Archives for April 2013

As May approaches, it heralds the start of National Arthritis Awareness Month!

The intent of this article is to enlighten women about osteoarthritis (OA), and educate them about the treatment, options, and care for OA.

Before our exceptional and informative interview with Virginia Osteoarthritis Surgeon, Dr. Manish A. Patel, lets talk a bit about osteoarthritis.

What actually is osteoarthritis? “Osteoarthritis is a disease that over time can break down the cartilage and require treatment or joint replacement!”

Are you aware that women who are over the age of 50 are more apt to develop osteoarthritis (OA) than men? It’s true!

In fact, actual joint replacement is a lot different than it was during our mother’s generation! I can attest to that as a fact! My mother had an accident involving her knee when she was younger. Over the years, personally choosing to “put off” the recommended surgical joint replacement option due to uncertainty and fear, her knee progressively became worse. It was really too bad because in todays standards she still was at a very productive age, and had limited herself with a condition that, “nipped in the bud”, would have changed her whole life.

Therefore, ladies, it’s crucial that we empower ourselves about OA by learning how to manage and treat this disease!

It’s really so unfortunate that people who suffer from severe hip or knee pain still wait on an average of seven to eleven years before having joint replacement surgery!! (Once again, reminding me of my mother’s situation, and her fear, misinformation, and lack of awareness about treatment options.)

Check out the following facts about joint replacement in the twenty-first century, and let common sense be your guide :

• “The average length of hospital stay for a total hip replacement was just 3.7 days in 2007-08, versus the average stay of almost 10 days in 1991-92, so women who opt for surgery may return to their families, careers and other activities much sooner.”
• “Many women think of joint replacement as a procedure their parents may be considering, but people are getting joint replacements at a younger age. In fact, more 45-64 year olds are having joint replacement surgery than ever before.”
• “In 2011, more than 650,000 total knee replacements and 325,000 total hip replacements were performed in the U.S.”

Manish A. Patel, MD, FAAOS, is an orthopaedic surgeon in Virginia. In the interview below, Dr. Patel shares a very easy to understand and thorough overview of :
• Osteoarthritis – the most common form of arthritis
• Ways to manage osteoarthritis
• Advances in technology

VICKI: When patients challenged with hip or joint pain come to see you , what do you often determine is the cause of their problem?

DR. PATEL: One of the most common reasons people complain of hip or knee pain is because of osteoarthritis. Osteoarthritis is the most common type of arthritis in the body. In the United States it affects approximately 27 million adults every year according to the Arthritis Foundation.

VICKI: What exactly is Osteoarthritis, how does it affect a persons body, and cause such discomfort?

DR. PATEL: Osteoarthritis is the wear and tear of the joints in the body. Patients with osteoarthritis will experience chronic pain and stiffness that affects the activities of daily living. With osteoarthritis, the cartilage in the joint breaks down and the bones start rubbing against each other. Over time, the cartilage is diminished; and when the bones start rubbing against each other, it creates a significant amount of inflammation in the joint, which causes the patient’s joints to swell.

VICKI: Is Osteoarthritis curable?

DR. PATEL: Osteoarthritis is not completely understood and there is no cure. Some of the risk factors include family history, age, obesity, joint injury, overuse, nerve injury or lack of physical activity. Typically, symptoms begin to appear after the age of 40 and progress slowly. It is a degenerative condition that may slow with early treatment, but affected joints continue to get worse and eventually impact activity level.

VICKI: How do you diagnose and treat Osteoarthritis?

DR. PATEL: Osteoarthritis diagnosis is typically based on a number of things, including medical history, physical examination, x-rays, MRI and/or laboratory tests. It is important for people experiencing severe hip or knee pain to talk with an orthopaedic surgeon in order to know their specific treatment options.

Some of the conservative treatments to treat osteoarthritis can be anti-inflammatories, physical therapy, cortisone injections, and visco-supplementation injections such as Orthovisc (aka rooster shots).

Individuals experiencing joint pain continue to put off treatment in hopes that their joint pain will get better because they are unaware of their options. As the arthritis progresses, they live with pain and continued limited activities of daily living and activities that they enjoy. The individuals do less walking, become dependent on pain medications and start using assistive devices such as canes and walkers. People are sometimes unaware that there have been significant advances in hip and knee replacement surgery since their parents and grandparents had the procedure done. Over time, surgeons have refined surgical approaches in an effort to minimize post-operative discomfort and make the procedure easier for patients to tolerate and recover from.

