Earlier today, I saw a patient needing hand surgery due to arthritis. We had a great conversation about arthritis, her hands, her wrists and the surgical process. That said, I thought you might like to read what I explained to her about what happens during hand arthritis surgery.
The hand joints receive a great deal of stress from normal use, although not as much as the knees or hips. However, stress in the joints of the hand is concentrated into a smaller area. The low ratio of area to stress can lead to worn cartilage over time, which is what occurs with osteoarthritis. When the cartilage is damaged, the two ends of the bone rub against each other, causing swelling, pain, and limited mobility. In patients with rheumatoid arthritis, the patient may also develop nodules around the finger joints and marked deformities. Hand arthritis surgery may alleviate some or all of the symptoms.
The best surgical procedure for arthritis depends on several factors. Which type of arthritis the patient has developed is one factor. The patient’s age, activity level, occupation, and the degree of pain suffered are also considerations. The specific joints involved can also dictate the best hand arthritis surgery for the patient. There are three basic surgical procedures available for arthritis sufferers
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. The affected joints can be replaced, the joint can be fused, or the surgeon can remove any bone spurs and damaged cartilage, sometimes referred to as a salvage procedure.
Salvage procedures are typically performed on those with rheumatoid arthritis if the patient has a great deal of inflamed tissue in the hand. It is also a common procedure for those with osteoarthritis in the early stages who have bone spurs that are painful. If the joint closest to the fingernail, called the distal interphalangeal or DIP joint, is involved, removing any bone spurs may be especially beneficial.
Fusing a joint requires the removal of the joint and a surgical fusion of the two ends of the bone, which effectively turns them into one bone. This procedure can eliminate the pain at the joint, but it also eliminates motion. Joint fusion is typically reserved for those whose arthritis is quite advanced. However, it is often preferable to joint replacement for younger, active patients. Higher levels of activity can place enough stress on the artificial joint that it wears out quickly.
Joint replacement surgery can be an effective type of arthritis wrist surgery for older patients with low activity levels or for rheumatoid arthritis sufferers. The surgery can alleviate pain while increasing motion and functionality. Unlike replacement joints for the knee or hip replacement surgery, which are typically made from ceramic or metal, artificial hand joints are also made from silicone or tissue from the patient’s body.
Replacement of the DIP joint is normally not recommended. The bones involved are too small to effectively hold the implant in place. Many orthopedic surgeons recommend fusion for this joint, since it eliminates the pain but has a minimal impact on overall hand functionality. The finger’s second joint is a better candidate for replacement, particularly on the two smallest fingers. The index finger is subjected to lateral pressure during many routine motions, such as turning a key in a lock, so it is not considered as good a candidate for replacement surgery. The third joint is seldom affected by osteoarthritis, so most replacement surgery on this joint is performed on rheumatoid arthritis sufferers.
Deciding on a type of hand arthritis surgery can be a complex issue. The patient may need to consult his primary care physician, his rheumatologist, and an orthopedic surgeon to arrive at the best option for his situation.
I hope this helped you learn more about what happens during a hand surgery for arthritis.
Every so often, I see a patient suffering from scoliosis. Like many other conditions, I usually answer the question, “Is Back Surgery For Scoliosis Common?” Well, here are my thoughts on that question:
Scoliosis is a condition that occurs when the spine develops a curvature to the side. Normally, the spine is straight between the neck and tailbone, with a slight curvature in the lower section and a slight outward curve in the upper back. With scoliosis, the spine forms either a C or S-shaped curve. The cause of most scoliosis is not known, although it sometimes is seen in families, suggesting a genetic predisposition to the condition. It can also be caused by conditions such as cerebral palsy and muscular dystrophy, as well as birth defects, asymmetrical leg length, and arthritis of the spine.
Scoliosis normally occurs in childhood, just before puberty when the body is growing quickly. Since patients typically experience no pain or discomfort, the condition is usually found by a physician during a routine check-up. Most patients will not require back surgery for scoliosis or even a brace, and the condition will have little impact on their lives. Children should be monitored every few months so that corrective actions can be taken should the curvature worsen.
