness of the hand muscles is also common with this condition.

How is cubital tunnel syndrome diagnosed?

The diagnosis of cubital tunnel syndrome is made by a thorough history and physical examination. If there is a concern about structural injury or damage, x-rays and nerve conduction tests may be ordered.

What is the treatment for cubital tunnel syndrome?

Cubital tunnel syndrome treatment starts with simple steps. Most cases of cubital tunnel syndrome resolve after a short time. Treatment options are:

  • Avoidance of leaning on the elbow
  • Taking anti-inflammatory medicines (naproxen and ibuprofen)
  • Padding the elbow for leisure and work activities
  • Splinting the elbow at night

Will I need surgery?

When conservative treatment fails, the orthopedic specialist may recommend surgery. Because the nerve may be pinched at several locations behind the elbow, to release pressure from all areas of pressure, surgery is done. For many patients, treatment consists of moving the nerve to the front aspect of the elbow, so the nerve is under much less tension when the elbow is bent (called ulnar nerve transposition).

What types of surgeries are there for ulnar nerve syndrome?

Several approaches can be considered to treat cubital nerve syndrome. These include:

  • Local decompression of the nerve – This is achieved by simple decompression without medial epicondylectomy. It involves the release of canstockphoto25790214deep tissue that overlies the nerve. This procedure is recommended with symptoms are mild or intermittent, there is little or no pain, there is no instability of the ulnar nerve, and/or the osseous structure of the elbow is normal.
  • Medial epicondylectomy – This involves making a large incision over the elbow, and decompressing the cutaneous nerves. The flexor pronator is detached from the elbow bone, and the medial epicondyle, or a portion of it, is removed.
  • Anterior transposition – This involves decompression of the ulnar nerve, excision of the proximal end of the medial epicondyle, and transposition of the nerve into the subcutaneous tissue.
  • Endoscopic release – This procedure uses a tiny scope with camera to allow for local decompression of the nerve. The advantages of this procedure include reduced complication rates, faster rehabilitation, and limited invasiveness. In a recent study, 87% of patients reported good or excellent results with endoscopic release surgery.

Orthopedic and Sports Performance Institute offers both conservative and surgical options for cubital tunnel syndrome in Gilbert Arizona. The includes injections, bracing, medications and various options for surgery. Most insurance is accepted, call us today!

FAQs on Rotator Cuff Repair in Arizona

Rotator cuff repair surgery is used to repair a torn shoulder tendon or muscle, or to repair a group of tendons and muscles. This procedure is done with a large open incision, or through a buttonhole-sized incision via shoulder arthroscopy.

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons that form a cup over the shoulder joint. These structures hold the arm bone (humerus) in the rotator cuffglenoid joint (shoulder area). One or more of the tendons and muscles can be torn from trauma or overuse.

How common is a rotator cuff tear?

In a recent study, researchers evaluated rotator cuff tendinopathy. They found that the annual prevalence was 1-7%, and some evidence suggested that the incidence increased with age.

Does the procedure hurt?

You will receive general anesthesia before the rotator cuff surgery. You will be asleep and have no pain. After surgery, you will be given pain medicine to alleviate discomfort.

What procedures are used to repair a torn rotator cuff tendon?

Three main types of surgeries are:

  • Open repair – With traditional surgery, a large incision is made over the shoulder. The deltoid (large muscle) is moved to the side so the tendon can be repair. This procedure is used for large or complex tears.
  • Arthroscopy – With this procedure, a small incision is made, and a scope is inserted into the joint. The camera projects images on to a TV monitor, so the doctor can use tiny instruments to make repairs.
  • Mini-open repair – This procedure involves using an arthroscope and a couple of small incisions to repair the rotator cuff.

How is the rotator cuff repaired?

Rotator Cuff TearTo repair the rotator cuff, the tendons are re-attached to the bone if possible. This is done using small rivets (suture anchors) that hold the tendon in place. These are made of metal, or they can be made with dissolvable materials. At the end of surgery, the incisions are closed and a dressing is applied.

