Antibiotics Before Dental Work For Joint Replacements
Last year I wrote an article about dental antibiotic prophylaxis, which talked about why dentists prescribe antibiotics for their patients to take before many dental procedures.
In that post I mentioned that anybody who has a joint replacement is supposed to get antibiotics prescribed to them before certain dental procedures. The reason for this is that there are millions of bacteria in our mouth that may enter our bloodstream during certain dental procedures. When an artifical joint gets infected, it normally is considered a failure.
Since antibiotics are very cheap and they can help prevent the infection of an artificial joint, it seems like a no-brainer to give antibiotics to patients before invasive dental procedures so that the catastrophic loss of an artificial joint can be avoided.
However, there really isnt conclusive evidence that antibiotics prevent joint infections in the average healthy person. That is why, in the American Dental Associations original 1997 guidelines on dental antibiotic prophylaxis for joint replacements, and in the 2003 guidelines, the ADA stated, Antibiotic prophylaxis is not routinely indicated for most dental patients with total joint replacements.
Advantages Of Bilateral Knee Replacement Surgery
Although it may seem like a big undertaking, having both of your knees replaced at the same time does have its advantages. The biggest benefit is the obvious one: significantly less pain than before surgery. Some of the other benefits include:
- May shorten your rehabilitation
- Only one hospitalization for two conditions
- Recovery may be shorter
- Only one leave from your job
Another advantage of having both knees replaced at once is that you can get back to your normal activities much quicker. The rehab and physical therapy is usually much more intense for bilateral surgeries, making your recovery smoother and quicker in the long run.
These advantages are mostly dependent on you and your motivation for recovery. The other big factor is how healthy you are. The younger and healthier you are, the more likely a bilateral knee replacement will work out in your favor.
Shorter But More Intensive Rehab
When you undergo any joint replacement surgery, you need to count on a fair amount of rehabilitation work so that your body can adjust to the new joint, which is especially true of knee replacement. If you have Dr. Dushey replace both knees simultaneously, your rehab will be more intense as you essentially need to double down on your efforts.
That said, you only need to undergo one round of rehabilitation with double knee replacement as opposed to two rounds spaced apart by several months or a year if you stagger your knee replacements.
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Why Revisions Are More Complex
Revision replacement is difficult for several reasons. First, when someone has surgery, scar tissue develops, and soft tissues become less identifiable. Performing the second surgery is always more difficult. Second, when performing a knee replacement, bone is removed. When performing a revision knee, often more bone has to be removed, and some may be lost as a result of the problem with the implant. Maintaining adequate bone to support the new implant can be a challenge. Finally, obtaining a knee that is flexible enough to allow for motion, yet stable enough to keep you steady, is also more difficult in revision situations.
Pros And Cons Of Having Both Knees Replaced At The Same Time
It is essential to be aware of all pros and cons associated with simultaneous bilateral knee replacement surgery before considering it.
Though it finishes-off the work in one go, this type of surgery has its share of benefits and risks. You have to approach it cautiously and go ahead only after a thorough discussion with your doctor.
Pros
- More convenient as replacement surgery for both the knees takes place in a single procedure.
- You may need less time off from work. You dont have to repeat office leaves for two surgeries as in the case of staged bilateral surgery.
- The time for recovery after knee replacement surgery is single for both the knees. It means you dont have to wait to get one knee operated and healed and then wait again after the second one.
- You may also enjoy the benefits of reduced cost with a single surgery. Your cost savings can be anywhere between 18% to 26%.
Cons
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How Is A Shoulder Replacement Done
With the anatomic total shoulder replacement surgery, a two-part implant replaces the joint. The component that goes on the upper arm bone is a metal ball usually connected to a stem that is inserted down the humerus. The other component is a cup-shaped piece of plastic to replace the socket.
This is called an anatomic shoulder replacement because the implant mimics the normal shoulder anatomy, says Dr. Entezari. Patient satisfaction with this procedure is above 90%. The longevity of shoulder replacement has improved significantly. About 90% of people whove had this surgery for osteoarthritis still have their original implant after 15 years.
