Dr. Gold's Orthopedic Surgery Blog

One of the key elements of a successful shoulder replacement surgery is a proper and well guided recovery.

A shoulder replacement can often allow a patient to resume many of his or her pre-operative activities. The procedure predictably provides pain relief, but functional improvement is variable and patient dependent. Additionally, an important part of this recovery requires the patient to commit to the surgeon’s recovery and post surgical rehab plan

. This may involve restricting certain activities, performing the prescribed exercises, and, if needed, attending occupational or physical therapy sessions on a regular basis. Each plan takes the patient’s age and health into account, so it is highly unlikely that one patient’s plan will be identical to another’s.

After the surgery is completed, the patient will spend one or two hours in the recovery room. He or she will not be moved to a hospital room until awake. If a nerve block (done to control post op pain) is placed before the procedure, upon awakening, the patient may notice that the arm on which surgery was performed is numb and that the wrist and fingers may not move normally for up to 24 hours.

While still in the recovery room, many surgeons order an icing machine for placement on the shoulder. These devices help reduce swelling and pain. Typically, the patient is instructed to continue using the device or ice packs after discharge. Other key elements of a shoulder replacement recovery include:

• As soon as the patient regains movement in the hand, it is helpful to begin exercising. This is normally just making a fist with the hand on the arm on which surgery was performed. The patient will likely be instructed to hold the fist for five seconds before releasing and to repeat the action frequently. This exercise can help keep the blood in that arm circulating and can reduce bruising.

• Most patients wear a sling for four to six weeks following surgery. It should definitely be worn in crowds or when the patient is mobile, such as climbing stairs. It may be possible to relax the sling while performing sedentary activities, such as watching television.

• During the first six weeks, most patients are told to refrain from driving. It normally takes this long to regain adequate range of movement in the shoulder to perform many activities of daily living. Few patients are able to return to work within the first 3-4 weeks, and those with more strenuous occupations may require eight months. As a rule, patients may use the arm for routine activities, such as writing or eating, but should not lift with the arm or make sudden movements with it for six weeks.

As for your hospital stay, most patients are in the hospital for two days following the surgery, and during this time, they usually see a physical therapist once or twice a day. The physician may order a patient to begin exercises as soon as the day following surgery. Exercises are designed to strengthen the arm as well as keep it flexible. The precise exercises will depend on the patient’s age, physical ability, and health, but as a rule, they are not load-bearing movements.

The surgeon will probably want to see the patient 7-14 days after shoulder replacement surgery. At this visit, the sutures are normally removed. Until that appointment, the patient should keep the incision clean and dry as possible. Once the wound is sealed and dry without any drainage, getting it wet, but avoiding scrubbing, is permitted.

Shoulder replacement surgery has an excellent success rate for resolving pain and improving functionality. Often, the patient can resume many activities, including low impact sports. Patients who pick the right surgeon and follow their therapy plans typically reap the greatest benefits.

I hope that helps you learn more about the recovery from shoulder replacement.

Until next time,

Stuart

I was recently asked to discuss orthopedic surgery on The Home Show Radio Show near my office in Torrance, Southern California. To listen to the second part of the recording, simply press the play button below.

Host: And welcome back to the Home Show here on News Talk 870 KRLA. My name is Jessie Lovelady, as if you don’t know it already, and I’m with Dr. Stuart Gold. He’s an orthopedic surgeon. I’m very proud to have him on the show and for you listeners out there that are always asking questions about are we going to do medical issues and things like that, hey, I have a doctor that even put out a book for you to help you and you can get that book.

All you have to do is go to orthopedicsurgerybook.com. Even I can find it that way so you listeners out there and it’s got a lot of things on there for you to kind of look at and all this information. I’m sure that a lot of you have questions that you’ve wanted to ask, didn’t know what to ask. We’re trying to help you here. Now, as far as asking, you know, how should you assess surgical skill, how would you do that?

Dr. Gold: Well, patient referrals are usually the best so if a friend has been happy…

Host: Um, hum.