What can I expect before the rotator cuff repair surgery?

After the Phoenix shoulder doctor diagnoses a rotator cuff tear, you meet with the orthopedic surgeon to discuss surgery. Two weeks before the procedure, you must stop taking any medicine that thins the blood (aspirin, ibuprofen, and naproxen). Be sure to discuss all allergies and medications with the doctor. You cannot eat or drink for 8 hours before your surgery, and should leave all valuables at home the day of surgery.

What can I expect after the rotator cuff repair procedure?

You will wake up from sedation or anesthesia with a bulking bandage on your shoulder, your arm in a sling, and an immobilizer on your arm. This is to protect the shoulder while it heals. Most patients are discharged home the day of surgery. Recovery may take up to six months, and you will wear the sling for 4-6 weeks. The doctor gives you medications for pain, and you will follow-up with a physical therapist who helps improve strength and function in the shoulder joint.

What is the prognosis after the rotator cuff repair surgery?

Surgery to repair a torn rotator cuff is successful for relieving shoulder pain. The procedure usually returns strength to the shoulder structure. Rotator cuff repair requires an extended recovery period, and not everyone heals the same. The doctor will advise you on which activities you can and cannot perform following recovery. Poorer results often are related to:

  • Advanced age
  • Large tears
  • Weak or previously torn rotator cuff
  • Not following aftercare instructions
  • Smoking

Orthopedic and Sports Performance Institute provides  rotator cuff repair procedures with expert shoulder surgeons in Arizona. Most insurance is accepted, with the procedures being offered in a minimally invasive fashion. Call us today!

Resources

Littlewood C, May S, & Walters S (2013). Epidemiology of rotator cuff tendinopathy: a systematic review. Shoulder & Elbow, DOI: 10.1111/sae.12028.

Current Concepts Regarding Customized Knee Replacement

                  Osteoarthritis is a degenerative joint disease that can affect any joint and is most commonly found among older people. The mechanism of how the disease develops is not fully understood. Currently, there is no known cure for osteoarthritis and research has focused on the knee arthritisprevention and treatment of symptoms for this condition. Osteoarthritis is more frequently found in joints of the lower limb. Risk factors of osteoarthritis include history of injury, increasing age and obesity. Conservative treatment for osteoarthritis includes the use of oral medication to provide pain relief, physical therapy and as a last resort, a surgical procedure known as total knee arthroplasty (TKA). TKA involves the replacement of the entire knee joint and rehabilitation is required after surgery for patients to be able to return to their routine activities.

                  TKA is a highly successful surgical procedure but failures can occur, mostly due to infection and loosening of implants (parts). Poor positioning of the components can contribute to loosening as it creates areas of stress. Some patients such as those who are younger and those with other health conditions may sometimes require a revised TKA. Studies have also shown that the demand for TKA will increase as much as 673% from 2005 to 2030 with a total of 3.48million procedures being required. This necessitates the need to improve the outcomes of TKA especially for younger patients.

                  In a traditional knee replacement surgery (TKA), the surgeon uses a standard implant from a range of different standardized sizes. The necessary adjustments are then made so that it fits the patient during the surgery. Since the standard implants are not designed specifically for each individual patient, it may result in an implant overhang (where the implant is bigger and hangs over the bone) or underhang (implant is too small leaving parts of the bone exposed and uncovered). It iFit-Designcan also result in an implant that does not align exactly. Studies have shown that compromises such as the overhang, underhang and slight misalignment can cause pain after surgery.

                  In customized knee replacement surgery, partial and total knee implants are designed and tailored specifically for each individual patient. This new technology is utilized to create customized implants that are specifically fit to each patient’s natural knee shape and curves. This enables the potential for the patient to feel like they have a more natural knee. Other benefits include optimal bone preservation. The goal of customized knee surgery is to restore the patient’s knee as close as possible to their pre-diseased state.

                  A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan is taken of the patient’s knee and the data is processed in a computer assisted design (CAD) system. The implants are then designed and manufactured specifically for that patient. With customized knee replacement surgery, hospitals benefit due to the improved efficiency of surgery while patients benefit with a shorter surgery and recovery time with improved knee alignment due to a better fitting implant.

