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Archive for the ‘Surgery’ Category

arthroscopy

arthroscopy

In a recent policy article, health insurance giant Aetna considers arthroscopic debridement and lavage for osteoarthritis of the knee experimental and investigational because its effectiveness has not been established.

The only people Aetna considers arthroscopic debridement and lavage medically necessary are for those with mild to moderate osteoarthritis who have loose bodies or meniscal tears in their knees.

This means Aetna is reading the literature.  They based their policy on 40 different references from medical journals and scholarly articles.  Arthroscopic debridement and lavage is not an effective treatment option for many people with knee osteoarthritis.



Total Knee Replacement

Total Knee Replacement

When you run out of treatment options for your knee osteoarthritis the time may come for you to have your knee replaced.  This surgery involves removing your knee and replacing it with prosthetic components.  The bottom of your femur, your knee cap, and the top of your tibia will all be cut out.

Some reasons for having your knee replaced are listed below:

  • Severe knee pain while walking or standing
  • Knee pain while resting either or day or night
  • Chronic knee swelling
  • Knee deformity
  • Knee stiffness
  • Failure to obtain pain relief from other treatment options
  • Inability to take medications


High Tibial Osteotomy

High Tibial Osteotomy

A high tibial osteotomy (HTO) is a surgical procedure used to treat knee osteoarthritis.  During the surgery a wedge-shaped bone is removed from the lower-leg.  This changes the angle of the knee joint and relieves pain.

You will be treated with intravenous medications immediately following surgery.  This will help reduce the chance of getting an infection from the hospital, help reduce the risk of blood clots, and help with the pain.  Expect to be in the hospital up to one week on the high side.

Once you get home crutches, a cane, or a walker will be required for about one month.  You will be able to put some weight on your leg, but how much and when will be up to your doctor.  Physical therapy will also be prescribed and required.

Most HTO’s are successful.  Make sure to ask your doctor for a detailed recovery plan so you will know exactly how long you will be off your feet.    Patients who have a high tibial osteotomy will experience swelling for 3 to six months.



Knee Arthroscopy

Knee Arthroscopy

Arthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage to the interior of a joint is performed using an arthroscope, a small camera.  The “scope” is inserted into the joint through a small incision.

The advantage of arthroscopy over traditional open surgery is that the joint does not have to be completely opened.   Instead, two small incisions are made – one for the arthroscope and one for the surgical instruments to be used in the knee cavity to fully remove the knee cap.

Though arthroscopic surgery is widely recommended by the orthopedic community to treat knee osteoarthritis, the usefulness of the surgery is doubtful. A study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in 2002. In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement with lavage, just arthroscopic lavage, or a sham surgery, which made superficial incisions to the skin while pretending to do the surgery. The study reported, “At no point did either of the intervention groups report less pain or better function than the placebo group. Because there is no confirmed usefulness for these surgeries, many agencies are reconsidering paying for a surgery which seems to create risks with no benefit.”



Knee Exercise

Knee Exercise

Pre-operative exercise programs help patients with osteoarthritis of the knee after they have their knees replaced.  People who undergo “pre-habilitation” experience better leg function and faster recovery times.

So even if you decide to have total knee replacement surgery you still have to exercise!

71 patients were divided into two groups at the University of Louisville.  One group underwent an exercise program before surgery.  The exercises was developed to improve knee and leg strength, through light walking and step exercises.  Standard preoperative care was provided to the other group of patients.

The group that exercised before they had their knees replaced experienced less pain during functional tests and increased extension strength.  The findings published in the Journal of Strength and Conditioning suggests exercise before surgery results in quicker recovery.



Knee Replacement

Knee Replacement

There is an increasing trend toward knee replacement (total knee arthroplasty) in treating knee osteoarthritis.  A teaching hospital in Hong Kong looked at 750 patients who had their knees replaced from January of 2000 to December of 2009.

The number of total knee replacements increased from 91 in 200 to 181 in 2009.  There were 588 females who had their knees replaced compared to 162 males with 589 left knees being replaced and 568 right knees.  The men age of the patients having their knees replaced did not change significantly but the number of patients over 80 years of age increased from 4.8% to 13.8%.

This article was published in the Hong Kong Medical Journal (Feb 2011).



Avoid Surgery

Avoid Surgery

Dr. David Hunter from New England Baptist Hospital in Boston and University of Sydney in Australia recently published a study in Arthritis Care & Research.  “Quality of Osteoarthritis Management and the Need for Reform in the US” is research aimed at drawing attention to the fact that health care professionals in the United States often treat the pain and try to increase function in arthritic knees, but seldom try to improve joint structure or try to work with patients on long-term solutions.

The authors of this study recommend conservative treatment options for knee OA, especially avoiding pharmacological solutions.  “Weight management and exercise programs tend to be overlooked by clinicians,” said Dr. Hunter.  “These conservative approaches are beneficial to patients who adhere to weight-loss and exercise programs.”

The study examined prior research on treating osteoarthritis of the knee and found that up to 30% of surgeries are inappropriate!  And as we discussed on this blog arthroscopy should be avoided as a treatment option for knee OA – it doesn’t work yet orthopedic surgeons still perform the operation – every day.

Weight loss and exercise are the best treatment options for knee OA – how many more studies have to be conducted on the subject?  Joint health supplements, and knee braces are conservative treatments that will help you get up and moving.



Peroneal Nerve

Peroneal Nerve

There are various complications that can arise from high tibial osteotomies (HTO).  Neurologic injuries such as damage to the peroneal nerve are one of those complications.  HTO’s are often performed to relieve the pain associated with knee osteoarthritis.

The peroneal nerve lies between the biceps femoris tendon and the outside top portion of the calf muscle, and winds around the top of the fibula bone.  The peroneal nerve branches out to various other nerves in the lower leg.  Nerves are like cables that provide pathways for the electrochecmical impulses that drive the central nervous system.

Damage to the peroneal nerve can result in drop foot, making the foot drag during walking.  Also feeling can be lost in the top of the foot and front of the lower leg.



Popliteal Artery

Popliteal Artery

A common surgery to treat osteoarthritis of the knee is a high tibial osteotomy.  Complications during the surgery can include neurologic injuries.  One such injury is damage to the popliteal artery.

The popliteal artery is an extension of the femoral artery, located behind the knee.  It supplies blood to the knee joint and muscles in the thigh and calf. Arteries are blood vessels that bring oxygen rich blood from the heart to various tissues in the body.

Damage to the popliteal artery can cause a partial or complete blockage of blood flow to the foot and lower leg.  This can cause pain, difficulty walking, or amputation.



Non Union

Non Union

High Tibial Osteotomies (HTOs) are a surgical procedure used to treat knee osteoarthritis.  There are complications with HTO’s.  Non-unions are one of those complications.

A non-union is when a broken bone fails to heal.  Non unions occur when the broken bone lacks blood flow or the fracture is unstable.  Tobacco use, old age, diabetes, and infections can make this condition worse.

Broken bones also need nutrition to heal.  Calcium, Vitamin C, Vitamin D, and protein are all necessary for bones to heal properly.

Bone grafts or bone growth stimulators are used as treatment options for non-union fractures.