Most patients’ brake reaction time had returned to baseline level or better within 2 weeks of undergoing total hip arthroplasty, allowing the patients to be able to drive safely again, according to study results.

Researchers retrospectively evaluated brake reaction time in 38 patients (mean age: 62 years) who underwent total hip arthroplasty (THA). All patients had the brake reaction time assessed preoperatively to establish a baseline and again at 2, 4, 6 and 8 weeks postoperatively, or until brake reaction time was the same as or better than the preoperative score. The researchers obtained patient history to rule out the use of pre- and postoperative narcotics during testing. Patients were able to drive again when their brake reaction time was the same as or better than the preoperative baseline.

The mean brake reaction times preoperatively and at the 2-week follow-up were 0.635 seconds and 0.576 seconds, respectively. Results indicated 33 out of the 38 patients reached their baseline at the 2-week follow-up. The remaining five patients reached their baseline at the 4-week follow-up.

According to the researchers, the average preoperative time for the five unsuccessful patients was faster compared with the 33 successful patients, meaning the five patients who did not match their preoperative time at 2 weeks had a faster time to achieve in order to be successful.

I allow most patients to resume driving within 2 weeks after surgery.

New research presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) highlights the benefits of total knee replacement (TKR) in elderly patients with osteoarthritis, including a lower probability of heart failure and mortality.

Investigators reviewed Medicare records to identify osteoarthritis patients, separating them into two groups – those who underwent TKR to relieve symptoms, and those who did not. Outcomes of interest included average annual Medicare payments for related care, mortality, and new diagnoses of congestive heart failure, diabetes and depression. Differences in costs and risk ratios were adjusted for multiple variables including age, sex, race and region. The results (adjusted for underlying health conditions) were compared at fixed periods of one year, three years, five years and seven years after surgery.

The seven-year cumulative average Medicare payments for all treatments were $63,940 for the non-TKR group, and $83,783 for the TKR group, for an incremental increased seven-year cost of $19,843. The cost does not include prescription drugs, which are reportedly much higher in the non-TKR group.

There were significant positives in the osteoarthritis TKR group: the risk of mortality was half that of the non-TKR group and the congestive heart failure rate also was lower, at three, five and seven years after surgery. There was no difference in diabetes rates among both groups. Depression rates were slightly higher in the TKR group during the first three years after surgery, though there was no difference at five and seven years.

One of the most common complaints after joint replacement is difficulty sleeping. My patients always ask, how can I get better sleep? The most common cause of sleep disruption is pain. It has been reported that more than half of patients wake up with pain after joint replacement.

Many factors can affect the quality of sleep after a major surgery including anesthesia-type, narcotic use and discomfort due to pain or restricted leg movements. As sleep is crucial to the recovery process, it is important to follow appropriate pain management protocols. Contemporary pain management protocols are designed to be multifaceted and inhibit pain in a multitude of ways. Many protocols use a variety of injections and nerve blocks for localized pain, as well as employing narcotics and anti-inflammatory medication for several weeks after surgery. As such, pain protocols should be fully followed to ensure an adequate recovery.

Usually around the second or third week after surgery, you will start to increase your activity levels while at the same time decrease your narcotic use. This often coincides with having a difficult time sleeping. When this occurs, you should take your pain medication an hour before bed to achieve better comfort and help restore your sleep cycle. A few days off from strenuous activity or physical therapy will not inhibit your recovery, but can have a tremendous effect on your ability to fall asleep and stay asleep. Overall, sleep deprivation after total joint replacement is manageable through pain management, the occasional use of sleeping pills, and activity modification.

A study at the Mayo Clinic has found that corticosteroids, commonly used as a short–term anti–inflammatory and analgesic for the treatment of musculoskeletal disorders, may be cytotoxic to mesenchymal stem cells (MSCs), the direct progenitors of chondrocytes and other musculoskeletal tissue.

The authors of the study concluded, “Corticosteroids frequently are used by physicians to reduce inflammation in patients with musculoskeletal disorders, but these agents may hinder the innate regenerative capacity of mesenchymal stem cells in exchange for temporary analgesia.” However, the researchers’ findings suggest that dexamethasone may be less damaging than other corticosteroids. A separate study, retrospectively conducted at the University of North Carolina at Chapel Hill, investigated the effects of corticosteroid injections in patients’ hip joints and found that 32 out of 33 consecutive patients (97%) showed marked decreases in joint space width, visible on standard radiographs, just six months after injection with corticosteroids and lidocaine. Previous studies have already shown that corticosteroids may have a deleterious effect on chondrocytes, suggesting a potentiation of degenerative joint disease. These two new studies contribute to the growing body of evidence that corticosteroid injections, while providing temporary relief of patients’ joint pain, may at the same time accelerate joint deterioration.

