BACKGROUND
INFORMATION:
- Arthritis is one of the most common reasons for
disability.
- Primary diagnosis for 430,000 hospital discharges
- $14 billion in hospital charges
- 12.1 % of Americans older than 60 years of age had symptomatic knee osteoarthritis (wear and tear arthritis/most common type)
Johnston
County Osteoarthritis Study
This study analyzed the
lifetime risk associated with developing osteoarthritis of the knee and
hip. The study was designed to be
representative of a civilian English speaking black and white population 45
years or older. Participants had
to be physically and mentally capable of completing the study.
The lifetime risk of
developing symptomatic osteoarthritis of the knee by 85-years-old was
44.7%. There were no significant
differences by race, sex and education, but obese participants had a significantly
higher lifetime risk (60.5% compared with 30.2% and 46.9% among those who were normal
weight and overweight, respectively).
In addition, patients with
a history of knee injury had a higher lifetime risk of 56.8% compared to
42.3%.
Overall, this study
demonstrates the high lifetime risk of symptomatic osteoarthritis is likely due
to the aging of the population and the alarming rates of obesity. One in two people is at risk of
developing symptomatic knee osteoarthritis and two out of three obese people. The link of obesity to symptomatic
osteoarthritis demonstrates yet another reason to educate the public about
weight loss and weight management.
Osteoarthritis is associated with enormous health costs as well as
disability. By educating the
public on how to manage or even eliminate obesity and weight issues, we have
the potential of decreasing the public health burden of this condition.
Murphey, L. "Lifetime Risk of Symptomatic Knee Arthritis." Arthritis and Rheumatism 59 (2008): 1207-1213.
Anthony M. DiGioia III, MD has joined the Wellsphere HealthBlogger Network to share his expertise and links to entries on his blog.
Dr. DiGioia has been selected as an "Everyday Hero" as part of Wellsphere's "Yes, We Care! Campaign." This program honors those who make extraordinary efforts to help, support and care for others. As part of this program, you can see Dr. DiGioia and other "Everyday Heroes" on the Map of Caring at www.wellsphere.com/YesWeCare. If you click this link and scroll about halfway down the page, you will be able to read entries about Dr. DiGioia's work. The page also features an "Everyday Heroes" video.
Vote now for Dr. DiGioia as the world's best health blogger! Wellsphere created the first annual "People's Health Blogger Awards" to recognize health bloggers who have made a difference in others' lives. Voting began on December 15 and will end on January 15. Go to Dr. DiGioia's Wellsphere page at www.wellsphere.com/Tony-profile/95977, and Click the "Vote for Me" badge to cast your vote. The winner and the World's Top 100 Health Bloggers will be announced on January 19.
Vote for Dr. DiGioia badge:
Pastor Barbara recently underwent a
joint replacement and wanted to share her experience with a video posted on You
Tube that is for friends and family members so she can update all on her
Journey to Wellness and road to recovery.
The video even shows Pastor Barbara playing a Wii video game (the hula
hoop) as part of her post-operative therapy only two days after her surgery. Dr. Tony DiGioia of Renaissance
Orthopaedics performed the surgery as part of the unique Orthopaedic Program at
Magee-Womens Hospital of UPMC which is grounded in the principles of Patient
and Family Centered Care.
RESTLESS LEG SYNDROME
(RLS)
What is "restless leg
syndrome?"
Restless leg is a
neurological disorder in which people feel the urge to move the legs when at
rest. People often describe the
sensation as burning, creeping, or pain in the legs, which can range from
uncomfortable to extremely painful.
This sensation usually occurs deep inside the leg, between the leg and
ankle, and less commonly in the feet, arms, thighs and hands. Because of this
sensation to constantly move the legs that does relieve the pain, it is often
difficult to sleep and stay asleep, causing extreme daytime fatigue and
exhaustion. The lack of sleep can
then cause impaired memory, difficulty concentrating and inability to perform
activities of daily living.
