Archive for the ‘Surgery’ Category
Knee Replacement
There is an increasing trend toward knee replacement (total knee arthroplasty) in treating knee osteoarthritis. A teaching hospital in Hong Kong looked at 750 patients who had their knees replaced from January of 2000 to December of 2009.
The number of total knee replacements increased from 91 in 200 to 181 in 2009. There were 588 females who had their knees replaced compared to 162 males with 589 left knees being replaced and 568 right knees. The men age of the patients having their knees replaced did not change significantly but the number of patients over 80 years of age increased from 4.8% to 13.8%.
This article was published in the Hong Kong Medical Journal (Feb 2011).
Guidelines for Treating Knee Osteoarthritis Ignored by Clinicians
Avoid Surgery
Dr. David Hunter from New England Baptist Hospital in Boston and University of Sydney in Australia recently published a study in Arthritis Care & Research. ”Quality of Osteoarthritis Management and the Need for Reform in the US” is research aimed at drawing attention to the fact that health care professionals in the United States often treat the pain and try to increase function in arthritic knees, but seldom try to improve joint structure or try to work with patients on long-term solutions.
The authors of this study recommend conservative treatment options for knee OA, especially avoiding pharmacological solutions. ”Weight management and exercise programs tend to be overlooked by clinicians,” said Dr. Hunter. ”These conservative approaches are beneficial to patients who adhere to weight-loss and exercise programs.”
The study examined prior research on treating osteoarthritis of the knee and found that up to 30% of surgeries are inappropriate! And as we discussed on this blog arthroscopy should be avoided as a treatment option for knee OA – it doesn’t work yet orthopedic surgeons still perform the operation – every day.
Weight loss and exercise are the best treatment options for knee OA – how many more studies have to be conducted on the subject? Joint health supplements, and knee braces are conservative treatments that will help you get up and moving.
High Tibial Osteotomy – Complications: Neurologic Injuries
Peroneal Nerve
There are various complications that can arise from high tibial osteotomies (HTO). Neurologic injuries such as damage to the peroneal nerve are one of those complications. HTO’s are often performed to relieve the pain associated with knee osteoarthritis.
The peroneal nerve lies between the biceps femoris tendon and the outside top portion of the calf muscle, and winds around the top of the fibula bone. The peroneal nerve branches out to various other nerves in the lower leg. Nerves are like cables that provide pathways for the electrochecmical impulses that drive the central nervous system.
Damage to the peroneal nerve can result in drop foot, making the foot drag during walking. Also feeling can be lost in the top of the foot and front of the lower leg.
Popliteal Artery
A common surgery to treat osteoarthritis of the knee is a high tibial osteotomy. Complications during the surgery can include neurologic injuries. One such injury is damage to the popliteal artery.
The popliteal artery is an extension of the femoral artery, located behind the knee. It supplies blood to the knee joint and muscles in the thigh and calf. Arteries are blood vessels that bring oxygen rich blood from the heart to various tissues in the body.
Damage to the popliteal artery can cause a partial or complete blockage of blood flow to the foot and lower leg. This can cause pain, difficulty walking, or amputation.
Non Union
High Tibial Osteotomies (HTOs) are a surgical procedure used to treat knee osteoarthritis. There are complications with HTO’s. Non-unions are one of those complications.
A non-union is when a broken bone fails to heal. Non unions occur when the broken bone lacks blood flow or the fracture is unstable. Tobacco use, old age, diabetes, and infections can make this condition worse.
Broken bones also need nutrition to heal. Calcium, Vitamin C, Vitamin D, and protein are all necessary for bones to heal properly.
Bone grafts or bone growth stimulators are used as treatment options for non-union fractures.
HIgh Tibial Osteotomy
High Tibial Osteotomies (HTO) are surgical procedures used to treat unicompartmental osteoarthritis of the knee.
Osteonecrosis is one of those complications. It is “bone death” caused by poor blood supply to the affected area. Though osteonecrosis is mst common in the hip and shoulder, in high tibial osteotomies it usually presents in the bone fragment above the surgical site.
There aren’t any symptoms in the early stages of this condition. But as it gets worse you may feel pain in the joint that increases over time, pain at rest, limited range of motion, and limping.
Bone grafts and joint replacement are the usual treatment options for osteonecrosis.
Knee Surgery
Deciding to have surgery is never easy. You need to consult with your surgeon and discuss your medical history.
High tibial osteotomies are most successful in patients who understand exactly what they are getting into. Patients should not be overweight, they should be active, and have a high tolerance for pain. Also patients need to be able to take several weeks if not months off of work.
This surgery is not a treatment option for everyone who suffers from osteoarthritis of the knee.
High Tibial Osteotomy
There are two different types of high tibial osteotomy surgeries to treat knee osteoarthritis.
A “closing wedge” osteotomy cuts out a wedge of bone to change the angle of the knee joint.
An “opening wedge” cuts the bone and fills the gap with a graft to change the angle of the knee.
Either surgical procedure is significant because the bones supporting your body weight are fractured, and then fixed. You will be off your feet for up to 6 weeks and a return to full activity can take as long as six months.
Osteoarthritis of the Knee
Unicompartmental Osteoarthritis is the primary indication for a high tibial osteotomy. Unicompartmental means that only one side of the knee is affected by the arthritis.
Once the cartilage between the femur and tibial plateau starts eroding the angle at the knee joint begins changing. If the inside of the knee wears away the result is a “bow-legged” deformity. If the outside of the knee wears away then the angle makes the legs appear “knock-kneed”.
The goal of a high tibial osteotomy is to realign the bones and restore a more normal angulation.
High Tibial Osteotomy
A high tibial osteotomy (HTO) is a surgical procedure often associated with osteoarthritis of the knee.
“Osteo” means bone. ”Otomy” means to cut. So an osteotomy is a cutting of the bone. Osteotomies are usually used to correct angulations of bones. In the case of unicompartmental osteoarthritis, the surgery requires that a wedge of bone is removed from beneath the affected compartment.