According to the 2005 US census, osteoarthritis (OA) was the leading cause of disability in the United States, affecting more than 50 million people. Current treatments are targeted at reducing symptoms of the inflammatory reaction that occurs after destruction of essential joint cartilage.

Laboratory studies have shown that eicosapentaenoic acid and docosahexaenoic acid reduce pro-inflammatory mediators and increase joint lubrication in vitro. Well-designed clinical trials are needed to substantiate or refute the potential benefit of fish oils in OA treatment. Long-term studies are needed to assess the possibility of prevention. In addition, standardization of the fish oil industry is needed for consistency of therapy.

One of the most common questions I get asked as an orthopaedic surgeon is, how do I prevent arthritis?

Osteoarthritis (OA) is the most common joint disorder in the United States. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older.

The number of people affected with symptomatic OA is likely to increase due to the aging of the population and the obesity epidemic. Although we can’t prevent osteoarthritis altogether, we can lower the risk factors that cause osteoarthritis. Here are some helpful tips:

1. Lose weight, or at least avoid gaining. Extra pounds are awful on joints: They increase the burden on them, and have a destructive metabolic effect. A chemical related to obesity upsets the balance between the buildup and breakdown of cartilage, meaning the natural degradation of cartilage moves more quickly than the renewal process that’s supposed to restore it. The effect is a net loss that, over time, becomes osteoarthritis.

2. Do exercise that doesn’t damage joints. That includes low-impact biking and swimming, along with yoga and pilates, plus walking if it’s not too fast, and weightlifting, as long as it’s not stressful. If you walk, make sure you have comfortable shoes, and try to walk on surfaces that are relatively flat. Asphalt is better than concrete.

3. Watch your biomechanics. How you lift and carry various objects, or perform physical tasks, including playing sports, can make a big difference to the health of your joints. The back is the most obvious part of the body that can be strained, but nearly all joints can be damaged by poor biomechanics. For instance, something as simple as gardening can put stress on joints if you dig at the dirt with your fingers instead of using a proper tool. Proper mechanics while playing sports will do far more than improve your athletic performance. It also minimizes strain on joints from head to toe that can manifest later as osteoarthritis.

4. Prevent and treat injuries. Too many ankle sprains, or insufficient treatment following sprains, can put you on the road to arthritis in your ankles. And once you alter the mechanics of your ankles to compensate for that, you can begin a process where the mechanics of other joints are also altered, through your knees up to your hips, etc. So, take care of your injuries, whether to the ankles, knees, or elsewhere.

5. Taking supplements is also a potentially useful step. Glucosamine and chondroitin both show evidence of helping cartilage avoid deterioration, at least to a degree.

6. Check your vitamin D. According to the National Institutes of Health, about 60 percent of Americans are deficient in vitamin D, especially African-American women and those of menopausal age, are especially likely to be lacking adequate levels. Patients who have adequate levels of vitamin D have less progression of osteoarthritis.

Another reason to drink more water: arthritis prevention. The cartilage in our joints is made up mostly of water, which is what makes it such a great cushion for the joints. When we are dehydrated, water gets sucked out of the cartilage and it’s more easily damaged by wear and tear. Keep your cartilage healthy by drinking water throughout the day. A daily 6 to 8 cups now may pay off in the years to come.

A study, published in the May British Journal of Sports Medicine, involving 6,000 Norwegian men born from 1923 to 1932 found that exercise late in life allows them to live longer. The study found that increasing physical activity benefited life span as much as did quitting smoking. The men in the study had a check on their health in 1972 and again in 2000.

Altogether, they were monitored for about 12 years. Holme reported that 51% of men who were sedentary in their 70s died from any cause compared with one quarter of those who were moderately to vigorously active.

Moderate exercise consisted of exercise sports or heavy gardening for at least four hours a week. Vigorous exercise involved hard training or competitive sports several times a week. “Just 30 minutes of moderate activity six days a week was associated with a 40% lower risk of death. More exercise reaped greater benefits, decreasing the odds of death from heart disease or any cause,” the researchers said. Men who were sedentary in their 40s lived five fewer years on average than those who were the most active.

