Not every joint problem needs surgery. Some of the best work we do at Manhattan Orthopedic & Sports Medicine Group falls into the wider category of non-invasive treatment options, a salient point particularly for arthritis sufferers.
A little background: Arthritis refers to the wearing out or malfunctioning of a normal joint and is classified as being either localized or systemic. Orthopedists specialize in the former, which refers to arthritis resulting from injuries or degenerative diseases that affect a single joint. Non-surgical treatments for localized arthritis involve a highly focused array of solutions on a case-by-base basis, including:
- physical therapy
- anti-inflammatory medication
- steroid and lubrication injections
- platelet rich plasma injections.
Conversely, systemic arthritis is a systemic condition that affects multiple joints at the same time and is thus treated by rheumatologists. Systemic conditions are usually the result of autoimmune disorders, such as
- rheumatoid arthritis
- psoriatic arthritis
- lupus arthritis
- Lyme disease
are primarily treated with medication rather than surgery.
Identifying the most effective non-invasive treatment for arthritis requires a simple understanding of joints. Joints use ligaments for stabilization, synovium for lubrication, and articular cartilage to cover and protect the bones themselves.
The joint’s interconnected architecture leads to some frustrating realities. As one element wears out, the rest of the tissues weaken as the surrounding muscles atrophy and degeneration progresses.
There are, however, a number of treatments that can relieve the pain and possibly slow the process, a few of which were mentioned above. To start, physical therapy can be used to prevent stiffness and strengthen both the muscles and ligaments in the affected joint. Anti-inflammatory medications such as Ibuprofen (Advil) and Naproxen (Aleve) can help reduce joint swelling (synovitis). This lessens the amount of destructive enzymes in the joint.
Similarly, steroid injections can temporarily decrease pain and swelling and allow you to retain everyday movement as you follow an ongoing regimen as prescribed by your physician. There are also certain injections for the knee, known as visco-supplementation that can provide better lubrication and increase range of motion.
The use of platelet rich plasma in a joint remains unproven, but may be considered if surgery is too great a risk.
Most arthritis treatments should begin far before discussions about surgery. However, individuals and injuries vary, so it’s important to understand how your age and condition may dictate different treatment options.
To find out what non-surgical options are available for you, make an appointment with one of our experts here to tackle your arthritis for good!
Why you should have your knee replaced is almost always a straightforward matter: to eliminate pain and to improve your quality of life. However, owing to our active lifestyles and unique backgrounds, the question of when to opt for knee replacement surgery can be a little tougher to discern.
Rather than waiting for your knee to give you a painful prompt, you might first ask yourself what you want to get out of a knee replacement. Some people are willing to forgo joint-intensive sports like running and tennis, so they can hold off on replacement surgery in the short-term. Others, however, would rather lick a newt than take a break from the courts, so they opt for a knee replacement earlier in life.
Knee replacements should have a life span of at least 15 – 20 years; at that point about 85-90% are still in great condition. Individuals who opt for an early knee replacement—i.e., someone still in their fifties—will likely require another replacement procedure down the road. If that’s a factor in your decision, then it’s worth considering that individuals who receive a new knee in their seventies can expect the prosthesis to last a lifetime.
There are, however, other factors that everyone should consider when thinking about a knee replacement procedure. If you have a history of diabetes, hypertension, or heart disease, then it is recommended you might want to have the surgery before these issues progress and make surgery more risky.
Similarly, obese individuals should consider weight loss programs and then have their knee replacements done earlier to prevent complications that can arise during surgery and also enable them to get active and keep weight off.
Amid all of our varied lifestyles and personal histories there’s one thing that certainly does not matter: the type, or brand, of knee replacement. There are lots of different knee replacements, but they’re all pretty much the same. If there is a best type, then it’s the one that your surgeon is most comfortable with. Just like a chauffeur who drives a BMW every day, he simply knows his BMW better than a fellow chauffeur knows his Mercedes. In the end, they’re both luxury cars. So it is with knee replacements.
And just as a chauffeur knows how to maintain his car’s performance so too should you be nice to your knee; so don’t ever think of treating it like a jalopy.
In short, if you live an active lifestyle and wish to keep it that way, then consider having a conversation with your orthopedist and primary care doctor when you’re still in your fifties, sixties, seventies or even eighties! Regardless of your age, if you have any questions and would like to chat over the possibilities with one of our orthopedists, call or email us today and make an appointment.
Baseball star Alex Rodriguez, known to New York Yankee fans as A-Rod, is in the news again. This time around it s not because of his exploits on or off the field, but because of his experiences in the operating room. Just last month, the sports pages reported that A-Rod is planning to undergo arthroscopic surgery at the hip to address a torn labrum. This will be his second surgery.
What’s amazing is that despite surgery, he’s expected to be back in full action by mid-summer of next year. How is that even possible for an athlete pushing 40? The answer lies in the non-invasive surgical technique known as arthroscopic surgery.
