Posted on 07/11/2010 1:44:51 PM PDT by neverdem
THERE is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking. No wonder, then, that joint replacement is growing in popularity.
In the United States in 2007, surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe.
Implants must sometimes be replaced, said Dr. Henrik Malchau, an orthopedic surgeon at Massachusetts General Hospital in Boston. A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within seven and a half years.
The percentage may sound low, but the finding suggests that thousands of hip patients eventually require a second operation, said Dr. Malchau. Those patients must endure additional recoveries, often painful, and increased medical expenses.
The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States.
Sweden also has a national joint replacement registry, a database of information from which surgeons can learn how and why certain procedures go awry. A registry also helps surgeons learn quickly whether a specific type of implant is particularly problematic. “Every country that has developed a registry has been able to reduce failure rates significantly,” said Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn.
A newly formed American Joint Replacement Registry will begin gathering data from hospitals in the next 12 to 18 months.
Meanwhile, if you are considering replacing a deteriorating knee or hip, here are some ways to raise the chances...
(Excerpt) Read more at nytimes.com ...
By the time my hips need replacing, the whole procedure will be free.
I had a total hip replacement in 86’, still going strong
I was 33 at the time
Why did you need total hip replacement at such a young age?
Had a full knee replacement in 2008. Biggest mistake of my life. If you are overweight, lose some weight first. I should have done that instead.
I had mine done in 2003 at 48, the only thing I cant do is run
My mother had both hers done and one wore out in 7 years and the other wore out in 8.
She blames the obesity on the joint problems, but having watched her becoming more and more inactive over the last 20 years I think it is the other way around. Because of the obesity she has the joint problems.
She is having her hip done Sept 1st, and hopefully we can convince her to get out and walk just a little bit. She is not even 65 years old, and already needs handicap parking because of the constant pain.
Yes, but the line may be long.
>> By the time my hips need replacing, the whole procedure will be free.
> Yes, but the line may be long.
And if you’re over 60, white, or male, the line will grow longer in front of you as you wait.
Just watch...nobamacare will eliminate this “costly” procedure if you are retired and “unproductive”.
nobamacare = stay well or die.
Cement is evil.
I have joked that under Obamacare I would probably get an amputation, but would get to keep the knife to whittle my own peg leg.
I had a long talk with hubbys Orthopedic surgeon (he had some cartilage trimmed, will eventually need knee replacement) and he told me this:
The problem is not with the actual replacement joint failing. The problem is where the bone and the replacement joint meet. The foreign material in there touching the bone sets up an inflammatory reaction and the bone gradually pulls away from where it’s connected to the implant so the implant gets loose.
He said the joints themselves will go forever, where they meet, but the looseness problem can occur as soon as a year after surgery or may not happen ever. It depends on the patient and they really don’t know who will have the problems.
It does become a vicious circle after awhile.
Yeah, yeah, Sweden does it better. Apples and oranges. Sweden probably limits the procedure to only the ideal candidates. We had a doc where I worked in the 80s who, if you judged him purely on his success rate, he’d be a failure. Higher complication rate than any of the other doctors. If there were “pay for performance,” he’d have been drummed out of the hospital.
What doesn’t go into the statistics though is that a lot of physicians have excellent success rates purely because they limit their cases to the ones with the best chances. The doctor I referenced above loved to take on the difficult cases. He was probably the best surgeon on the whole university staff. He did the Jehovah’s witnesses who wouldn’t accept blood transfusions, the obese, the medically fragile. Of course he made sure his patients were informed of the risks, but generally it was risks they were willing to take to be able to live without pain.
I had to have both my hips replaced in 2003. Mostly because of some massive doses of steriods. Long story.
But my Doctor told me that I could not put weight on the leg for 4 weeks. The reason was because the blade that went into my leg was not glued or cemented. It had tiny holes in it. I’m thinking they scooped out the marrow and then inserted the blade in. But the marrow grew through the metal blade.
I have no trouble with it except I too can not run. I also drive an 18 wheeler and get in and out all the time. I had a wonderful Doc.
My doc isn't using cement and the bone will grow into the implant matrix.
I am extremely more carefull, but still get thrown off ahorse once a year it seems
“Cement is evil”
Add steel decks.
Jumping out of trees & planes doesn’t help either.