Severe cases may require back surgery for scoliosis, since the spinal curvature can take up the space that the lungs need to expand properly. A twisted spine can also apply pressure to the heart, which can sometimes damage the heart. The patient may also be more prone to pneumonia, and, over time, arthritis of the spine and back pain may develop.
Back surgery for scoliosis can reduce the spinal curvature and prevent further curving. Typically, two or more vertebrae are surgically fused together. If necessary, the surgeon may use metal rods, screws, or wires to align the spine and keep it straight while healing occurs.
The physician will make treatment recommendations based on certain factors. The severity of the curve, its shape and location, and the gender and age of the patient are all considered. More pronounced curvatures are more likely to worsen, as are S-shaped curves or those in the middle of the back. Females with scoliosis are more likely to see the curvature worsen than males
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. After growth is complete, there is little likelihood that the curvature will worsen. All of these factors are evaluated by the physician when deciding whether to use braces, perform back surgery scoliosis, or just monitor the condition.
Spinal manipulation, such as is performed by chiropractors, has been shown to be ineffective for scoliosis. In fact, many chiropractors will not treat patients with scoliosis. Physical therapy is likewise ineffective for straightening the curvature, but may provide some relief from pain. General exercise to promote overall good health, however, is usually recommended for patients with scoliosis.
I hope this helped you learn more about the frequency and commonality of back surgery for scoliosis.
I often get questions about reverse total shoulder replacement surgery. To help patients understand this surgical approach, I thought you might like to read my thoughts on this form of treatment.
In a healthy shoulder, the rounded end of the humerus, or upper arm bone, fits into a socket on the scapula, or shoulder blade. This creates a ball-and-socket joint that allows the arm to be lifted, bent, and rotatated. It also permits the arm to be moved laterally as well as forward and back. The tendons and muscles of the rotator cuff provide stability for the joint, counteracting the deltoid muscle, which tends to pull the humerus upward.
Patients who have a severe rotator cuff tear as well as arthritis in the shoulder may be candidates for reverse total shoulder replacement surgery. Those who have undergone a traditional shoulder replacement that failed may also be helped by the procedure. Candidates are normally experiencing severe pain, decreased mobility, and instability in the shoulder joint.
A reverse total shoulder replacement is the surgical removal of the diseased joint and the insertion of a prosthetic joint. It is called a reverse procedure because it reverses the body’s anatomy
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. Instead of locating the ball on the end of the humerus, it is on the scapula, while the replacement socket is attached to the humerus. This arrangement allows the deltoid muscle to assume much of the work required to lift and stabilize the shoulder.
The operation normally is about two hours long and usually takes place in the hospital under general anesthesia. A nerve block can also be used if the surgeon and patient deem it preferable. Most patients will remain as inpatients for two days after surgery. Extensive physical therapy is normally required, but patients may have their activities limited for the first few weeks. Driving is not recommended for the first five or six weeks, lifting should be avoided, and the arm may be placed in a sling around the clock for a time. Reverse total shoulder replacement surgery will not allow the patient to play contact sports or work at jobs that require heavy lifting. It is seldom performed on patients whose rotator cuffs are intact.
Once surgery is complete, the patient will be transferred to the recovery room, normally for one or two hours. Occasionally a tube is placed to drain fluid from the area of the incision. The drainage tube is typically left in place until the day after surgery. Once pain is controlled, the patient can be discharged home. However, he pr she may need to arrange in-home care and physical therapy to assist with routine activities for a week or two. The surgeon will establish an exercise routine that the patient should follow faithfully after discharge.
After surgery, the patient may be given pain medications orally or intravenously. Each patient requires a different level of pain medication, and some patients experience little need for analgesics. Pain medication is usually not required after the first two weeks except for therapy in cases where the shoulder tightens up or scars.
I hope this helps further explain a total reverse shoulder replacement surgery!
When patients are preparing for hip replacement surgery, I typically answer the following three questions about their recovery from hip replacement — “What Will Happen During My Recovery From Hip Replacement?” and “How Long Is The Recovery?” and “Will I experience Pain During Hip Replacement Recovery?”
