Total Knee Replacement Surgeries Have Doubled Over Past Decade
According to a new study, more than 4.5 million Americans are currently living with Total Knee Replacements (TKR). Over the past 10 years, TKR surgeries have doubled.
The study, presented at this year’s Annual Meeting of the American Academy of Orthopaedic Surgeons, used US Census data, combined with the National Health Interview Survey, the Multicenter Osteoarthritis Study, and the Osteoarthritis Initiative to come up with their findings.
Osteoarthritis is still the leading cause of Total Knee Replacement surgery. The study found that the sharpest rise was amongst the younger age group. Even so, the number of knee replacements generally increases with age. For example, 10 percent of Americans over 80 years old have had at least one TKR, compared with 4.7 percent in those aged 50 and up.
Dr. Silverman Comments
The elderly population is growing. Baby boomers are hitting retirement and don’t want to slow down. Who can blame them?
As a result, the rate of total joint replacement is increasing. As our techniques and equipment improve, replacements last longer and orthopedic surgeons are putting joints into younger patients. As health care extends the lives of patients, they are more active and wear out these new joints at a faster rate. Consequently, more revisions are going to be required. Revision is always more challenging for the surgeon and always associated with a higher rate of complication.
This study lists Osteoarthritis (OA) as the most common cause. However, what causes OA? Obesity and diabetes are the true problems. Excess pressure from being overweight for years and the nutritional issues associated with diabetes (e.g. hyperglycemia related to the American typical diet leads to excess damage to cartilage and Degenerative Joint Disease).
The cost of Cheeseburger, Fries and shake may seem cheap, but the costs to society are enormous (pun intended).
Related Sources:
AAOS.org
5 Tips for Preparing for Surgery
Preparing for surgery can be stressful. A little planning before your surgery will make life much easier during recovery. Here are 5 things to remember as you prepare for surgery from Minneapolis Orthopedic Surgeon, Dr. Lance Silverman:
- Go grocery shopping before your surgery and stock up on food. Depending on the type of surgery, you may not be able to stand for long periods of time. This will make cooking difficult. Prepare meals and freeze them before your operation.
- If possible, arrange your sleeping quarters on the same level as your kitchen and bathroom to avoid having to use the stairs.
- Notify your employer of the time you will be gone from work because of the surgery. Additionally, complete applications for short-term disability benefits before your surgery.
- Put the things you regularly use within easy reach. Stock up on books, movies, games, and anything else to keep yourself busy as you recover.
- Arrange for family, friends, or neighbors to help with childcare, yardwork, pet care, trash pickup, and anything else you will be unable to do during recovery.
Recovering from a surgery takes time and patience. It can be very stressful, but if you follow these 5 tips, you will find yourself prepared and relaxed.
5 Reasons Knee Walkers Are Better than Crutches
Note: This is a guest blog by Tom Schwab, founder of Goodbye Crutches.
To better understand what our customers who are recovering from surgery experience on a daily basis, we recently had “crutch day.” On Monday morning everyone was given a pair of crutches to use for the entire day. While we had a lot of fun (watch on You Tube) we also learned a lot about why a Knee Walker is easier to use than crutches. Here are the top 5 reasons I found Knee Walkers preferable to crutches.
- No Cheating: It has been proven that people can’t accurately gauge just how much weight they put on an injured leg. People will bear weight until it hurts and often that’s enough to do damage or compromise healing. With a Knee Walker your foot can’t touch the ground, so you are guaranteed to be completely Non-Weight Bearing.
- Don’t Need Arm Strength: After just a few hours on crutches my arms were tired. If it had been crutch week the soreness and chaffing would have been an issue. With the Knee Scooter your arms aren’t involved.
- More Stable in Any Weather: I can’t imagine confidently using crutches in snow or rain. The Knee Scooter can be used in all conditions except deep snow.
- Makes Normal Life Less of a Chore: By lunch I was making decision based on whether or not it was worth the effort. I admit I didn’t wash filthy hands before eating a sandwich. It was too much work and they‘d only get filthy again from the rubber hand grips. I better understood how recovery from an injury or surgery can lead to isolation and even to depression. A Knee Scooter can make everyday tasks more manageable.
- You Need To Eat and Drink: On crutches there was no way to get a cup of coffee to my office. I ended up kicking the travel mug down the hall. With the knee scooter I could put the travel mug in the basket. The basket on the Knee Walker was also helpful at lunch and for carrying papers at work.