VICKI: Would you please share some of the new advances in Joint Replacement?

DR. PATEL: One such technique is the anterior hip replacement, a less invasive option to traditional hip replacement surgery. With anterior approach, surgeons make one small 3-5” incision on the front (anterior surface of the hip) and work between muscles and tissue without cutting or separating them from either the hip or thigh bones, reducing muscle trauma. Many candidates for hip replacement surgery expect a long and sometimes painful recovery and they are quite relieved that the anterior hip approach can get them back on their feet into normal everyday activities sooner than they think.

In addition to this, a new advance in total knee replacement includes development and use of personalized surgical instruments, which assists surgeons in knee alignment at the time of the actual procedure. Obtaining neutral alignment is critical in long-term success of the knee replacement surgery. I use the TruMatch® system, from DePuy Synthes Joint Reconstruction, which is a customized instrumentation system specifically designed for individual patients from a CAT scan taken of their knee. I perform a muscle-sparing knee replacement that allows my patients to be off a cane or walker in less than two weeks.

With significant advances in instrumentation, implants and techniques, total joint replacement can provide significant pain relief and allow patients to live an active lifestyle again.

VICKI: That is very encouraging. How would a person seek help for their joint pain ?

DR. PATEL: Most individuals with chronic hip or knee pain wait an average of 7 to 11 years before they have joint replacement surgery. Many people delay joint replacement surgery because they are afraid they don’t have the right information or don’t understand the treatment options. A lot of the myths and questions can be answered by talking to an orthopaedic surgeon.

In my role as a total joint replacement surgeon, I meet with my patients
several times prior to surgery and help answer any questions they may have.

I also put the patients in touch with some of my previous patients such as Larry, a knee replacement patient featured on:
http://www.reallifetested.com to help answer any questions they may have from a different perspective. Larry is the typical patient who led an active lifestyle and started having progressive pain in his knee, stiffness, swelling and failed conservative treatment. He continued to modify his lifestyle where he did less and less things. Ultimately, he ended up getting a knee replacement. Within two weeks, he was back on the football field as a coach running right next to his football players on the sideline. Larry and others like him are also featured on: http://www.HadIKnownThen.com

Like many surgeons, our practice offers additional resources and support such as a total joint replacement education program where patients have the opportunity to visit the hospital and meet the operating staff and nurses that will be with the patient every step of the way. To get more information about my practice please visit:
http://www.SouthamptonOrtho.com.

For more information, including educational resources, seminars and a doctor locator tool to help find an orthopaedic surgeon in your area, please visit:
http://www.reallifetested.com.

VICKI: Thank you some much, Dr. Patel, for all of your in-depth and easy to understand information regarding osteoarthritis and dealing with it, joint replacement, new technology, and wonderful links for even more sources to peruse. Much success in your ongoing efforts to help patients live more productive lives with all of the advancements to deal with osteoarthritis. What a wonderful contribution as we start Arthritis Awareness Month in May!

(Quotes and Paraphrased information in this article:
Provided by PR-Fact Sheets
Sources:
[i] Arthritis Foundation. Osteoarthritis Fact Sheet. http://www.arthritis.org/files/images/newsroom/Osteoarthritis
_Fact_Sheet_from_AF-Final_12-10-09.pdf. Accessed January, 2013.
[ii] DePuy Hip: A&U/Segmentation. Final Report January 2008. Data on file.
[iii] Cram P, et al. Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008. Journal of the American Medical Association. 2011 Apr 20; 305(15): 1560-7.
[iv] Liu S, et al. Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States. International Orthopaedics. 2009 Jun; 33(3): 643-51. Epub 2008 May 7.
[v] Memtsoudis S, et al. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. Journal of Arthroplasty. 2009 Jun; 24(4): 518-27.
[vi] 2012 Premier, Inc.
Interview with Dr. Manish A Patel: Osteoarthritis – the most common form of arthritis- management of osteoarthritis- technology advances
Personal commentary from my mother’s experience with osteoarthritis.)

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