OSPI offers the best knee replacement doctors in Arizona who perform customized joint replacement. In addition, the procedures may be performed as an outpatient when indicated. Most insurance is accepted, call us today!

knee replacement

 

References:

Customized Knee Replacement in Arizona

The knee is a complex, mobile joint. Knee joints are the largest joints of the body, and they differ in shape and size from other joints. A customized knee replacement uses specially designed implants that are made to fit the unique knee of the patient. Traditional knee replacement requires the surgeon to attempt to match prostheses to fit the knee.

How many knee replacements are performed each year?

In the United States, around 4.7 million people have a total knee replacement. Prevalence increases with age, with around 8% canstockphoto11809008have a history of total knee replacement. Women are more likely to have this operation than men (3 million: 1.7 million).

Why are customized knee implants important?

Once the Arizona knee surgeon selects the implant, the technique requires precision structuring so the implant fits snugly with your individual bone structure. An improper implant fit could result in residual issues that may cause problems after surgery.

Customized knee replacements are an innovative approach to correctly knee problems. The need for a precision implant fit has driven this new trend. Manufacturers now offer customized and personalized implants that are appropriate for gender and the individual knee. In a 2010 study, customized implants were found to reduce sizing problems during surgery, and also, found to replicate the curvature of the patient’s knee, giving a more natural feel to the replacement.

How are customized knee prostheses made?

Customized knee implants are created from CT and MRI scan data obtained from the patient. This assures the implant iFit-Designmatches the natural curves and shape of the knee. Knee implant manufacturers use specific technology to change the images of the knee into a 3D model, which is used to make an implant that matches the patient’s knee. Using scan data, the manufacturer can customize the implant using computer-assisted surgical instrumentation utilized by the surgeon during the procedure.

Why are women’s implants different than men’s?

Called gender-specific knee replacement, women are more petite and require special sized implants. A regular, traditional implant is designed for men, which means the implant for a woman could overhang on the bone at the sides. This could cause soft tissue interference or mid-flexion instability. For some patients, over-sized implants may cause pain and discomfort long after healing is complete. For this reason, new implants are used to accommodate the knee, which is smaller top-rightin women from side-to-side and from front-to-back. This reduces implant misfit and persistent knee pain.

Why do the differences between men and women make knee replacement difficult?

Researchers have found many differences between women’s knees and men’s. The gender-specific implants are based on research that shows:

  • Women’s knees have a thinner profile at the front.
  • Women’s knees have a distinct shape that accommodates the different angle between the knee and hip.
  • Women’s knees have a different contour.

Some researchers believe the differences in knee shape and size have less to do with gender and more to do with genetics. Certain ethnic influences tend to determine knee joint sizes.

Orthopedic and Sports Performance Institute offers customized knee replacements that have an amazing fit with exceptional outcomes. The total knee replacement surgeons in Arizona work with patients from all over the Valley including Gilbert, Mesa, Chandler, Queen Creek and Maricopa AZ.

Most insurance is accepted, call today to meet with the top knee specialists in AZ!

Resources

Bourne, et al; Patient Satisfaction after Total Knee Arthroplasty. Who is Satisfied and Who is Not? Clinical Orthopedics and Related Research; 2010, 468: 57-63.

Mahoney, et al; Overhang of the Femoral Component in Total Knee Arthroplasty: Risk Factors and Clinical Consequences. The Journal of Bone and Joint Surgery; 2010, 92: 1115-1121

 

Minimally Invasive Total Knee Replacement vs. Traditional Total Knee Replacement

Total knee replacement has been a successful procedure for the treatment of end-stage, severe knee arthritis. According to clinical studies, long-term results for functional improvement and pain relief are excellent using total knee replacement. However, the traditional approach to knee replacement requires a large incision and a long recovery period. Many patients suffer from permanent quadriceps weakness after knee replacement.