Here are my thoughts given those questions:
Everybody recovers from surgery in his or her own way. Recovery from hip replacement surgery is no different. In most cases full weight on the operative limb is permitted immediately after surgery. The use of ambulatory aids such as a walker or crutches are used until balance and strength is regained. Depending on your healing potential you may be without the ambulatory aids as early as 10 days. In slower healers this may be extended for up to 6 weeks. Full recovery again is patient dependent. The range is 6 weeks to 6 months; with the average time to full recovery is 3 months.
Hip replacements require a 2-4 day stay in the hospital in the majority of cases. The first few days can be painful, primarily as a result of the incision
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. Pain is controlled with medication by mouth or intravenously. In many cases an epidural catheter is placed for 12-36 hours. Pain medicine is introduced through the catheter and dulls or eliminates the surgical pain while still allowing you to move. Following the first few days the pain resolves quickly.
The best point regarding hip replacements is how successfully the preoperative arthritic pain is resolved. This procedure will predictably restore a patient’s lifestyle in almost every case. This accurate prediction as always depends on establishing the correct preoperative diagnosis and assuring that there is no overlapping neurogenic reason for hip pain. As always please check with and question your own surgeon regarding his estimate of your recovery.
I hope that helps you learn more about the recovery from hip replacement surgery.
I’m fascinated by some of the thoughtful and well-organized information on the Internet. This morning, I came across an interesting video which featured a 3-D animation and discussion of a knee replacement surgery. That said, I thought I would share it here at my orthopedic blog.
I’m hopeful that the images and narration of this knee replacement surgery video might help you get a feel for the surgical process of this type of othropedic operation
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Without a doubt, there is great value in orthopedic surgery and with the ever-expanding array of techniques and new technology available to surgeons like myself, there is a lot we can do to ease people’s pain and give them back their lives. That being said, I have also found that, unfortunately, while it can correct many problems, there are some things that orthopedic surgery cannot fix. Some things just aren’t fixable.
So you know, that was a hard lesson to learn and one that in all my years of training was never clearly addressed. We are surgeons. We fix things. That means we make things better, improve situations and conditions using knee replacements, hip resurfacing, and elbow surgery via synovectomy.
I thought you might like to hear the entire recording, so I’ll be posting it here — in three parts — over the next few weeks. During the radio show, I talked about several, different types of orthopedic surgery including:
I hope this further helps you learn more about orthopedic surgery. And, the next two parts of the radio show will be posted here shortly — so, please check back shortly.
Stuart
P.S. If you would like to read the transcript for this part of the show, I have provided it below:
Host: Welcome to the Home Show here on News Talk 870, the show that has something for everyone. And, of course, the Home Show brings to you today a very, very special guest, Dr. Stuart Gold, and before we introduce him, I would like to mention to my listeners that thank you so much for coming out to see me in person out at the Ontario Home and Garden Show. Met lots of you and it was really good to hear your reviews of my show and what you want to hear in the future. So, thank you for that. Now let me tell you about my guest, Dr. Gold, and he is an orthopedic surgeon. He is a board certified orthopedic surgeon, I might mention, with over 23 years of practice specializing in sports injuries, joint replacement, arthritis, complex acute limb fractures, reconstructive and limb salvage, and Dr. Gold is a diplomate with the American Board of Orthopaedic Surgery and uses the state of the art implants which offer longevity and comfort to active baby boomers and seniors. I’m one of them. And Dr. Gold is recognized nationally and internationally and he is the director of the Orthopaedic Institute in Torrance so, everybody, he’s local here. Now he has been involved in orthopedic education for 20 years and is currently the Chief of Fracture Reconstruction and Associate Clinical Professor of Orthopaedics at the Harbor UCLA Medical Center and if you would like to schedule an evaluation with Dr. Gold, I’m going to give you this number, not just this one time, but if you could write it down every time I give it so you don’t mess it up, it’s 310-542-3472. And I’m going to be talking also about a book that just came out and with that, welcome, Doctor. How are you?
Dr. Gold: I’m great, Jessie, and nice to be here. It’s been great meeting you.
