Sea Crest Health Care Center

806,000 hip and knee implants were performed in the US in 2007 – that’s double the amount done a decade earlier. However, a 2007 study demonstrates that 7% of Medicare patients who underwent a hip replacement required another replacement hip within seven and a half years.  That number, small as it sounds, translates into thousands of patients who eventually need a “do over”. A joint surgery involves risk, pain, convalescence, rehab and medical expenses; no one wants to go through that more than once if necessary.

A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

As the Baby Boomer generation ages, there is a swelling populaton of people suffering from osteoarthritis. Arthritis pain seems to go hand in hand with insomnia, with joint pain keeping awake 60% of those with osteoarthritis

A new study, reported in the Aug. 15 issue of Journal of Clinical Sleep Medicine, finds that cognitive therapy has a beneficial effect on osteoarthritis patients and insomniacs – assisting them in their quest for a good night’s sleep.

Cognitive behavior therapy for insomnia or CBT-I,was given by an experienced clinical psychologist who taught participants cognitive restructuring techniques that helped change unrealistic beliefs and irrational fears regarding sleep or lack of it.

Handwritten sleep logs kept by participants documented their sleep patterns, and pain level was graded by the Short-Form McGill Pain Questionnaire (MPQ) and the Body Pain Subscale (SF-PAIN) question from the Medical Outcomes Study Short Form-36 Pain.

Results showed that after CBT-I treatement, patients were falling asleep faster than before, and remained sleeping approximately 37 minutes longer. CBT-I seems to be an effective tool for treatment of osteoarthritis in conjunction with other pain management techniques, and may also work well with other chronic pain conditions.

by Jose Sonik
The more aggressively you screen for and try to prevent osteoporosis, the lower your risk of a hip fracture is, studies show.
Hip fractures are common in the elderly, especially women, who lose essential calcium during pregnancy and menopause.
Kaiser Southern California has developed a three-step action plan that they say can reduce hip fractures by as much as 25%.
The three steps are as follows:
Bone scans: Kaiser recommends x-ray absotiometry, the best bone density test available. The tests should be taken by all women over 65, all men over 70, everyone on high dosages of medicines that leach calcium from the bones, and anyone over 50 with a history of fragility fractures. These are the high-risk populations, and a scan could catch a weakening bone before it becomes a fracture.
Education and treatment: Learning and teaching about osteoporosis helps people help themselves. The more you know about osteoporosis, the better you can protect yourself from fractures. Kaiser found that patients who understood their treatment opted for more than just drug treatment: they got home safety checks to help prevent falls. Slippery bathtubs, cords across the room, and loose rugs are all tripping hazards that can snap a fragile bone.
Fall Prevention: If you’re at risk for a fall, consider learning fall-reduction techniques, that will lower your risk for a fall. Physical therapy can improve balance and coordination, reducing the risk still further.
Kaiser ran a three-part program with 620,000 patients in Southwestern United States, and found an overall reduction of hip fractures by 35%. Why wait for them to test it in your neighborhood? Start your own three-part program today.

by Jose Sonik

Some news from the science front! Hormone replacement in women is linked to hip replacement -  and childbearing is linked to knee replacement. These two new findings come out of England where 1.3 million women were followed since 1996.
Hormone replacement therapy is quite common among post-menopausal women, particularly those at risk of osteoporosis. Estrogen prevents bone-loss, which in turn prevents osteoporosis. But it seems to have a negative affect on join strength. Notable, estrogen with progestragen was more closely correlated with hip replacement than estrogen alone or tibolone.
The second finding is more startling. It’s well known that running, excessive jumping, climbing, and carrying heavy things can damage the knees, but nobody ever thought to apply that to carrying children. Though, when you think about it, some of those babies can get quite heavy.
This finding creates one of those tight corners often created by conflicting medical advice. Exercise during pregnancy is highly recommended, but it’s important to avoid unduly stressing the knees. Here are a few recommendations:
1. Swimming. Swimming takes the weight off your legs while getting your heart rate pumping. An outdoor pool or swimming no more than once a week because of the chlorine and ammonia that can build up over indoor pools.
2. Rowing, weightlifting (from sitting position), and similar exercises are healthy and will also get you ready to start carrying around a 10 lb baby.
3. Biking on a stationary bike will support your weight while giving you great aerobic exercise.
4. Yoga is both relaxing and healthy and a good idea any day.

by L. Hauben

Some news from the science front! Hormone replacement in women is linked to hip replacement – and childbearing is linked to knee replacement. These two new findings come out of England where 1.3 million women were followed since 1996.
Hormone replacement therapy is quite common among post-menopausal women, particularly those at risk of osteoporosis. Estrogen prevents bone-loss, which in turn prevents osteoporosis. But it seems to have a negative affect on join strength. Notable, estrogen with progestragen was more closely correlated with hip replacement than estrogen alone or tibolone.
The second finding is more startling. It’s well known that running, excessive jumping, climbing, and carrying heavy things can damage the knees, but nobody ever thought to apply that to carrying children. Though, when you think about it, some of those babies can get quite heavy.
This finding creates one of those tight corners often created by conflicting medical advice. Exercise during pregnancy is highly recommended, but it’s important to avoid unduly stressing the knees. Here are a few recommendations:
1. Swimming. Swimming takes the weight off your legs while getting your heart rate pumping. An outdoor pool or swimming no more than once a week because of the chlorine and ammonia that can build up over indoor pools.
2. Rowing, weightlifting (from sitting position), and similar exercises are healthy and will also get you ready to start carrying around a 10 lb baby.
3. Biking on a stationary bike will support your weight while giving you great aerobic exercise.
4. Yoga is both relaxing and healthy and a good idea any day.