Benefits

The mini-incision technique, also called minimally invasive total knee replacement, is an alternative to total knee arthroplasty canstockphoto11809008(TKA). The minimally invasive procedure is a true quadriceps-sparing surgery. The proposed benefits of the mini-incision procedure include:

  • Gain of early knee flexion (bending)
  • Decreased pain and need for analgesics
  • Improved quadriceps function
  • Decreased blood loss
  • Shortened length of hospital stay
  • Cosmetically better smaller incision
  • Early recovery
  • Rapid rehabilitation

To evaluate the short-term clinical and functional outcome of minimally invasive surgery TKA compared to traditional total knee replacement, researchers evaluated 80 knees. They found that patients in the minimally invasive TKA group had significant decrease in post-operative pain, hospital stay, and blood loss. The study showed that the mini-incision technique offered many benefits.

In another study comparing the two procedures, researchers compared 50 total knee arthroplasties performed with the traditional method with 50 that were performed using the mini-incision technique. The found that overall, the minimally invasive canstockphoto10845760surgery took significantly longer to perform. The traditional approach was found to be easier for the surgeon, and a substantial learning curve may be required for the surgeon to perform minimally invasive knee replacement.

Incision Size

With traditional knee replacement, an incision of 6-8 inches is required. The patient’s size and the extent of joint damage will also determine the length of an incision. The doctor must have a large incision to fully visualize the joint, the implants, and the disease tissue.

With the minimally invasive technique, the incision is only 4 inches long, which is half the length of a traditional TKA incision. Surgeons perform surgery using special instruments that are designed to move around muscle and soft tissue rather than cut through it. A smaller incision is more aesthetically pleasing to the patient.

Recovery

Recovery after total knee replacement from traditional techniques takes around 6-8 weeks, depending on age, health status, and previous knee injury. Each person’s recovery time will vary, but most patients drive after 3 weeks, garden after 4-6 weeks, canstockphoto1903417and golf after 8 weeks. The surgeon will determine what activities you can participate in and which ones you must avoid.

After a minimally invasive knee replacement, recovery takes half as long than traditional surgery. While every patient is different, most people are driving after 2 weeks, gardening after 4 weeks, and golfing after 6 weeks. Regardless of which procedure you have, certain high-impact activities are not permitted, as they place extreme pressure on the new knee joint.

Considerations

The minimally invasive approach is may not be an option for an overweight or obese person, as well as for very muscular people, those who require a complex replacement, and people with severe knee deformity or instability. The mini-incision procedure requires specialized instruments and is more technically challenging to the surgeon. According to some studies, the risks of complications is higher with the minimally invasive TKA, which can be detrimental for the final outcome of surgery.

While the minimally invasive total knee replacement is a good alternative in the hands of an experienced orthopedic surgeon, you should work with your surgeon to decide which procedure is best for you. Choose an Arizona total knee replacement surgeon who is experienced if you wish to have the mini-incision procedure, and work with your doctor to lose weight before surgery.

Study Background:

Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation.

Aim:

Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA).

Materials and Methods:

During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group).

Results:

Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion.

Conclusion:

This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach.

 

Resources

Dabboussi N, Sakr M, Girard J, & Fakih R. (2012). Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach. N Am J Med Sci, 4(2), 81-85.

King J, Stamper DL, Schaad DC, & Leopold SS (2007). Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am, 89(7), 1497-1503.

Preparing for a Total Knee Replacement in Arizona

Preparing for a total knee replacement begins weeks to months before the actual surgery date. Good physical health is important for a successful operation. Getting the upper body strong will improve your ability to use crutches or a walker, and performing leg-strengthening exercises will improve ability to walk on your new knee. In addition, you should follow the Arizona knee replacement doctor’s orders explicitly before undergoing a total knee replacement.

Meeting with the Gilbert Orthopedic Surgeon

To prepare for the total knee replacement, you will meet with the AZ orthopedic knee surgeon. The doctor will ask you Knee pain 3questions about your past medical history, inquire about your current knee problems, and perform a physical examination. In conjunction with an internal medicine evaluation, you may have x-rays, laboratory tests, and an electrocardiogram (heart rhythm test). If you are a smoker, many doctors require that you refrain from smoking for 6 weeks before surgery.