Restless leg syndrome is
slightly more common in women and usually occurs in patients middle aged and
older. Events which can
trigger restless leg are long car trips, sitting in a movie or any other
periods of prolonged inactivity.
In most cases the cause of restless leg syndrome is unknown, but it can
be caused by certain medications, chronic medical conditions, pregnancy, and
even caffeine, alcohol and tobacco.
Temporary restless leg syndrome can be caused by total joint
replacement.
RESTLESS LEG SYNDROME
AFTER TOTAL JOINT REPLACEMENT
After a total joint replacement, patients can often experience a "restless leg-like syndrome." That is not a true restless leg, but rather a temporary condition resulting from muscle and joint healing as well as the swelling from surgery. It is more likely to occur after knee replacements, and it can involve a feeling of diffuse pain, calf pain, cramping or the sensation to move leg around. It is mostly experienced at night and resolves as the muscles and joints heal - approximately 6-10 weeks after the surgery.
TREATMENT OF RESTLESS LEGS
SYNDROME
AFTER TOTAL JOINT
REPLACEMENT
Treatment of restless leg
after total joint replacement involves just moving the leg. When awakened at night by the
sensation, the best thing to do is stretch and walk around. Also, for most patients the symptoms
are less noticeable in the early morning, allowing time to rest. Decreasing caffeine intake and tobacco
and alcohol use can also lessen RLS.
Moderate exercise, regular sleep patterns, ice and massage can help
eliminate the urge to move the leg.
·
Walking
·
Exercising
or moving your joint, especially at night
·
Stretching
·
Ice
and massage
·
Regular
sleep patterns
·
Anti-inflammatories
or other medications on a case-by case basis
Please keep in mind that
restless leg syndrome caused by total joint replacement is a temporary
condition and usually will resolve 6-10 weeks after the surgery.
WHAT IS A CONTINUOUS PASSIVE MOTION (CPM) MACHINE?
A motion machine will be used post-operatively to
improve your range of motion more quickly and to make you feel more comfortable
following the knee replacement surgery.
Even with the less invasive procedure, the healing of your incision can
cause scar tissue to form, which causes your tissues to be stiffer than normal
tissue. The use of the CPM machine
after your total knee replacement guides tissue growth, increases motion and
helps reduce stiffness. Your new
joint also likes to be moved so this motion machine can make you feel more
comfortable too!
You can use the CPM machine based on your comfort
level, and it can be used as much or as little as you would like to use
it. We recommend that you use the
CPM machine at least two times daily for one to three hours at a time.
WHAT TO EXPECT...
- The Day of Surgery
A CPM machine will be set up on your bed. The motion will be set to full
straightening with an initial bending of up to 90 degrees. Even when you are resting, the CPM
machine will work your knee!
- Post-op Days One
to Three
Your bending will be increased based on how much
bending you achieve in physical therapy.
In general, the bending will be increased by 10 degrees more than
achieved during your last exercise session. The goal will be for you to achieve 110 degrees or more of
bending. A portable CPM machine
also will follow you to home.
·
Bruising may last for
up to 6-8 weeks. This is part of
the normal healing process.
·
Being on the blood
thinner after surgery can contribute to this bruising too. However, this medication is very
important so please continue to use it as you are directed.
·
Swelling of the leg,
and down into the foot, can sometimes last for two or three months.
THINGS YOU CAN DO TO MINIMIZE THE
SWELLING AND BRUISING:
·
Elevate the leg when
you are not doing your exercises or when you are resting.
·
For the first two to
three weeks after your surgery, ice your knee or hip for 20 minutes every hour
and also after exercising. This
will help to minimize both the swelling and the bruising. After a total knee replacement, using
your CPM (Continuous Passive Motion) will improve your range of motion, make
your knee feel better and reduce swelling.