By Ruth Folger Weiss

A few months after undergoing routine hip replacements, a number of patients of  a well known LA orthopedic surgeon started suffering from excruciating pains. The surgeon, Dr. Lawrence Dorr, was stymied until he discovered one factor they all had in common; the same replacement joint, manufactured by Zimmer Holdings, was implanted in all of them. Several needed to have their replacement replaced in another bout of surgery. When Zimmer was first contacted about this problem, they just brushed it off. It took a year of more complaints and pressure from doctors until they pulled this device off the market. In the interim many more patients unknowingly had their joints replaced with a faulty Zimmer “Durom Cup” with crippling results.

This upsetting scenario could have been avoided, and many patients could have been spared the agony, if the U.S. would have a Joint Registry in place. A Joint Registry is a national database that tracks the well being of patients with artificial hips and knees. Countries such as Australia, Britain, Norway and Sweden have such a system in place and the benefits are numerous. Tracking the success rates of the different joints available results in the faulty ones being pulled from the market much quicker. The registry data puts pressure on manufacturers to explain why their products perform poorly and the registry alerts surgeon to stop using flawed joints.

Monitoring devices like artificial joints supposedly falls under the domain of the The Food and Drug Administration but they are often overwhelmed by the vast number of products it monitors and because doctors often do not report problems.

Nearly one million hips and knees were replaced in the U.S. alone last year, about half of the world’s total. As the world’s leader in joint replacement, the U.S. should take the initiative and be the leader in follow-up too.  So far all efforts to establish a database here have failed due to the many hurdles, financial and practical, of our fragmented and decentralized health care system, as well as a lack of support from Medicare.

by T. Lee

Common medical wisdom has it that you should wait as long as possible before getting a knee replacement. After all, even titanium doesn’t last forever, and you don’t want a second replacement in your twilight years.

But that wisdom is getting old fast. Knee replacements routinely last 20 or more years, which means they’re likely to last the average candidate’s lifetime.

There’s good reason not to wait until joint pain becomes unbearable. By the time all the cartilage has worn out and walking becomes agony, the average person has become an invalid. The worse off you are going into a surgery, the worse you’ll be coming out. Entering as a cripple is a guaranteed way to ensure that you don’t make a complete recovery or regain full use of the limb.

If your doctor keeps telling you to wait, don’t be afraid to get a second opinion, or insist that he recommend a replacement. “Wait until you can’t bear it anymore,” isn’t a good recommendation. If you’re hobbling with a walker, you deserve a replacement. In addition, men tend to get a replacement recommended faster than women, so if you’re female, don’t take “no” for an answer when you think you deserve a “yes.”

by T. Lee

What do you get when you combine an aging population with a gaining population?

Hip and knee replacements.

As baby boomers age and acquire arthritis, and as obesity continues to rage among the younger population, knees and hips are wearing out at an unprecedented rate. And as they wear out, they are being replaced at an unprecedented rate.

Arthritis is usually associated with aging, and the grinding down of cartilage at the joints. But cartilage can also be ground down by excessive weight placed on the joint by obesity.

Today, both populations of arthritis patients are growing, as baby boomers hit retirement and obesity grows in the general American population.

Arthritis can cause stiffness, swelling, and general joint pain, restricting, or even severely limiting, patient mobility. When pain-killers cease to help, join replacement surgery is a popular option. Titanium joints can last 10 or so years before they need to be replaced, and drastically reduce pain and increase mobility close to ordinary activity levels.

Between 2000 and 2004, there was a 53% increase in knee replacements and a 37% increase in hip replacements. According to a report by Dr. Sunny Kim at the Florida International University, if these trends persist, there will be 1.4 million knee replacements performed in the year 2015 alone. The cost to health care providers would be enormous.

~ L. Gordon 

What do you get when you combine an aging population with a gaining population?

Hip and knee replacements.

As baby boomers age and acquire arthritis, and as obesity continues to rage among the younger population, knees and hips are wearing out at an unprecedented rate. And as they wear out, they are being replaced at an unprecedented rate.  

Arthritis is usually associated with aging, and the grinding down of cartilage at the joints. But cartilage can also be ground down by excessive weight placed on the joint by obesity.  

Today, both populations of arthritis patients are growing, as baby boomers hit retirement and obesity grows in the general American population.  

Arthritis can cause stiffness, swelling, and general joint pain, restricting, or even severely limiting, patient mobility. When pain-killers cease to help, join replacement surgery is a popular option. Titanium joints can last 10 or so years before they need to be replaced, and drastically reduce pain and increase mobility close to ordinary activity levels. 

Between 2000 and 2004, there was a 53% increase in knee replacements and a 37% increase in hip replacements. According to a report by Dr. Sunny Kim at the Florida International University, if these trends persist, there will be 1.4 million knee replacements performed in the year 2015 alone. The cost to health care providers would be enormous.