Category Archives: joint replacement surgery

Tipoffs to need for repeat joint surgery

Nancy Walsh writing in MedPage Today reported “Specific patient characteristics, such as depression and renal disease, can help predict which patients with knee or hip replacements are most likely to need repeat surgery joint-replacement-surgerywithin a year, a researcher reported” at an American Academy of Orthopaedic Surgeon meeting.

Investigators found that “in Medicare patients, one of the most significant independent risk factors for total knee arthroplasty revision within a year was chronic pulmonary disease, while depression was a main reason for revision total hip arthroplasty within 12 months.”

Several “factors influence outcomes in joint replacement surgery, including physician, health system, and device factors, but patient characteristics, particularly in older patients, have not been studied much, according to” Kevin Bozic, MD, “who presented results from two studies.”

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Orthopedic Knee Device Undergoes Safety Alert From FDA

joint-replacement-surgeryDebra Sherman writing for Reuters reported that the US Food and Drug Administration released  a Safety Alert, notifying healthcare providers that Johnson & Johnson’s DePuy unit has issued an urgent, Class I recall, for its LPS Diaphyseal Sleeve. The FDA said that thus far, it has received 10 reports of incidents in which fractures or looseness caused the orthopedic device, which is used for reconstructive knee surgery, to malfunction.

Fractures that occur at the taper joint of the sleeve could cause soft tissue to become compromised and result in infection, function loss, limb loss, or death, the agency cautioned in the Alert.

Another danger of knee replacement surgery.

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Jaw pain… is it arthritis?

When a patient has jaw pain, it’s important to differentiate between TMJ syndrome and osteoarthritis.jaw-pain

TMJ syndrome is due to an abnormal displacement of the meniscus, a fibrocartilage disk in the jaw joint. TMJ sufferers complain of popping, clicking, and locking in the jaw.  Osteoarthritis sufferers have pain crunching, and difficulty opening their mouth wide.

Osteoarthritis is due to wear and tear of the hyaline cartilage of the jaw joint.

For both groups, conservative management is advised with rest, physical therapy, anti-inflammatory medicines, moist heat, night guard splint, and sometimes steroid injections.

Surgery may be advised for osteoarthritis… less so for TMJ.

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FDA Wants All Metal Hip Replacements Off The Market

Barry Meier writing in the New York Times reports the FDA wants to halt the sale of all metal hips which have been failing prematurely. An estimated 500,000 patients in the US have received the artificial hip.all-metal-hip-replacement

Under the FDA proposal, “makers of artificial hips with all-metal components would have to prove the devices were safe and effective before they could continue selling existing ones or obtain approval for new all-metal designs.” The action “is intended to close a loophole in the 1976 federal law under which medical devices were first regulated. It is the agency’s first use of powers that Congress granted to it last year to deal with medical devices, like all-metal hips, that have been in regulatory limbo for decades.”

Another complication of joint replacement.

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Joint replacement surgery associated with heart attack risk

Jim Morelli writing in Arthritis Today commented on a new study published in the Archives of Internal Medicine.

joint-replacement-surgery“We found that total hip and knee replacements substantially increase the risk of heart attack during the first two weeks, in particular in patients older than 60,” says lead study author Arief Lalmohamed, a researcher in the department of pharmaceutical sciences at Utrecht University in the Netherlands. “We learned from this study that we need to focus more on preventing cardiac outcomes following this major surgery.”

The study relied on national registry data on about 95,000 Danish patients who underwent total hip replacement or total knee replacement surgeries between 1998 and 2007. The average age of the hip patients was 72, while the average age of the knee patients was 67. The researchers found that during the two weeks immediately following each surgery, heart attack risk rose sharply – 25-fold for heart-attack-in-hospitalhip patients and 31-fold for knee patients, compared with similar people in the Danish registries who did not have these surgeries.

After two weeks, heart attack risk dropped dramatically – although the overall risk of heart attack after hip replacement surgery remained elevated for six weeks. Researchers also found that the association between hip and knee replacement surgeries and heart attack was strongest in those 80 years or older. They found no significantly increased risk in patients younger than 60.

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