Explore Latest FACTS (and Fiction)
in Non-Operative and Operative Treatments of Hip, Knee and
Back Arthritis
By Paula Deasy
ARTHRITIS IS THE LEADING CAUSE OF DISABILITY IN THE U.S; 42.7 MILLION
AMERICANS HAVE ARTHRITIS AND MORE THAN A THIRD REPORT THAT ARTHRITIS PAIN
LIMITS THEIR DAILY ACTIVITIES. For many,
anxiety or fear of the unknown prevents them from seeking help that could
improve their quality of life.
On Saturday, June 21, Dr.
Anthony M. DiGioia, III, a leader in Patient and Family Centered Care and one
of the pioneers of less invasive and computer assisted orthopaedic surgery,
will chair an event for patients in the Bone and Joint Health Series entitled Let
Your Journey to Wellness Begin! Boomeritis:
Help for those Aching Hips, Knees and Back. The Bone and Joint Health
Series presents four events each year.
The upcoming program on June 21 will be held at the CCAC Boyce Campus
and is open to the public and free of charge!
"In this age of having
massive amounts of information available at one's fingertips, patients and
families can have a hard time sorting through it all," said Dr. DiGioia, a
practicing orthopaedic surgeon at Renaissance Orthopaedics and founder of The Orthopaedic
Program at Magee-Womens Hospital of UPMC.
"The program on June 21st is designed for patients and their families who have an interest in learning more about those aching hips, knees and back," DiGioia explained. "The goal is help people sort out fact from fiction and let them hear directly from the experts about the non-operative as well as the operative treatments. Our hope is that these events will improve communication and knowledge and reduce anxiety so that patients can make informed choices regarding treatment and maintenance of health."
A keynote presentation entitled "Patient and Family Centered Care: Reducing Anxiety and Providing Exceptional Care Experiences and Outcomes" will be given by Dr. DiGioia. He will be joined by orthopaedic and spine surgeons, a rheumatologist and a physical therapist to discuss the evaluation, diagnosis, treatments and exercise possibilities for those suffering from hip, knee and back pain. In addition there will be an "Ask the Doctor" panel discussion as part of the program.
Another resource for those
seeking help for aching bones and joints is the blog at
www.amd3.org/ROblog. "The site was created on the advice of our Patient and Family Advisory Council and in response to all of the information about bone and joint health, " DiGioia continued. "We have a 'Fact & Fiction' column that can help patients obtain current and accurate information, and the blog site enables people to learn from patients' stories and to ask questions of patients and families living through similar experiences."
For more information or to register for the June 21st event, visit
www. boneandjointhealth. org.
For questions, call 412-683-3260 or send an
email to info@ boneandjointhealth. org.
- What restrictions do
I have after total joint replacement?
- There are very few restrictions
for patients after surgery.
The only activity we do not recommend for patients is jogging for
exercise as it accelerates the wear on your new joint. Patients with hip replacements are
told not to cross the operative leg over the other leg at the knees as
this can put you in a position where you could potentially dislocate. You
can cross at the ankle and bend all the way down as long as the legs are
apart at the knees. You can resume all other activities based on your
comfort and confidence level.
- Do I need to take an
anticoagulant after surgery?
- All of Dr. DiGioia's
surgical patients are to have Lovenox injections for 2 weeks
postoperatively and then ASA (aspirin) for 2 weeks. Some patients have a
higher risk for blood clots and have to take the blood thinners for a
longer time.
- How soon after my
total joint replacement can I return to work?
- You may return to
work as soon as you feel comfortable. Following a normal TKR/THR a
patient should be out of work no longer than 4-8 weeks, but many patients
can return to work in as little as 3 weeks.
- Will I be able to go
to a rehab facility after surgery?
- 99% of our patients
are able to return home after surgery without any problems. You are full weight
bearing the night of your surgery and are able to climb stairs right away
as well. For 2-5 days
following discharge, a physical therapist will come to your home to work
with you, and you will attend outpatient therapy for 2 to 4 weeks at a
physical therapy location close to your home. On occasion, however, if there are medical or surgical
issues, patients will be sent to a skilled nursing facility, but we
always prefer for our patients to go home. For the most part insurance companies are no longer
covering stays in rehabilitation facilities after joint replacement.