The orthopedic surgeon will discuss your current medications and allergies. Certain agents that thin the blood must be held for several days before surgery. In case you require blood transfusions during surgery or right after, you may want to store your own blood at the hospital’s blood bank. In addition, you should see your dentist to evaluate for infected teeth or gums, which could cause problems with the new knee.

Meeting with the Physical Therapist

Before you undergo surgery, you may see the physical therapist and start an exercise program. The therapist will work with you 2-3 times each week to perform strengthening and flexibility exercises. The work out helps prepare your muscles and soft tissue structures for surgery and recovery.

The physical therapist may either come to your home to assess your recovery environment or simply discuss it with you. If you have stairs, problems with hallways, and other issues, the therapist may recommend that you recover for the first couple of weeks in a skilled nursing facility. This will depend on your unique situation and health conditions.

canstockphoto10845760Preparing your Home and Assistance after Surgery

When you are preparing for surgery, you should begin thinking about recovery after surgery. You will go home from the hospital 2-5 days after the total knee replacement. Since you cannot drive, you should arrange to have a ride home. In addition, you will need someone to help you at home for a few days (getting meals, dressing, follow-up appointments, etc.)

Right Before Surgery

The morning of your surgery, you can brush your teeth and take necessary medications with a small sip of water. You are not to eat solid food within 8 hours before your surgery, and should not drink or eat after midnight. We recommend that you shower the morning of your surgery using an antibacterial soap.

When you arrive at the hospital, you will register at the surgical center. A nurse will have you change into a procedure gown. After discussing the procedure, you must sign a consent form. The nurse will attach monitoring devices to assess blood pressure, pulse, and oxygen level. In addition, an intravenous (IV) catheter is placed in your arm.

Orthopedic and Sports Performance Institute offers the top knee replacement surgeons in Arizona. Often times outpatient knee replacement is performed, and most insurance is accepted at the practice. Call us today to discuss your options with our Gilbert and Chandler knee specialists!

Life after a Total Knee Replacement

Pain and suffering from severe degenerative joint disease of the knee can compromise a person’s ability to maintain gainful employment, as well as perform usual activities of daily living. A total knee replacement (TKR) is a successful procedure for keeping people active and working. Returning patients to a higher level of functioning is the goal of knee arthroplasty, along with eliminating the chronic knee pain.

Returning to Work after Surgery

Around 98% of total knee replacement patients who were working before their surgery are able to return to work after surgery. Knee pain 3In addition, 90% of these patients are able to resume their previous position. A total knee replacement, also called total knee arthroplasty (TKA), is one of the most widely performed procedures in the world, and it is used to relieve pain and restore function in patients with advanced knee arthritis.

According to an independent survey center that interviewed more than 660 TKR patients 1-5 years after surgery, patients resume normal activities after the procedure. Their finding revealed that around 75% of patients were employed before surgery, and almost all of these people returned to work after the procedure. Men were more likely to have worked during the 3 months before surgery than women (83% vs. 70%), but of those patients, the rates of work return after surgery were similar.

A recent study out of Sweden evaluated joint replacement patients through self-reported assessments and physician evaluation. The researchers found that at 5- and 10-years post-surgery, most patients reported an active lifestyle. Surgery durably and substantially improves physical activity levels for men and women of all age categories.

Quality of Life Studies

canstockphoto11809008In a review of studies regarding quality of life among people who underwent total knee replacement surgery, and the various associated factors that impact recovery, researchers found several factors that were associated negatively with an active lifestyle. These factors were obesity, comorbidities, advanced age, persistence of pain, and lengthy wait for surgery.

Another study evaluated the self-reported outcomes after a total knee replacement to determine factors that influenced quality of life at 6 weeks, 3 months, 6 months, and one year post-surgery. Of the patients, 162 females and 40 males had a mean age of 69 years. At 6 weeks post-surgery, physical function was satisfactory. However, significant improvement was noted at 3 months postoperatively. Patients had decreased VAS pain scores, as well.

