New Joints, New You

New surgical techniques from Sarasota health care providers are giving active baby boomers another lease on life.

By ericg October 1, 2012

New surgical techniques are giving active baby boomers another lease on life.

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Baby boomers are active—and their knees, shoulders and hips are paying the price for it. But thanks to advances in technology and surgical techniques, when your joints give out, you don't have to trade in your running shoes for the rocking chair. According to the American Academy of Orthopaedic Surgery (AAOS), the fastest-growing group of joint replacement patients is under 65. Knee replacements have doubled in the past decade—and more than tripled in the 45-to-64-year-old age group. And that's just the beginning. Another AAOS study predicts a 673 percent spike in total knee replacements and a 174 percent increase in first-time total hip replacements by 2030. If you're one of the many people considering a joint replacement in your future, here are some tips, information and advice from area experts.

Hip New Trends

The hip joint is nature's shock absorber—it's the point of contact between the leg and the torso. Like the shocks in your car, hip joints tend to wear out. Just ask some of the more than 76 million people in the United States suffering from hip pain. Each year, nearly 170,000 people undergo total hip replacements.

That word "total" can sound scary. But board-certified orthopedic surgeon Dr. William R. Kennedy claims there's nothing to fear. He should know. Kennedy has performed more than 5,000 hip replacements since 1971—and designed three hip joints, manufactured by Swiss and American companies. "It's often the best option," he says. "Total hip replacement gives new life to people suffering debilitating hip pain from arthritis." He adds that his Sarasota-based practice, Kennedy-White Orthopaedic Center, has experts in both anterior and posterior approaches.

What's the difference? According to Kennedy, it's a question of different techniques to achieve the same result.

He explains that the hip joint is basically a ball-and-socket joint where pelvis and thigh converge. In a total hip replacement, the surgeon swaps out the ball at the top of the thigh bone (the femur) and the socket of the pelvis with prosthetic replacements. How he gets to the hip joints is the difference.

In posterior surgery, the surgeon approaches the hip joint from the back—through incisions on the back side of the hip. While it's still the main option, especially in very difficult cases, surgeons are turning to less invasive approaches to replace the hip joint. Anterior hip replacement is one of them.

The anterior techniques used today are not new, but the way the surgery is done is. Today, leading-edge surgeons perform the procedure with much smaller incisions, thanks to better equipment. The result is a less invasive procedure and a shorter recovery time. But anterior hip replacement surgery is not for everybody, and with the smaller posterior incision used today, both anterior and posterior surgery have their place in total hip replacement.

How long should the artificial joint last?

The chance of failure increases with time as the plastic bearing wears, says Kennedy. Eighty percent should do well for 20-plus years, "although there can be initial failure of one to two percent and in five years, you might see a three to five percent failure," he says.

Who's the ideal patient for this type of surgery?

"Ideal joint replacement candidates should be over 50, active and in good physical and mental health with no sign of infection," says Kennedy. "They should also be willing to accept some mild limitation of activity after surgery. But less extreme sports such as golf, tennis, fishing, bowling or normal snow skiing are acceptable activities."

What to expect after undergoing hip replacement:

^ A hospital stay of two to four days.

^ Driving a car in two to three weeks.

^ Golf chipping and putting by six weeks.

^ Tennis doubles at three months; singles in six months.

^ Ballroom dancing in three to six weeks—slowly at first.

^ Wait to hit the ski slopes until next season.

Top Tips to Prepare for Joint Replacement Surgery:

^ Stop smoking for at least three months before surgery.

^ Exercise to maintain muscle strength and a healthy body weight.

^ Bolster your diet with foods, vitamins and nutrients that enhance your body's natural antioxidant properties, boost the immune system, and support wound healing. Omega-3 fish oils are especially good for their anti-inflammatory properties.

^ Have realistic expectations of the recovery period. Often muscles have atrophied from lack of use. Heed your surgeon's recommendations about when it's safe to resume normal activities.

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Shoulder to Shoulder

Once upon a time, humanity's ancestors walked on all fours. As we evolved, we learned to walk upright. Instead of supporting our weight, our arms and hands became free to reach out and grab things. Neat trick—and it's all thanks to our shoulder bones.

Strictly speaking, the shoulder is the awkward meeting point of humerus, scapula and clavicle. Evolutionarily speaking, the bones in the human shoulder are a Rube Goldberg retrofit. Over a lifetime, they endure much punishment. When the protective lining of cartilage wears away, it's called shoulder arthritis—the painful bone-on-bone variety. More than 16 million Americans suffer from it. According to Dr. Avi Kumar, an orthopedic surgeon at Sarasota's Coastal Orthopedics, they don't have to.