Host: You know, we are going to have a great time. There is so much to ask. I’m so excited and first let me tell you that that book that you wrote about The Patient’s Guide to Orthopedic Surgery, I read that book and you’re right. It takes you about 45 to 50 minutes, but I had to read it over again because it was so interesting so I want to thank you for putting that out and we’re going to talk about that in just a little bit. However, you know, there are different types of questions that I have for you and I know that, you know, a lot of people ask, “Will surgery fix me?” So I want you to kind of tell us a little bit about what you’re doing and why we’re asking you these questions.
Dr. Gold: Well, “if you can fix me” is one of the reasons why I wrote the book and there’s several people in the world who have had surgeries who expect to be completely rendered back to, what would they say, pre-injury or perfect level.
Host: Humm.
Dr. Gold: Unfortunately, even with the state of the art equipment we have and the best hands, it’s very difficult to get somebody 100% better. I will say that it does happen on occasion and truly depends on the combination of the patient and the doctor and the recovery, but we fix people meaning we get people better, get them back to enjoying their life. Unfortunately, it’s rare that they will be 100% improved.
Host: And Doctor, what are the honest surgical results and outcomes of this?
Dr. Gold: It truly depends on the type of surgery you’re having, the type of person you are as far as genetic healing, and in some cases, it will also be surgeon dependent. And in each scenario, be it a knee problem, a shoulder problem, a hand problem, a back problem, all the results are going to be different based on the body part and the type of issue that the patient is dealing with. The recoveries that can be expected, again, are usually not 100% but in many cases can be between 90 and 100%. In many diagnoses or with other problems, particularly problems related to nerve inflammation, then the results may ultimately be more in the 60 to 80% improvement range.
Host: Very interesting. Now, again if you just joined us, we are speaking with Dr. Gold and he has a book out, The Patient’s Guide to Orthopedic Surgery, and this is very interesting because I think a lot of us baby boomers out there and seniors want to know. I mean, I want to feel good. So, you know, will it be as good as new once I have this done?
Dr. Gold: Well, what you need to understand is we’re living in an age where we say, “younger is better”…
Host: Um, hum.
Dr. Gold: However, chronological age (your real age) and physiologic age (medical age) can be very different
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. People want to remain active and younger these days.
Host: Oh, sure.
Dr. Gold: However, there are 60 year olds who have medical problems and can’t and don’t move around that much. Then I have plenty of patients who are in there 70’s and 80’s who still want to be active. They’re skiing. They’re playing tennis. They’re playing golf. They’re cycling.
Host: That’s good.
Dr. Gold: They want to stay active.
Host: Um, hum.
Dr. Gold: And fortunately, we do have many procedures, not all of them surgical, that will allow people to be more active, and the real premise of the book is to understand all the non-operative options prior to deciding to proceed with surgical intervention.
Host: Now, again, I would like to mention your number out there where they can reach you, Doctor, and that number is 310-542-3472. That number, again, is 310-542-3472. And, you know, Doctor, what determines the extent of my recovery because, you know, I think we’re all different, right?
Dr. Gold: That’s exactly right, Jessie. In reality, most people fit into the middle of what we would call a bell curve. Others are outliers at both ends of the curve.
Host: Um, hum.
Dr. Gold: Most people fit in the middle. Some people heal very quickly and they’re at one end and some people heal very slowly. The people that heal more slowly may have what we call co- morbidities (medical issues that will delay healing and recovery), and this is the reason why their tissues don’t recover as quickly. They may form scar tissue. They may be a diabetic who is more prone to infection. Generally, the genetics of that person is truly what dictates their recovery and some people just are fortunate enough to heal faster. Most people heal at an average rate. But you need to understand that if you’re one of those slow healers that you may still get an excellent result. You just need to be more patient.
Host: Got to find that good doctor. Now, the success rate, let’s talk a little bit about that.