A day on crutches proved the surgeon was right when he told me that if I ever had to be on crutches for 8 weeks I’d show up at my first office visit with a black cast. I’d be embarrassed, he’d be mad, and we both wouldn’t like the long-term outcome. If crutches don’t work for your lifestyle, talk to your doctor. There may be options to help you regain your mobility, stability, and livelihood while you recover on one foot.
Tom Schwab is owner and founder of Goodbye Crutches, the nation’s largest distributor of crutch alternatives. If you can’t bear weight and you can’t bear crutches call Goodbye Crutches
Bisphosphonate Treatment for Osteoporosis: Does it Make Sense?
As an Orthopedic surgeon, I have always used the expression “does it make sense?” when thinking about treatments. Bisphosphonate treatment for osteoporosis just doesn’t make sense.
Bone is a dynamic tissue—it is constantly changing, building up new bone to replace old and damaged bone. Osteoporosis commonly results when bones breakdown faster than they can build up. Bisphosphonates are a non-specific treatment that block bone turnover. Early statistics in cases involving these drugs show a significant reduction in new fractures. But there are other, more serious consequences of blocking bone turnover.
In a recent study, researchers found that more than 50% of patients who were prescribed these drugs for more than 3 years following a femur fracture broke their other femur. Those who discontinued using the drug early on broke their other femur less than 20% of the time.
The drug’s long term effects were completely predictable. This drug is designed to prevent bone fractures, and is mostly prescribed to older patients. But after 3 years on the drug, the risk of fracture starts to increase, and at this point it may already be too late to reverse the damage of years without bone turnover.
In my opinion, doctors should encourage more natural ways to increase bone mass in all patients, both young and old. Weight bearing exercise, smoking cessation, and improved Calcium intake and Vitamin D levels are small but effective methods. Additionally, patients with osteoporosis and a greater than 5 year life expectancy should consider other options that work to build bone without stopping turnover, such as Calcitonin supplementation and Forteo (teriparatide).
Related Sources:
Medscape.com
Top 5 Reasons Barefoot Running is Best
Barefoot running has gained popularity in the past several years. Barefoot running is a style,not actually running barefoot. You can wear a shoe that is made to simulate barefoot running (MBT Masai Barefoot technlogy), or an Intrinsic muscle activating shoe (5 Finger Vibram), or just land on the ball of your foot. Proponents say that it reduces the risk of running related ankle and foot injuries. While there are some cons, the benefits greatly outweigh the negatives according to Minneapolis Orthopedic Surgeon, Lance Silverman. Here are the top 5 reasons barefoot running is best.
- Heel strike is unnatural. All children walk and run on their toes. It’s only after they get older and heavier and wear cushioned heel shoes that “adult – style gait pattern evolves.”
- Striking with the forefoot leads to fewer injuries in some studies. When you land on your heel, the impact is tremendously focused. Only larger muscle groups can modify the impact. You can’t fine tune the landing. When you land on your forefoot you have a wider impact zone, and more than a dozen different muscles including large and small muscles that allow better loading of the bones and joints. In fact, the largest and most powerful muscle (the Gastrocsoleus) is uniquely activated in forefoot strike. This is phenomenal advantage.
- Microklutzes, aka “heavy walkers,” are all Heel strikers. All heavy walkers strike with the heel. Some orthopedists believe that these heavy walkers are hypothetically at a higher risk of Arthritis.
- It strengthens muscles up the entire leg. Patients who switch to shoes that force this type of gait note significant muscle soreness. Soreness is good. It means you are more active and burning calories. Activity is tied directly to physical and mental health. Active people live longer, healthier lives, improve their immune systems, and prevent or block progression of diseases from Alzheimer’s to Zoster. It’s a small change, but it can have long lasting effects.
- It builds agility. There is nothing graceful about the heel strike. It is not beautiful to watch. Forefoot landing is beautiful. No Dancers land on their heels. Not even stomping dance involves heel strikes.
Running Injuries: Causes & Prevention
A recent study of the Harvard Cross Country team examines how and why runners sustain ankle and foot injuries.
The study, published in Medicine & Science in Sports & Exercise, analyzed four years worth of statistics about Harvard runners. Researchers found a correlation between how a person runs and the likelihood of their getting injured.