This quality of life study has proved that patients can return to previous level of functioning and enjoy an improved functional status. Researchers found that at one year post-operative, most patients reported that they had a significant improvement in quality of life. The researchers concluded that quality of life after TKR was noticeably different, with patients experiencing significant improvement for all parameters measured.

Longevity of the New Knee

It is difficult to predict how long the total knee implant/prosthesis will last, as lifespan depends on several factors. For a few patients, surgical complications occur which affects the longevity of the new knee. However, the majority of new knees last for 20 years, giving patients pain relief and improved function.

Surgeons, researchers, and prosthesis manufacturers all continue to work to improve the long-term outcomes of total knee replacement. The life of an implant depends on the use and wear. In addition, uses of new high performance material had shown to decrease wear by as much as 60%.

Orthopedic and Sports Performance Institute offers top knee replacement surgeons in Arizona. The procedures are often able to be performed on an outpatient basis, with most insurance being accepted. Call the top orthopedic surgeons in Gilbert and Chandler today!

Resources

American Academy of Orthopedic Surgeons. (2013). 98 percent of total knee replacement patients return to life, work following surgery. ScienceDaily. Retrieved from: www.sciencedaily.com/releases/2013/03/130321082857.htm

Da Silva RR, Santos AA, de Sampaio CJJ, & Magos MA (2014). Quality of life after total knee arthroplasty: systematic review. Rev Bras Ortop, 49(5), 520-527.

Papakostidou I, Dailiana ZH, Papapolychroniou T, et al. (2012). Factors affecting the

quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord, 13, 116.

Physical Therapy After Total Hip Replacement

One of the most commonly performed orthopedic surgeries is a total hip replacement (THR). The surgical techniques and prosthesis used for a THR have improved over the years, allowing the patient to now achieve optimal recovery and less pain. Physical therapy is an important aspect in a successful, full recovery after hip replacement.

In the Hospital

Right after your total hip replacement, a physical therapist begins working with you to restore joint motion and strength. Initially, therapy begins in physical therapy1the hospital the day after surgery. A therapist shows you how to get in and out of bed, ways to get into the shower and car, and how to walk using a walker or crutches. In addition, the therapist has you perform simple exercises in bed to prevent blood clots, such as gluteal squeezes and tightening the thighs.

After a hip replacement, some patients received additional physical therapy in a rehabilitation facility before going home. This will depend on the age of the patient, what the home environment is like, and functioning when discharged from the hospital. The physical therapist works with the patient using exercise equipment for strengthening and mobility. Balance exercises are used to decrease risk of falling. In addition, the physical therapist uses heat to warm up tight muscles and ice to reduce soreness and swelling.

Avoiding Dislocation

After a total hip replacement, there are some considerations the physical therapist follows to help you decrease risk of dislocating the new hip. With the posterior approach hip replacement, you cannot bend the hip past 90 degrees, must avoid crossing your legs, and cannot rotate the hip inward. Maneuvers to assist with avoiding these activities include use of a raised toilet seat and shower chair, use of a pillow between the knees, and using an orthopedic device to put on shoes and socks.

Home Physical Therapy

Once you go home, the physical therapist will visit you 3-4 times each week to improve hip strength, mobility, and flexibility. Common therapy exercises include:

  • Buttock contractions – Tighten muscles and hold to a count of 5.
  • Abduction exercise – Slide leg out to the side as far as possible and then back.
  • Quadriceps set – Tighten thigh muscles and try to straighten knee. Hold for 5-10 seconds.
  • Straight leg raises – Tighten thigh muscles with knee straight. As muscles tighten, lift leg sever inches from bed and hold for 5-10 seconds.
  • Standing exercises – These include standing knee raises, hip abduction, and hip extensions.
  • Walking and full weight-bearing – These exercises are used to help you perform light everyday activities.

physical_therapy

Recovery at Home

Don’t be surprised if you feel fatigued right after surgery. This will improve over the next few weeks, however. You should arrange to have someone help you out for 1-2 weeks after your total hip replacement. The exercises given to you by your physical therapist are an essential part of recovery.