Dr. Gold: Now, the success rate, again, would depend on what body part and what type of procedure you’re performing. An example would be a knee arthroscopy which is when we stick a small telescope into the knee joint and work with cameras through small incisions and correct menisical tears which is the cartilage in the knee or sometimes ligament injuries. The results in most surgeons’ hands are very successful with this type of procedure. Another example, which the results may not be quite as high are when we’re doing nerve releases and that could be in the arm or the elbow. They could be in the back or in the neck as well. When these procedures are carried out, the results are a little less predictable and patients need to have a full understanding of what to expect when they have these types of nerve decompression surgeries. If they go in to it with the right mindset, when they recover and if they feel 70 or 80% better than they did before the surgery, they truly have an excellent result. If they feel 100% and they’re very fortunate, but when patients go in to a procedure expecting to be all better, or all fixed as we were talking about earlier, then many of them will be disappointed
Host: Whoa. Okay, if you just tuned in to the Home Show here, we are listening to the voice of Dr. Gold and, of course, he is our specialist, orthopedic surgery. He’s got a book out and you also can get this book by going to a website. Right, Doctor?
Dr. Gold: That’s correct.
Host: And can you get that website address out?
Dr. Gold: The website is quite simple. It’s orthopedicsurgerybook.com. All one word and when you check the website you will be able to review not only the book, but in addition to the book, we have a whole learning center on all the different body parts which we work with in orthopedic surgery. It will give you information and a little bit of knowledge prior to any visit to an orthopedic surgeon.
Host: This is very interesting. Now, again, I’d like to give out your direct number. That’s 310-542-3472. 310-542-3472. So, again, your office is located in Torrance and right there at 19000 Hawthorne [ph] Boulevard, Suite 100, so if any of you want to make an appointment, you can call him and I’m giving you the address there and, again, if you have any questions and would like to hear the doctor talk more about that, not a problem. Give him a buzz. Now, finding the right surgeon. That’s a big word, big sentence, finding that right surgeon, Doctor. Who’s the best doctor for you? Tell us.
Dr. Gold: Well, the best doctor for you is the best doctor for you.
Host: Humm.
Dr. Gold: Everybody’s different. You all have friends. Some friends you find it very easy to communicate with. There are other people that, even though you may know or even work with them, are a little more difficult to communicate with. So, we all have the personalities that we appreciate and prefer, and the first thing is to truly find a physician who is going to communicate well with you. And, again, that’s different for everybody. Your questions should be answered. You shouldn’t feel like you’re being rushed and you should be allowed to ask your own questions to truly understand what to expect if you’re considering surgery. But more importantly, if you’re talking to a surgeon and there are many options available, hopefully all those options will be discussed with you, most notably the non-operative options prior to considering any surgery.
Host: So important. Now, as far as identifying that right doctor, how can I do that because, you know, I’m sitting here and I’m a patient and I’m wondering how am I going to know?
Dr. Gold: Unfortunately, it takes a little bit of work.
Host: Humm.
Dr. Gold: The Internet has been helpful for many patients these days, but what I encourage people to do is seek references from their friends. Seek references from nurses and other employees of hospitals who know the doctors on a different level. In addition to that, there’s a good chance you may not find the right doctor for you on your first visit, and if that doctor is not the right doctor, there are many choices out there. You may need to make a couple of visits to find that right doctor.
Host: So interesting. Now, this is a big thing for me, the communication between the surgeon and the patient. Let’s talk about that.
Dr. Gold: Again, as I was stating, people who are not comfortable with a doctor, have to find someone they can sit down with and ask questions. If they’re not answering your questions, that’s not the doctor for you. And more importantly, there’s different types of doctors out there. There are people who do research. There are people who educate. There are surgeons who are just technical wizards but really don’t have much of a personality. And again, some people don’t have a problem with that. But what’s most important is that the educator may not be the best surgeon. The researcher may not be the best communicator. The technical wizard may be great with the knife but doesn’t communicate with you. If you look hard enough, you can usually find the right combination for you. And if you want the technical wizard with personality, you may need to make a few visits or ask around, and sometimes you just need to remember that the big researcher, the inventor, may not be always the most technically gifted although he’s a brilliant person.
Host: Okay. Dr. Stuart Gold. We are going to take a quick break for you listeners out there. Our orthopedic surgeon will be back in just a moment and before we leave, let me do this. Let me give you his direct number once again. That’s area code 310-542-3472. We’ll be back in a moment.