I’m on a liquid glucosamine mix, Celadrin (O/C) & a pack of Knox gelatin per day. Works for me instead of going to the injection or getting a knee chop job.
umm interesting, my hip is metal on metal, in fact the Ortho insisted on it, said it would last longer, then the plastic and metal. is a major PITA to go through the airport. I have had zero problems I am careful about what I do. try really hard not the step into the air off of step stools.
I took a step backwards off a step stoll, about 4 months after the replacement was done. took a quick trip to the er to make sure I didn’t screw up the work!!!
Only downside was an urge to crow when the sun came up.
Has your mother tried glucosamine chondroitin? I have arthritis in my hip. At first it was so bad, I could barely walk a block and half to the bus stop and was in pain going from my office to the office kitchen just down the hall.
Working with my doctor, I started taking GC and now rarely have any pain and other than avoiding doing the stairs too much, no restriction. I can walk 2-3 miles at a time and can do interval running in short stretches (tho I find my hip feels much better the next day after running on a treadmill than on the street). I am 56.
My mother has terrible issues with her knee, but would not take any supplements. You have to take GC while you still have cartilage left. If you wait like my mother, you have to get a knee replacement, live in pain, or take shots. If you mother still has cartilage, she might try the GC for a few weeks and see if that helps.
I have been having hyalgon injections under my knee caps because of no cartlidge. They are wonderful. Almost back to my old self. I can get them every six months, so I am hoping they last that long. You may want to check them out if your pain is in the knee cap.
You’ve probably seen(and posted !) this article, only in comment is Sweden addressed. It seems to me patients are likely “selected” on more restrictive criteria there, since they appear to ration by number of doctors performing procedures. The comment reads:
“The one counter-example to your point I would cite is Sweden. In Sweden, tenders have reduced implant pricing a great deal. Procedure volume is centralized in a smaller number of surgeons. According to the Swedish surgeons I’ve spoken with, there are no sales reps in Sweden because 1) the companies can’t afford them; and 2) the surgeons don’t need them.” http://www.600bn.com/?p=21#comments
I am astonished at how opaque the information retrieval ,at least at the Google level, is , for comparing medical procedures , costs, availability from country to country. It certainly benefited the Democrats during the Obamacare debate to obfuscate, but it dates from at least the Hillary care era.
As always, without knowing what is deemed a 'failure' (which might be entirely different between the two countries) this statistic is meaningless.
Assuming proper placement and no infection, the bone/cement interface is responsible for most arthroplasty failure and deterioration.
Bone ingrowth prostheses are far superior.
‘Gender’ based implants are a marketing stunt.
A study on knee problems showed that the muscles put 4 x the strain on the joint compared to weight. In other words, for every pound you loose, you take 4 pounds of strain off the knee joint.
You appear to have some inside knowledge of joint repalcements. I have a bad knee and need some striaght info on knee replacement. You make it appear that there are several types of replacement joints. Could you elaborate on the plus and minus of each. I need to lose weight, but need a knee now. What should I do, wait till I am thinner, probably a year or two, or get one now? I am not very mobile due to my inability to walk or stand very much.
One time during physical therapy with my wife and grandson were watching a therapist made tears run down my face straightening my knee. Our grandson turned to his grandmother and said, "Grandma, she's making Grandpa cry!" My bride quietly replied, "It's okay. I am paying her to do that." Our grandson backed up and didn't misbehave for some time.
Want to know what a TKR really consists of? Check out this video here and select virtual knee surgery.
Want data on how excess weight causes knee problems? Then check out this link near the bottom to find out each extra pound causes an extra four pounds of stress on each knee each and every step. Do the math 25 extra pounds x 4 = 100 pounds of extra stress each and every step. Not so good. Climbing stairs the multiplier is no longer 4, but 20. Again, do the math.
Prior to my double TKR I was in constant pain. Today I am pain free. My only limitations - knee bend limited to 135 degrees at best, no running, and no sky diving. Oh well.
Plan on checking again after losing 40 pounds. Cheers!
I had the injections 3 months ago and am doing great! I take glucosamine too and the intense pain is gone.
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FReepmail me if you want on or off my health and science ping list.
My friend, who celebrated her 100th birthday on Tuesday had 5 operations over the course of a year to replace her hip.
That was four years ago and she still has only two speeds:
Forward and Faster....
I believe the higher failure rates here are due to the great number of doctors doing these operations, which are very financially rewarding for them. Only a certain percentage of these doctors are excellent surgeons, and of those, only a certain percentage have the experience needed. Try to find a doctor with both, is my advice. Go for the best on this one.