You should be able to stop using crutches or a walker, and resume normal leisure activities within 6 weeks of the surgery. However, it could take up to 12 weeks for pain to completely resolve. Your new hip is continuing to recover for up to 2 years after the operation, which involves scar tissue healing and restoration of muscles.

Orthopedic and Sports Performance Institute in Gilbert AZ offers top surgeons specializing in joint replacement (hip and knee), along with sports medicine too. Most insurance is accepted with patients being seen from all over the Valley including Mesa, Chandler, Queen Creek and Scottsdale too! Call us today.

Recovery after Anterior Approach Total Hip Replacement

Anterior hip replacement is a less invasive approach to hip joint surgery. With the anterior approach to total hip replacement, the orthopedic  surgeon in Gilbert AZ accesses the joint from the anterior (front) of the hip as opposed to the lateral (side) or posterior (back). The anterior approach allows the Arizona hip surgeon to make repairs and replacements without detaching tendons, muscles, or soft tissue.

Small Incision

The anterior approach to hip replacement was first described in the 1940s. This approach is gaining in popularity, and advocates for anterior approach total hip replacement consider its advantages to be earlier restoration of walking, low dislocation rates, and muscle-sparing ability. The ModularEndoprosthesisprocedure begins with the patient lying on his/her back. The surgical incision is slightly lateral to the front superior iliac spine of the pelvis. The 4- to 5-inch incision runs toward the lateral aspect of the ipsilateral knee. After moving soft tissue and muscle, replacement is made.

Because the anterior total hip replacement surgery uses a small incision, and muscles are moved rather than cut, the result is less trauma and damage to the hip soft tissues. Recovery time is usually faster with the anterior approach than traditional surgery, and patients report less post-operative pain. After only 2-3 weeks, patients begin walking without assistance, which is compared to 5-6 weeks with posterior hip replacement surgery.

Length of Hospital Stay

After the minimally invasive hip replacement, you will stay 1-4 days in the hospital. You may stay longer if you have serious health conditions, severe hip arthritis, and complications during the procedure. The length of stay varies from patient-to-patient, but the anterior approach to hip replacement is usually related to a shorter length of hospital stay than the posterior or lateral approaches.

Physical Therapy

Physical therapy begins the day of surgery. To strengthen the hip joint, you must do small exercises, such as contracting buttock and leg muscles and ankle pumps. The therapist works with you to learn exercises that help regain full hip movement. You will work with the therapist two times each day. Once you return home, the physical therapist will see you 3-4 times each week.

 

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Home Recovery

After you leave the hospital, you should have family or friends stay with you for a few days. You will need help with errands and household activities. In addition, you cannot drive for 2-4 weeks, so you will need transportation home from the hospital, to follow-up appointments, and to the pharmacy. It is also important to stock up on easy to prepare foods, such as frozen, canned, and premade meals.

Incision Care

Your anterior incision will be closed with staples or sutures, which are removed around 10-14 days after surgery. The surgical site will be numb, sore, bruised, and/or swollen for a few days. You may experience itching or pulling of the incision site as well. We recommend using an icepack for 10-20 minutes several times a day to relieve discomfort. In addition, avoid using any lotions or creams on the hip area. To keep the incision clean and dry, avoid showering until your wounds are healed. You can bathe, however.

Physical Activity

Being physically active is an important aspect for recovery. Within 2-4 weeks, you will be able to resume your daily routine and normal activities. During the first week, you will start walking with a walker and advance to using a cane. To avoid falls and injuries, you should only walk in areas where there are handrails, no loose rugs, and no cords. You may begin driving after 2-3 weeks, depending on how you progress.

 

OSPI offers the top hip specialists in Arizona, specifically the East Valley. Hip replacements done by the anterior approach need an expert to be done well. Call OSPI today, most insurance is accepted!

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