Most runners initially strike the ground with the heel of their foot, rather than the ball. This is due, in part, to the cushioned running shoes that we use. However, some hypothesize that running on the balls of your feet is more natural, as some evidence suggests that early hunter gatherers ran this way.
The study did not find that running on the balls of your feet was a guaranteed way to prevent running injuries. But, it did find that those who run on their heels are more likely to sustain ankle & foot injuries for some reason.
69 percent of the runners in the study were heel runners. The other 31 were ball runners. The heel runners were twice as likely to injure themselves enough to miss two or more days of training.
Dr. Silverman Comments
“The running injuries in this study are all due to overuse,” says Minneapolis Orthopedic Surgeon, Dr. Lance Silverman. “An overuse injury occurs when tissue breakdown exceeds tissue build up. Tissues such as bones, ligaments, and tendons break down when the muscles that protect them are fatigued.”
When running, a person places 3-4 times their body weight on each foot that strikes the ground. The foot, leg, and core muscles absorb the impact of each step (this is known as Ground Reaction Force). When muscles tire, they expose the tissues to supra-physiologic stress. This leads to stress fractures, chronic ligament sprains, and tendon strains.
Running in shoes is distinctly different from running barefoot. The heel counter (back of the shoe), the arch, and the cushioned bottom of the heel limit the stress imparted to the foot. In fact, shoes and arch supports actually weaken the foot muscles.
“The answer to preventing injury lies in cross-training and shoe wear,” says Dr. Silverman. “Finding shoes that support less, training foot support muscles more, and using non-impact exercise to vary the training schedule will prevent injury.”
Related Sources:
NYTimes.com
The Art of De-Casting
Note: This is a guest blog by Bonnie Siegel, an endurance athlete and former patient of Dr. Silverman.
Most people win sponsorships by way of impressive podium finishes, amazing splits, and breaking course records. Me? I fall and crash.
It was a beautiful day for a run. I carefully maneuvered down the steep trail, dodging rocks and leaves beckoning me to test their stability. Suddenly I heard a crack, and the next moment I was hopping on one foot as my other ankle mushroomed over the top of my running shoe.
Enter Dr. Lance Silverman. Mad ankle and foot witch doctor.
After surgery to fix two destroyed tendons and a ligament in my left ankle, he had the audacity to put me (an endurance athlete) into a cast for four weeks!
The cast lasted as long as I could take it – one week. After seven days I crept into my bedroom and locked the door. Using a kitchen knife and some scissors, I cut the cast off.
When All Else Fails, Listen to the Patient
A week later I confessed my sins to Dr. Silverman. He begged me to listen to reason and promptly sent someone to my house to put me into a walking cast. I hung up on him.
After some aggressive research on cadavers and case studies in Europe regarding the early removal of casts, Dr. Silverman changed his tune and repeated the truism: “When all else fails, listen to the patient.” He pledged from that point forward that all of his patients would have early cast removal. What defined “early” was the true question.
Now that I had a wonderfully repaired ankle, I hoped never to see his smiling face again. Alas, I tore the ligaments in my other ankle the very next year. Once again I entered into the surgical room with Dr. Silverman uttering some sort of threat about early cast removal as I went under the anesthesia tide. The last thing I heard him say was, “We made this one extra sturdy just for you. Let’s see you try to get this bad boy off!”
I certainly tried. A perfectly good pair of scissors, and the brand new hedge cutters I had were no match for Dr. Silverman’s armor. And so I endured my cast for the newest recommendation of two whole weeks. Dr. Silverman said compromise is good for the soul and I humbly admitted that two weeks wasn’t all that bad.
I was elated when they removed the beast. Of course they noted the multiple attempts to remove the cursed thing as most of the bottom had been hacked off, and a large portion of the cast stuffing was missing.
Dr. Silverman was kind enough to forgive me of my cast violence and also show his support for health and fitness. He became my triathlon sponsor.
And I secretly dig my scars.
How to Decide Between Surgical and Non-surgical Treatment
With ankle and foot problems, there are three general treatment options.
- Live with it, do nothing. Most people never choose this option. This is only a good option if the risk of doing something strongly outweighs the benefit of treatment.
- Non-surgical treatment. This includes options like physical therapy, bracing, casts, injections, and medicines. Many foot and ankle conditions improve with these but, few are cured. Instead, these treatments help you accommodate for the problem. But sometimes the problems that develop from finding ways around the problem are worse than the problem itself. Bunions, for example, get worse, develop arthritis, and cause painful deformities to the second toes. Loose ankle ligaments cause the peroneal tendons to tear sometimes beyond repair.