Don’t fool around with resurfacing. You will have to have it done again. A little birdie told me.
Also take large doses of Ester C and rub on castor oil. Miracle workers for joint pain.
Thanks Doc, you have the best pings. Appreciate your hard work.
In France everyone is limited to a 32 hour work week, so I would think the surgeons don't keep their skills honed like a 60 hour/week surgeon. Obama now wants to greatly restrict medical intern hours, no more grueling work weeks to master the trade. This is to lower the bar to let more minorities become doctors. This can't be good for the future, when everything's "free" and anyone can become a surgeon, with equal pay for all, if they want to.
My Glucosamine liquid has the C in it.
Glucosamine, MSM, Bromelain, Ester-C, Chondroiton, Mussel
I buy it by the gallon and me & my horse share. I use the spoon first:)
I doubt your Glucosamine has nearly enough Vit C. I take a minimum of 4 grams daily.
What about the poor horse having to go after you? Feed the horse first!! :)
No it isn't, but the article doesn't say they all need replacing in 7 years, just that a very few do. It's biology and engineering, no two people are identical. One would expect a few outliers in the time to failure graph.
My Ortho said he's never replaced a knee implant, and he's been doing them for 25 or 30 years. Every one he put in, in which the patient is still alive, is still working.
He encouraged me, unlike the previous ortho I'd been seeing ( who had both knees replaced himself, but then retired) to get the replacement(s) done first, then exercise and lose weight, not wait until I could lose some weight. The guy does a lot of knee and hip replacements, probably around 4-5 per week. I just wish, as does he, that we could have done both of mine at once. But there was no clear indication the left one needed it. Not even an MRI showed that much damage. But when he got in to take a look, the meniscus had a huge flap tear, not repairable. So, once the first one is sufficiently healed up, I'll be back on the table for the second one.
It can, but not so much if you already bone on bone. Go to one of those on your brother's list. Listen to him, and I think You'll get it done. I say that as one who is only two weeks (tomorrow) into recovery from that "major surgery" (which it is). Try to see that they use a continuous motion machine after the surgery. It helps a lot with initial range of motion. Just before they released me, on Friday after a Tuesday surgery, I was well over 80 degrees. Now I'm 110. (Which is all that they "require", but my other leg does 130, so that the goal for both). I'm only a degree or two from being able to completely straighten it as well. Some of that, especially on the "bend" side, is the skin pulling on the scar, which still has the stables in it (until Wednesday this week).
If they are already interns or residents, they are doctors already. They already have their degrees.
How does Obama want to restrict medical intern or first year resident hours? BTW, this is called postgraduate medical education.
“My orthopedic doctor also recommended taking glucosamine and condroitin which surprisingly helps if you take them long term.”
Actonel is in a group of medicines called bisphosphonates (bis FOS fo nayts). It alters the cycle of bone formation and breakdown in the body. It slows bone loss while increasing bone mass, which may prevent bone fractures.
Actonel is used to treat or prevent osteoporosis in men and women. Actonel is also used to treat Paget’s disease of bone.
Actonel is only part of a complete program of treatment that may also include diet changes, exercise, and taking calcium and vitamin supplements.
Actonel has approval to reduce fractures at vertebral and nonvertebral sites (hip, wrist, pelvis, clavicle, leg, humorous)
My mistake. Lowering the bar on interns is not yet an Obama policy: Bloomberg: New Doctor Intern Inspections to Cost Hospitals $15,000 Yearly
Hospitals will be required to reduce physician interns’ working hours and be inspected yearly to ensure the first-year doctors are properly supervised and getting enough time off under newly proposed rules.
The Accreditation Council for Graduate Medical Education, a nonprofit organization that evaluates more than 8,800 U.S. residency programs, outlined the proposed policies in a paper published today in the New England Journal of Medicine. The procedures would trim the length of time interns can be on call to 16 hours from 30 previously and require greater supervision of the new doctors.
Long schedules for interns, medical school graduates in their first year of hospital training, were once a rite of passage, with reports that some new doctors worked 140 hours a week. In July 2003, the accreditation council restricted intern working hours to no more than 80 a week and 30 at one stretch after a 1999 Institute of Medicine report found medical errors claimed 44,000 to 98,000 lives annually.
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