Readers of this space may know that arthroscopic surgery involves a camera and a couple of small incisions. Knee arthroscopy has been around for decades, but only recently has hip arthroscopy become more widespread. The benefit is that the technique is minimally invasive and allows for faster recovery times than traditional methods.
Hip arthroscopy is the method of choice for repairing labrum tears. The labrum is the soft tissue bumper that encircles the socket of the ball-in-socket hip joint. Labrum tears can cause reduced athletic performance and lead to varying levels of discomfort. If you’ve ever experience a torn labrum, you know something’s wrong but you may not know what, exactly, is the problem.
In fact, A-Rod had the same issue when doctors were initially trying to diagnose what was sapping his performance near the end of the recent season. An MRI of his hip revealed the labrum injury.
There are two ways the labrum can become injured: it can either fray or tear. A frayed labrum occurs from repeated strains and the normal wear of physical activity. Torn labrums are usually the result of some sort of trauma, be it a hyperextension of the hip joint or a bad fall. The sensitive imaging techniques of MRIs allow doctors to diagnose these slight injuries and then recommend a course of treatment.
The first-line treatment for labrum tear is physical therapy, which can help strengthen the surrounding muscles and tissue to allow the body to compensate for small tears. If there’s still pain, however, arthroscopic surgery may be recommended. The good news is that arthroscopic surgery is a same-day procedure, meaning you’re in and out of the hospital on the same day. Recovery can take some time, but using A-Rod as an example, you can get back to high-level activity within about 6 months—and that’s a timeline for a professional athlete. The weekend warrior could get back to normal workouts in about half that.
If you have a nagging hip injury that hasn’t gotten better for some time, then it’s a good idea to come on down and let us check it out. Even if you’re not A-Rod, we can still make sure you’re back to peak condition and rounding the bases for the company baseball team.
That’s something to cheer about.
On a musculoskeletal level, the human body can be deemed an exquisite machine that runs on a special blend of diet and exercise. But as high-performance vehicles go, new parts are sometimes required to keep us running, jumping and soaring. For many Americans, the most transformative form of bodily maintenance is a total joint replacement, be it of the hip, knee, shoulder or other.
Science and human ingenuity allow a majority of joint replacements to remain functional for over 20 years, and in the past this would have lasted the lifetime of most individuals. But as younger individuals undergo total joint replacements, a new level of maintenance must be stressed, especially as most of these individuals will often outlive the life expectancy of their own prostheses! To ensure such longevity, however, the most important mechanic in the body’s shop has to be the patient herself or himself.
The prostheses used in total joint replacements are themselves high-end pieces of engineering that require a particular form of maintenance. This doesn’t suggest daily upkeep, but vigilance in the short-term must be a part of any long-term strategy to keep one’s prosthesis in top condition.
Like any normal joint, a prosthesis will undergo wear and tear in its lifetime, and in a number of years the bearing surfaces which bears much of the load will have to be replaced. If left unchecked, the polyethylene, (plastic) will wear to the point where metal begins to rub on metal, causing severe discomfort which may require an operation to replace the prosthesis. Replacing the load-bearing components is a routine and relatively simple step in the maintenance of a joint prosthesis.
As a patient, being aware of when you received your replacement and how physically active you are will factor into how long before the plastic bearing needs to be replaced. Normal wear becomes evident after an average of about 10 years, so it is prudent that patients get see their orthopedist at the 10, 15 and 20 year point to keep an eye on its long-term health.
Conversely, if a patient complains of pain and discomfort early on, this usually has little to do with wear and is often the result of loosening or infection. This can occur due to biology or mechanical problems and should be attended to immediately.
Modern total joint replacements have very high rates of success and last longer than ever, but they can’t run forever without an individual’s sustained attentiveness. The best engineers know the secret of maintaining elite vehicles is how you care for what’s under the hood. When it comes to a new prosthesis, a set plan of long-term maintenance can lead to outsize benefits for the rest of your life.
ROBOTIC KNEE SURGERY- PLEASE NOTE THAT THIS PROCEDURE WILL NOT BE AVAILABLE UNTIL WE RETURN TO OUR PERMANENT OFFICES
Manhattan Orthopedic & Sports Medicine is proud to announce ROBOTIC ASSISTED PARTIAL KNEE REPLACEMENT (MAKOplasty®). Through the use of a Robotic Arm our surgeons now perform more precise partial knee replacements using a MINIMALLY INVASIVE technique. This cutting edge technology helps restore a patient’s more natural knee motion. (more…)
The media has recently identified the early failure of certain metal-on-metal hip implants as a modern peril in our rush to adopt new technologies. The problem with many of these reports, however, is that the few journalists have provided the proper context required for a reasonable assessment of hip implants over the past 40 years. (more…)