Dr. Gold: with whom they’ve been dealing with, and have had a good result, that’s usually the best referral. However, if you don’t have answer to that or you’re not sure, then if you know any nurses, particularly nurses who work in operating rooms, or anesthesiologists, these are the people that know the physicians and surgeons who are technically gifted and the best. These people would be the best referral for the technical part. As far as personality, again this is something that would come either from direct referrals, doing a little research with your friends, checking the doctor out online to see what he’s accomplished and what he’s done. But just again, because someone is very accomplished doesn’t mean that they’re going to have the personality that you’re going to click with.

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In August 2010, Johnson and Johnson issued a recall for hip replacement systems sold by DePuy Orthopaedics, one of its divisions. The two systems involved in this recall were the ASR-XL Acetabular System and the ASR Hip Resurfacing System. Since introducing the devices in 2003, DePuy reportedly sold more than 90,000 of these two systems worldwide.

Johnson & Johnson Hip Replacement Recall

Statistically, it is expected that no more than 5 percent of patients who undergo this type of surgery will need a corrective operation within five years. However, data revealed that between twelve and thirteen percent of patients receiving the ASR systems needed additional surgery within that five-year time span. Surgery to revise a hip replacement is more difficult and the patient’s recovery may take longer than after the initial surgery.

Patients involved in the Johnson and Johnson hip replacement recall typically complained of swelling, pain, and difficulty in walking. If not corrected, these issues can lead to more serious complications. The implant may loosen or dislocate, or the bone may fracture, and falls can result. The devices can also release toxic metals into the patient’s bloodstream.

The Federal Drug Administration granted DePuy permission to forego clinical trials and begin marketing the devices in 2003. In 2008, researchers from the United Kingdom began conducting tests on the prosthesis. They reported that the joint, which placed two pieces of metal in contact with each other, was eroding and leaching metals into the blood.

Early in 2009, DePuy began marketing a new head for their implants, stating that it “reduced associated ion release” significantly when compared to conventional devices that used metal-on-metal construction. There might have been a Johnson and Johnson hip replacement recall at that point, but the company did not act. They did, however, discontinue the ASR devices later in the year, but they never issued a recall or notified the public of potential problems from the implants.

The issue came to a head in 2010, when the UK’s equivalent of the FDA issued alert-advising physicians to monitor patients who had received the devices for cobalt and chromium toxicity. Soon after, the state of Alaska, through its Department of Health and Human Services, recommended that physicians develop a plan to monitor patients for toxicity and the need for additional surgery.

The Johnson and Johnson hip replacement recall announcement stated that the company would cover customary, reasonable costs for treatment, including additional surgery if required. No mention was made of lost wages or compensation for pain or suffering. However, some patients have sued and been awarded settlements

.

Until next time,

Stuart

Tennis elbow is a painful inflammation of the tendons connecting the outer forearm muscles to the elbow. Although it can be caused by a traumatic injury, it most often results from overuse. Repetitive actions that require twisting the arm can cause stress and small tears in the tendon, causing pain and soreness. As the name implies, those who play racquet sports may develop the condition, but it can also be caused by activities such as painting, working with a screwdriver, or gardening.

Approximately 95 percent of the people who develop tennis elbow can find relief through temporarily eliminating the activity, applying ice packs periodically during the first three days followed by heat, and taking non-prescription pain relievers. A brace (elbow band) may also be used to redistribute pressure away from the tendon. Physical therapy and stretching exercises may also be beneficial. One or two selective injections of cortisone frequently accelerate the recovery if other measures have failed.

Should other treatments fail, a patient may consider a surgical solution. Whether a patient undergoes a traditional tennis elbow operation or has arthroscopic surgery depends on his or her physician’s assessment. The surgeon must determine the best point of entry into the elbow and the nature of the repair or reconstruction that must be done. The specifics of the case will determine the technique used.

A tennis elbow operation, whether performed through open surgery or arthroscopically, involves certain common steps. The tendon is cut, or released, so that the surgeon can remove the damaged tissue. If it is possible to do so without tightening the tendon excessively, the tendon is then reattached. Whether the procedure is performed under local or general anesthesia is determined by the patient’s case history and the surgeon’s knowledge and experience.