- Surgical treatment. Orthopedic surgeries are designed to return function to a dysfunctional organ or system. Some surgical decisions are easy, others are more challenging. Whatever the injury, the decision to proceed with surgery should never be taken lightly.
If a patient and doctor decide that surgery is an option, it is essential for the doctor or surgeon to speak with the patient about the procedure. These are a few essential questions to ask your doctor before deciding whether or not to have surgery.
- What will I gain from surgery that I can’t from non-surgical treatment? If surgery can offer a cure that non-surgical treatment will not, this is an important point to make. For example, physical therapy often resolves pain from ankle instability, but it’s just a matter of time until the ankle rolls again.
- What are the most common complications? To both a patient and a doctor, nothing can be more upsetting than a post-operative complication. Even worse is the post surgical guilt that can accompany it: Why did I have this surgery? What could I have done differently? Why do these things always happen to me? General Eisenhower said, “Plans are meaningless, planning is everything.” You can’t prepare for everything, but knowing about the major things that could go wrong and how to prevent them makes the decision easier.
- What are the risks and the benefits? If the risks are high and the benefits are low, the answer is obvious. For example, cosmetic foot surgery to wear the latest 5″ high heel shoe is not a good risk/benefit ratio. But, a woman with a closet full of shoes she can’t wear because of pain or a deformity is very reasonable.
A caring and thoughtful surgeon needs to explain the good, the bad, and the ugly of every surgery. But, with enough information and counsel, you will be able to determine which treatment option is best.
Gronkowski’s Sprained Ankle Leaves Super Bowl Fate Uncertain
New England Patriots star tight end Rob Gronkowski sustained a high left ankle sprain during the AFC championship game last week against the Baltimore Ravens, leaving his ability to compete in the super bowl uncertain.
The injury occurred late in the third quarter when Gronkowski was tackled awkwardly after receiving a pass. He returned to the field for the final few minutes of the game, but sat out the team’s first super bowl practice.
Watch video of the injury.
Dr. Silverman Comments
High Ankle sprains involve a twisting outward of the ankle on a fixed foot. Instead of spraining ligaments connecting the leg to the foot, ligaments connecting the two bones inside the leg are injured. It is very difficult to play with these sprains as every single step hurts and re-stresses the ankle. We watched Steelers QB Rothlisberger become a completely different player with diminished mobility and poor throwing skills after a similar injury. It is unknown how severe this sprain is, but every step is going to hurt. He will run routes cutting to the right as he will not be able to plant and twist off of his left foot well.
If he is walking comfortably in a boot now, it is unlikely that he needs any other treatment. Weight bearing X-Rays are needed to confirm the limited nature of the injury. Comparing it to the un-injured side is essential.
Some columns have mentioned injections for the big game, but if he gets an injection into the joint to numb it for the game, he runs the risk of turning a stable injury into an unstable one or injuring the ankle again. I would never offer that as the risks are far too great. Taping and bracing will give him some time early on, but eventually the soreness will over-rule that competitive instinct and he will have to quit. Anti-inflammatory injections not directed to the area could be performed, but the function of the ankle will not improve.
Bucks’ Center Andrew Bogut Fractures Ankle
Milwaukee Bucks’ Center Andrew Bogut is out indefinitely after fracturing his ankle during last night’s game against Houston last night.
The injury occurred when Bogut jumped to block a shot and landed on Kyle Lowry’s foot. An MRI confirmed that Bogut had fractured his left ankle.
Watch video of the injury.
Bogut is out indefinitely because of the injury. He will miss many, if not all, of the Bucks’ remaining 49 games this season.
Dr. Silverman Comments
Bogut came down on a supinated ankle (twisted inwards). As he planted his foot, he twisted his leg to the outside.
This is classically known as a supination external rotation mechanism. There are a limited number of fracture patterns that can result from this injury.
Stable patterns are non-displaced and most often don’t require surgery. Rehabilitation begins gradually. If the injury is out of place or involves the inside of the leg, surgery is required to stabilize and permit a more rapid rehabilitation.
If this fracture was not identified on x-ray and only with MRI then that is a good sign that it is stable. This fracture should be healed in about 4 weeks.
Related Sources:
Milwaukee Journal Sentinel