A new Australian study finds that drinking multiple cups of black tea is linked to lower fracture risk in older women. The study, which looked at 1,188 older women (aged 75 and over) participating in the Calcium Intake Fracture Outcome Study in Australia, found that those who drank at least three cups of tea a day had a 30% lower risk of having any osteoporosis–related fracture compared with women who rarely drank tea. A key ingredient in tea that is thought to benefit bone health are flavonoids.

Why tea?

A key ingredient in tea that is thought to benefit bone health are flavonoids (a type of antioxidant). Flavonoids are found in diverse plant foods ranging from fruits and vegetables, herbs and spices, essential oils, and beverages. For each one-cup/day increase in tea intake, there was a 9% decrease in the risk of a serious osteoporotic fracture, but this was no longer significant after adjustment for bone-mineral density. Although previous studies have consistently shown associations between flavonoid consumption and higher bone mineral density, this is the first study to show a positive link between flavonoid intake and fracture risk. The study was also unique in that it looked exclusively at women aged 75 and above, a high-risk age group.

Bones heal faster when treated with a component of marijuana, according to a study at Tel-Aviv University in Israel. The helpful ingredient is cannabidiol (CBD), a non-psychotropic component of the marijuana plant. Results of the study are published in the Journal of Bone and Mineral Research.

The results of the study were not a surprise. Previous work had demonstrated that bone formation is triggered by cannabinoid receptors that help to prevent the loss of bone. They also found that skeletons, in general, appear to be is managed by cannabinoids. Researchers from Tel Aviv University injected one group of rats that had mid-femoral fractures with cannabidiol. A second group received both CBD and tetrahydrocannabinol (THC), the psychoactive component of marijuana. Within eight weeks the rats that received only CBD exhibited significant healing. The researchers found that CBD by itself made bones heal more quickly and come back stronger than before.

Most hip replacements eventually wear out. Unfortunately, an artificial hip is not as durable as your own hip. Because the hip implants are made of metal and plastic, these materials begin to wear over time, just like the rubber on your car tires.

The good news is that studies show that common types of hip replacements can last more than 20 years. While there are hundreds of studies, they all vary in the type of implant used and the type of patient who had their hip replaced. One very large study found that 80% of hip replacements were functioning well after 15 years in the younger (less than 65) patients, and 94% of the older (over 65) patients. You should remember that while some patients may have hip replacements that last several decades, other patients may require a second hip replacement just a handful of years after their surgery.

Revision hip replacement (a second hip replacement) is a major undertaking that often has less successful results than an initial hip replacement. On a bright note, a report found that only about 2% of hip replacement surgeries required a second surgery within five years of the initial hip replacement.

Factors Affecting Longevity of Hip Replacements

Many studies have been done to determine how long a hip replacement will last. With hundreds of different types of hip replacements, and countless different types of patients, there is no rule to how long a hip replacement will last in a particular individual.

Implant manufacturers are constantly striving to create a “better” implant that will last longer. Some of these implants have only been used for a handful of years, and determining whether or not they will last longer is a question only time can answer.

Some of the factors that seem to influence the longevity of hip replacement implants include:

Age of the Patient

Younger patients require a hip replacement to last much longer. On top of that, younger patients tend to be more active. Therefore, patients who have hip replacement in their fifties or younger can usually expect to require a second hip replacement in their lifetime.

Patient Activities

Some activities may not be appropriate for patients with a hip replacement. While these activities may not be painful or difficult, they may place excessive stress on the hip replacement, causing the parts to wear out more quickly.

The more an individual weighs, the more stress that is placed on the joint replacement implant. Maintaining a normal body weight is critically important when trying to make a joint replacement last. Appropriate exercises can be helpful in maintaining a healthy hip replacement.

This may sound obvious, but there are some specific medical conditions that can lead to complications affecting the joint replacement. Patients having invasive medical procedures (including dental work) may require antibiotic treatment to prevent bacteria from getting into the joint replacement. Patients with osteoporosis should ensure that they are being adequately treated, as a fracture in the bone around a joint replacement can affect the functioning of the implant.

The Latest and Greatest

One temptation of patients and surgeons alike is to be attracted to the newest hip replacement on the market. Undoubtedly, this implant will claim to function better and last longer than other hip replacements. While these newer implants may be better, it is also important to understand that being new means there is no long-term data on how well these implants will function over time.

I always recommend that patients and myself try to find an appropriate balance between modern design and not being a ‘test’ patient.