Both open and arthroscopic elbow surgery can produce successful results, eliminating the most of the pain the patient was enduring

. However, regardless of the method used, patients will likely need to commit to an exercise program to strengthen and stretch the muscles and tendons in the elbow. The most successful operations are those involving patients who follow a post-operative program of rehabilitation.

Recovery time varies by patient and the type of tennis elbow operation performed. Those with relatively minor damage who have arthroscopic surgery can usually resume normal activities, including sports, in six to twelve weeks. If the damage was more severe, it can be as long as six to eight months before the patient is cleared to resume heavy lifting or racquet sports.

I hope that helps you understand more about operations for tennis elbows.

Until next time,

Stuart

The human knee is among the most complex joints in the body, as well as the largest. It can be damaged through injury, disease, or wear. One common injury is a torn meniscus. Meniscal (cartilage) tears can during activities of daily living and work, but more frequently with sporting activities in weekend warriors as well professional athletes.

The knee joint is formed by three bones: the femur, or thighbone; the tibia, or shinbone; and the patella, or kneecap. In between the femur and the tibia lie two shock absorbing wedges of cartilage, called the menisci. These are comprised of a rubbery material and not only cushion the knee but help it maintain stability. Most often, when an individual refers to a torn knee cartilage, they mean the meniscus.

The meniscus can be torn in several different locations. Tears are denoted by their appearance and the position of the tear within the meniscus. Common references include the flap, longitudinal, parrot beak, transverse, and complex tears. The tear may happen in conjunction with another knee injury, such as a ligament tear. However, in older patients, the tear may result from a meniscus that has thinned and weakened over time. If the cartilage is sufficiently degenerated, a patient may experience a tear just from arising awkwardly from a seated position.

Patients with a torn meniscus normally experience pain in the knee, swelling and stiffness. The knee may “catch” or lock, or it may feel as if it is about to buckle. Motion may be restricted as well. Left untreated, a piece of the cartilage can come free and migrate to the joint, causing slippage or locking of the knee.

The need for knee surgery meniscus depends on the size, location, and type of the tear, but should be decided based on the patient’s symptoms. The outer third of the menisci receive an excellent blood supply. Tears in this area are normally easily repaired through surgery if they do not heal without it. However, the rest of the meniscus does not have a blood supply, meaning that tears will not heal. Tears in this area are frequently in worn, thin cartilage

. Since tears cannot mend, they are normally trimmed during surgery.

Surgeons may recommend knee surgery meniscus if the patient’s symptoms do not abate with conservative treatments. The procedure is normally performed through a minimally invasive surgery, or arthroscopy. This is among the most frequently performed surgeries, and carries a minimal risk of infection as well as minimal scarring.

After knee surgery for meniscal tears, the patient usually does not need a cast or brace to immobilize the joint. Braces may be used after a meniscal repair for 4-8 weeks. Most patients will a period of therapy or rehabilitation. The majority return to the activity level enjoyed prior to the injury. Typical results include reduction or elimination of pain, increased stability of the knee, and a reduction or elimination of swelling.

I hope that helps you better understand knee surgery for the meniscus!

Until next time,

Stuart

Earlier today a patient asked me to describe what happens during a herniated disk neck surgery. That said, I had a few minutes to jot down parts of our discussion for you to learn from. Here are the highlights of our discussion.

In between the vertebrae are discs filled with a jelly like fluid contained by a more rigid structure, similar to a jelly donut. The discs help provide an articulation (joint) which facilitates movement, but more importantly they serve as shock absorber

. Age or injury can cause the discs to leak, and the jelly or disc material can exert pressure on nearby nerves. When this occurs in the neck (cervical region), nerves leading to the arms or legs can be affected. Pain, numbness or weakness in the arms and legs can occur, and may be quite severe. While many patients heal with time and rest, herniated disk neck surgery may be required to provide relief and to prevent further damage to the nerves.

