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Jan
20

Hip and Knee replacement updates: Part 2 of 3

DO YOU NEED A NEW HIP OR KNEE?

This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine. 

Dr. Mackarey's Health & Exercise Forum

There is good news for those in need of a hip or knee replacement today! Recent advances have ushered in a new era of joint replacement for patients in Northeastern Pennsylvania.

Recent studies conclude that hip and knee replacement surgery has had a very positive impact on lifestyle and overall health benefits for more than 7 million people in the United States that have had a hip or knee joint replaced. In view of this, it is predicted that this number will increase substantially with the aging baby boomer population.

Health & Exercise Forum has dedicated three weeks to the topic of “Hip and Knee Replacement Updates.” Last week, Part I discussed hip and knee arthritis and treatment options, including knee replacement. This week, Part II will offer a self-assessment to determine if you are ready or eligible for a new hip or knee. Next week, Part III will present the benefits and complications of a new hip or knee and will specifically discuss a new option in hip and knee replacement surgery – MAKO Robotic Assisted Joint Replacement.   

I had the opportunity to meet with a local man named Bob, who had MAKO Robotic Assisted Knee Replacement. The interview, along with more detailed information from an in-house article from geisinger.org provided sage insight from a patient’s perspective. 

Bob, from West Mountain, is a “poster child” for MAKO. He is 67 years old engineer and suffered from pain, stiffness and weakness in both knees from advanced arthritis. He had difficulty walking around his work facility as well as leisurely activities with his friends and family. He relied on nonsteroidal anti-inflammatory drugs and other conservative measures while he researched his best surgical option. Ultimately, he decided to see Dr. John Mercuri, a fellowship-trained orthopaedic surgeon specializing in hip and knee replacements and is certified in MAKO robotic assisted joint replacement.

Bob had one knee replaced and three months later the other using MAKO. Bob credits the same-day-surgery and robotic approach for his ability to accelerate his rehab and return to normal activities such as returning to the gym in 10 days. Bob says, “I have a lot to do in life…hunt fish, get out in nature and enjoy the world!

Bob used the Lower Extremity Functional Score (LEFS) to indicate his functional levels:

  • Before Surgery – 45/80 (44% disabled) 
  • One month after the second MAKO knee replacement – 53/80 (34% disabled)
  • Today, 6 months later – 72/80 (10% disabled or 90% functional)

WHO IS ELIGIBLE FOR A NEW HIP OR KNEE?

Hip and Knee joint replacement is recommended for chronic, disabling arthritic joint pain not responding to conservative management such as: non-steroidal anti-inflammatories, Tylenol, physical therapy, weight loss, activity modification, assistive devices, steroid injections, or tramadol. Most surgical patients are between the ages of 50 and 80, but joint replacements have been performed successfully in patients of all ages. Common physical activities such as bicycling, swimming, golfing & walking are almost always allowed following surgery. Today, with recent advances, the options continue to improve.

NEW RESEARCH – FINDS THOSE WHO WAIT TOO LONG FOR NEW HIP OR KNEE SUFFER OTHER HEALTH PROBLEMS

New research shows that those who suffer from hip or knee pain due to arthritis for an extended period of time may be doing a great disservice to their overall health and well-being. The results showed that over time those suffering from advanced arthritis of the hip or knee lose their ability to walk more than 1-2 blocks or climb stairs without severe pain. Also, they are unable to use a treadmill, bike, elliptical or stepper for aerobic exercise. As a result of this inactivity, they gain a significant amount of weight and are unable to enjoy traveling or doing things with their family due to the inability to walk. In addition to weight gain, a sedentary lifestyle leads to high blood pressure and sleep apnea. Over time, it is likely to lead to coronary artery disease and adult onset diabetes. Consequently, the arthritic pain in the knee can contribute to many health issues. 

While surgery should never be taken lightly and is always the last option, sometimes it is the best choice.

How Do You Know if You’re Ready For A New Hip or Knee? Take the Test!

Score each question below as follows: 

POINT SCALE
Extreme Difficulty or Unable to Perform = 0 points
Quite a Bit of Difficulty =1 point
Moderate Difficulty = 2 points
A Little Bit of Difficulty =3 points
No Difficulty = 4 points
ACTIVITIES
Usual work, housework, daily activitiesScore _______
Hobbies, recreational activities, sports Score _______
Safely get in and out of a bathtub Score _______
Walking between rooms Score _______
Putting on shoes and socks Score _______
Squatting Score _______
Lifting objects (like a bag of groceries) from the floor Score _______
Performing light daily activities at home Score _______
Performing heavy activities at home Score _______
Getting in or out of a car Score _______
Walking 2 blocks Score _______
Walking a mile Score _______
Going up or down 10 stairs Score _______
Standing for one hour Score _______
Sitting for one hour Score _______
Running or walking fast on even ground Score _______
Running or walking fast on uneven ground Score _______
Making sharp turns while walking fast Score _______
Hopping or a skip step Score _______
Rolling or turning in bed Score _______
TOTAL SCORE: __________/80

Scoring: The higher the score the more functional you are and less likely to need surgery for a new knee. For example, 80 out of 80 total points is normal. 60 and above is fairly functional. 40 to 50 points is a danger zone and below 40 you might start talking to your doctor about a surgery. Your orthopedic surgeon will help you decide if a hip or knee replacement is best for you. Next week in “Health & Exercise Forum” read about the MAKO robotic assisted hip and knee replacement.

SOURCES: Rothman Institute, Philadelphia, PA;  American Academy of Orthopaedic Surgeons, Stryker Corporation, Geisinger Orthopedics and Sports Medicine

For More Information: aaos.com; stryker.com; YouTube MAKO Robotic Joint Replacement

John Mercuri, M.D.

Medical Contributor: John J Mercuri, MD, MA; Orthopedic Surgery –  Adult Reconstruction; Geisinger Orthopaedics and Sports Medicine; Clinical Assistant Professor at Geisinger Commonwealth School of Medicine.     

Visit your doctor regularly and listen to your body.      

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next Week: Part II of III on “Hip & Knee Replacement Updates.”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM..