Tag Archive: orthopedic

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!

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An Overview of Stress Fractures and Treatment

A stress fracture is a small crack in a bone. This common injury occurs in high impact sports, such as basketball and long distance running. Stress fractures are painful, but they usually heal with rest.

How common are stress fractures?

Stress fractures comprise about 10% of all athletic injuries. The incidence of stress fractures is around 10-20% of the general population.

Which bones are more likely to incur a stress fracture?

The most common injured bones include the metatarsals (foot), as well as the lower leg bones (tibia and fibula). Stress fractureMore than 50% of stress fractures occur in the lower leg bones, with 25% of these injuries occurring in the metatarsal bones of the feet.

What increases the risk for stress fractures?

Certain factors increase the incidence of stress fracture, either directly or indirectly. Risk factors include:

  • Muscle weakness
  • Muscle inflexibility
  • Inappropriate footwear
  • Training changes (shoes, terrain, intensity, and activity)
  • Excessive muscle strength
  • Poor running technique
  • Lower extremity alignment anomalies
  • Previous history of injury

What sports activities are likely to lead to stress fractures?

There is a higher incidence of stress fractures in sports that require repetitive movements. These include:

  • Cricket (bowling the ball)
  • Rowing
  • Aerobics
  • Running
  • Basketball

What bones are affected by stress fractures?

  • Tibia (lower leg) stress fractures – These are associated with running, jumping, walking, and dancing, and are stress fracture3more common in females.
  • Metatarsal (foot) – These are linked to dancing, running, marching, and walking.
  • Femur (thigh) stress fractures – These are seen mostly in female athletes who engage in running and walking.

What causes a stress fracture?

Stress fractures are more likely to develop in persons who have just begun a new activity, or those who have increased the intensity of their workout routines. Stress fractures occur when the muscles are not conditions, causing them to tire easily so they do not support and cushion the bones. In addition, stress fractures are more common in women than men.

What are the symptoms of a stress fracture?

A stress fracture causes a dull, intense pain at the affected site. The pain is worsened with walking, standing, or exercising. Swelling is likely to occur, and some patients have mild bruising.

How is a stress fracture diagnosed?

To diagnose stress fracture, the doctor will conduct a thorough physical examination of the painful area. X-rays may not detect a stress fracture, so the doctor may order another imaging scan, such as a nuclear bone scan or magnetic resonance imaging (MRI) scan.

What is the treatment for stress fractures?

Initial treatment involves the RICE protocol. This involves rest, ice, compression, and elevation. The extremity is rested for a few days, and ice packs are applied to reduce pain and swelling. A compression bandage will reduce the likelihood of re-injury, and elevation helps take down swelling. For pain, nonsteroidal anti-inflammatory drugs integrity-fracture-walkerare used, such as naproxen or ibuprofen.

In addition, a walking boot may help prevent excess pressure on the fracture, provide pain relief and accelerate healing. There is some evidence for electrical impulse treatment of stress fractures as well.

Surgery for a stress fracture may become necessary if conservative treatment fails. In addition, athletes who desire to get back into sports activities faster may desire surgery for a speedier recovery. One example may be a 5th metatarsal fracture that is keeping a person out of competition.

Can stress fractures be prevented?

Prevention is important for any athlete wishing to avoid stress fractures. This involves:

  • Modifying training – To reduce the incidence of stress fractures, training regimens should be individualized.
  • Stretching – During warm-up, the athlete should perform leg muscle stretching.
  • Use of orthotics – This includes shock-absorbing shoe inserts, which reduce the occurrence of leg stress fractures.
  • Supplements – Taking calcium with vitamin D is helpful for preventing stress fractures.

Resources

American College of Sports Medicine (2015). Stress Fractures. Retrieved from: https://www.acsm.org/docs/current-comments/stressfractures.pdf

Patel DS, Roth M, & Kapil N (2011). Stress Fractures: Diagnosis, Treatment, and Prevention. Am Fam Physician, 1;83(1):39-46.

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