Herniated disk neck surgery is reserved for only the most serious cases. The patient will typically be treated with non-surgical methods for several months first, and neck surgery is then considered if the patient does not improve. If there are neurological problems that are being caused by the compression, such as limited functionality, loss of balance, pain, tingling or numbness, or severe headaches, the surgeon may also recommend an operation to resolve the problem.

There are two primary types of herniated disk neck surgery. The surgeon may choose to make a small incision and insert a tiny camera to view the damaged disc and then remove and or repair it. A larger incision allows the surgeon to view the damage firsthand, as well as locate any other problems in the area.

• The first method carries a lower risk of infection and a faster recovery time
• The second method allows the surgeon to view a more complete picture of the affected area.

Both methods involve the surgical removal of the damaged tissue, or herniated disc. Depending on the approach used and the amount of damage that must be corrected, incisions are seldom more than two inches in length and require only minimal cutting of muscle tissue.

After the damaged disc is removed, the vertebrae are often surgically fused, typically with a bone graft, to close the gap. In most cases now, a plate is added to provide greater stability. In some cases an enlargement of the opening (foramen), the canal where the nerve exits is performed. A fusion is not used in all of these cases.

Many times, surgery to correct a herniated disc can be done on an outpatient basis or with only one night in the hospital. Depending on the procedure used, post-operative pain can be minimal. Patients may be required to wear a neck brace after the operation to stabilize the area and prevent re-injury for a short period of time. The specifications for the brace and the duration of its use will vary by patient. Patients may need to limit certain activities for a time after surgery, but again the specifics are determined on a case-by-case basis. Typically, however, the recovery time is measured in weeks, although complete fusion takes several months.

I hope that helps you learn more about what happens during a neck surgery for herniated disk.

Until next time,

Stuart

Arthritis in the ankle may be caused by normal cartilage wear from activity or after a specific injury such as an ankle fracture resulting in post-traumatic arthritis. Ankle arthritis may also be caused by inflammatory conditions such as Lupus or Rheumatoid arthritis. In early stages, patients may experience little or no pain, and discomfort is usually attributable to activities that are high-impact or weight bearing. As the condition progresses, however, some patients may find that the pain does not abate even at night or is present even without weight placed on the joint. Ankle surgery for arthritis is far less common than surgery for other arthritic joints, such as knees or hips. However, there are three basic surgeries that can be an option for patients that do not respond to other treatments, such as splints and special shoes, steroid injections, weight loss or changes in activity levels.

The most commonly performed ankle surgery for arthritis is a debridement. This procedure is typically performed as day surgery on patients in the early stages of arthritis. It is normally an arthroscopic procedure, requiring a minimal incision. Most patients have a short recovery period and can begin placing weight on the ankle within an hour or two of surgery. The procedure has a success rate of 75 to 80 percent for improvement, with about a five percent chance that the debridement may actually worsen symptoms.

Arthroscopic ankle surgery for arthritis normally requires two incisions, each less than one centimeter in length. To perform the debridement, the surgeon uses a telescope and small instruments inserted through the incisions to remove any damaged cartilage or bone spurs. He then cleans and smoothes the surfaces of the bones.

Patients with arthritis of the ankle may also undergo fusion surgery. This involves removing the covering of the joint (cartilage) and placing it in position so that the bones will join together. The ankle must be kept in position while the bones fuse, and this is usually accomplished by screwing the two sides of the joint together. In some cases, a metal rod is inserted in the heel to compress the sub-talar and ankle joints. It generally takes about three to four months for the bones to fuse, but some patients may require a longer time for fusion to occur

.

The third ankle surgery arthritis is joint replacement. This procedure is relatively new, so fewer of these operations have been performed than on other joints. Patients normally recover their range of motion, but the operation is unsuitable for those who are active in sports or who perform heavy-duty manual labor. In an ankle replacement, the surgeon removes the worn surfaces on the ends of the two primary bones. The articulation (joint) between the tibia and the talus gets replaced with contoured metal components. A spacer, typically made of polyethylene (a special type of plastic), is added between the two surfaces.

I hope this helps you better understand ankle surgery for arthritis.

Stuart