"Patients with severe shoulder arthritis have options," he says. Kumar specializes in shoulder and elbow surgery. That said, he's quick to add that his surgeon's skill is never the first choice. "Initially, we start with rest, medication, cortisone injections and rehabilitative exercises," he says. "Shoulder replacement surgery is a highly effective treatment for shoulder pain and arthritis that doesn't respond to other treatments."

Kumar explains the procedure in layman's terms. First, the orthopedic surgeon removes the shoulder's damaged components. Next, he replaces them with prosthetics. That could be the artificial ball joint at the top of the upper arm (humerus) or the socket joint it connects to in the scapula. Or both.

It's extreme surgery for an extreme problem. "If you're experiencing severe loss of motion, weakness and shoulder pain—the kind that interferes with daily life and wakes you up at night—then it's time to see a qualified orthopedic specialist," says Kumar. If your doctor determines the damage is bad enough, shoulder replacement surgery is the way to go. So what can patients expect after this surgery?

"Most patients can resume most activities of daily living, including playing golf and tennis, within six months," Kumar says. Healthier patients, especially those without diabetes or a smoking history, generally heal faster and regain their range of motion quicker."

Kumar adds that his main problem is slowing his patients down in the recovery period. "They're so used to living with pain and loss of function they can to take it too far, too fast," he says. "I tell them to take it easy. You've got your shoulder back, and the rest of your lifetime to enjoy it."

Top tips about shoulder replacement surgery:

^ Pain relief after surgery is quite dramatic. Most patients have very little pain within a few weeks after surgery, although patients who were on preoperative narcotics may continue to experience pain for several months.

^ About two-thirds of lost function is regained after shoulder replacement surgery.

^ Be compliant with physical therapy, but don't overdo it. Two to three times a week is plenty. Doing more will not get you to the finish line any faster. It may actually delay recovery.

^ Notify your doctor if you experience any sudden onset of pain, fever, or drainage from the surgical wound; this could be an early marker of infection.

New Knees

The knee is the most complicated joint in the human body—and it takes the most punishment. Age is often the punisher. If not taken care of, last-stage osteoarthritis can ravage the knee. More than four million Americans over age 50 have prosthetic knees as a result. But physical damage can happen to people of all ages. Bottom line? When damaged knees affect your quality of life, it's time to think about replacing them.

Dr. Ronald P. White is a board-certified orthopedic surgeon at Kennedy-White Orthopaedic Center with advanced fellowship level training. He shared his insights about knee replacement surgery with us.

What is minimally invasive knee replacement—and who best benefits from it?

Minimally invasive does not necessarily mean a smaller incision but instead less violation of the soft tissue beneath. All primary total knee replacements without significant bony abnormalities would benefit from minimally invasive total knee replacement.

Who is a candidate for partial knee replacement and who for total knee replacement?

A partial knee replacement candidate is someone who has arthritis of the degenerative type that is limited to just one compartment of the knee, with intact ligaments and passively correctable alignment. They should also have less than a 15-degree fixed flexion contracture. A candidate for a total knee replacement would be someone with inflammatory arthritis, such as rheumatoid arthritis, or degenerative arthritis that involves more than one compartment. Both should be in general good health, motivated to get better and free of infection.

Latest trends in materials used in knee replacement?

There has been no real change in materials. Primarily these are cobalt, chromium, titanium, polyethylene, and occasionally ceramic-coated metal. Emphasis is placed more now on the durability and longevity of the polyethylene (plastic) bearing. We look for trends which give us a 95 percent success rate or more at 15 years.

What should someone expect after knee replacement?

On average, hospitalization is about three days. The patient should be walking with a walker or crutches on the first postoperative day with weight-bearing as tolerated. They should anticipate therapy for six weeks with limited therapy thereafter for an additional four weeks. A cane or a crutch will generally be used for three to six weeks. Full recovery may take up to a year. Ballroom dancing is usually permitted at eight weeks, golf at eight to 10 weeks, and doubles tennis at 12 to 16 weeks. One should avoid impact sports such as jogging or running. Swimming, bicycling, doubles tennis, golf, bowling—these activities are often encouraged.

What is the prognosis for people who have undergone knee replacements?

Recent literature indicates that 85 to 90 percent of total knee replacements will last 15 to 20 years or longer. Overall, the prognosis for people who have undergone knee replacement has been excellent.

You may be a candidate for knee replacement if...

^ People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. They also may experience moderate or severe knee pain at rest.

^ Other treatments haven't helped. More conservative treatments include weight loss, physical therapy, a cane or other walking aid, medications and braces.

^ You have a knee deformity. Knee replacement can be especially helpful for people who have a knee that bows in or out.

^ You're 55 or older. Young, physically active people are more likely to wear out their new knees prematurely.

^ Your general health is good. Conditions such as restricted blood flow, diabetes or infections can complicate surgery and recovery.


Source: Mayo Clinic

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