We used to put long stem implants down in the humerus, says Dr. Entezari. With newer implant designs, we use shorter stems, and if the bone quality is good we can use stemless implants. This makes surgery less invasive and preserves more bone.
The design of the socket side has also improved with use of more durable materials and implants that fit better.
A limitation of anatomic shoulder replacement is that you must have an intact rotator cuff. This is because the rotator cuff keeps the ball seated in the shallow socket at the shoulder joint. Other muscles around the shoulder move the joint.
People with weak or torn rotator cuffs cant have an anatomic shoulder replacement. They may be able to have the reverse procedure.
How Long Replacements Last
Most knee replacements last several decades, some longer. However, there are also times when a knee replacement needs to be redone after years or even just months. Understanding why a knee replacement has worn out is critical to performing a successful revision knee replacement.
The average knee replacement lasts more than two decades, but there are reports of implants lasting longer, and new materials and surgical techniques are hoped to provide even longer-lasting knee replacements. That said, there are times when knee replacements may last a very short time, even in otherwise healthy patients. A small percentage of patients end up needing their knee replacement revised within a few years of their initial surgery.
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How Knee Replacement Surgery Works
The medical term for total surgery is total knee arthroplasty, or TKA. This procedure involves removing structural portions of your knee joint and replacing them with mechanical parts. Because TKA removes all of the in the joint, your knee wont hurt when you walk after getting it replaced and completing rehabilitation.
Traditionally doctors have replaced just one knee at a time, in two separate surgeries spaced months apart. This is called staged TKA. But some orthopedic surgeons now will offer to replace both knees at once. This procedure is called simultaneous bilateral total knee , or more commonly double knee replacement.
Reasons That You May Need A Knee Replacement
When your knees hurt on a daily basis and its starting to affect your life, it may be time for you to look into treatment. You may have tried many conservative treatments without much relief. But what could be causing you to have so much pain that youre considering a knee replacement?
The main culprit behind chronic knee issues is osteoarthritis. This condition causes the cartilage that cushions your joint to deteriorate, leading to inflammation and pain. This condition can become severe, causing daily problems with certain activities including:
- Climbing up a flight of stairs
- Difficulty walking even short distances
- Trouble getting up from a sitting position
- Pain even at rest
Osteoarthritis is a chronic condition, so there is no permanent cure. There are treatments that help with the symptoms, but the only way to repair your knee completely is with an artificial knee replacement.
If both of your knees have damage from arthritis, you’re probably curious if you can get them both fixed at the same time. The truth is that you can, but there are advantages and disadvantages to this procedure.
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Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
Candidates For Simultaneous Bilateral Knee Replacement
Not everyone qualifies for simultaneous bilateral TKA. In general, you must be experiencing significant, disabling arthritis in both knees. Many people who undergo double knee replacement have deformed legs due to the extensive effects of their arthritis. Simultaneous bilateral TKA may not be appropriate for a person with moderate or even for someone whose arthritis is advanced but not debilitating.
Your age, overall health and other medical conditions also can influence whether or not youre a candidate for double knee replacement surgery. In general, people over age 80 or those with or a prior history of deep venous thrombosis probably would be better off having their knees replaced in separate procedures.
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What Are The Risks Of This Surgery Are There Any Specific Complications Of Undergoing Simultaneous Knee Replacement
Mr Henry BourkeUnfortunately, all surgical procedures have some risks. The most important risks of knee replacement surgery are infection , post-operative stiffness, on-going pain and blood clots . There are also some uncommon risks such as blood transfusion, nerve or vessel damage, fracture and in time the knee replacement may loosen. Having two replacements done at the same time does increase some of these risks very slightly. The most important of these is the risk of transfusion. As two knees have been operated on the risk of a transfusion does go up. In our series thus far the incidence of transfusion has been 12.5%. This is usually 1-2 units of blood given straight after the operation.
Mr Rakesh KucheriaThe risks of any operation are 1-2% of infection, Deep Vein Thrombosis, Pulmonary Embolism, anaesthetics, neurovascular damage and risks in this care are similar to having a single knee replaced. If the patient was to have both the knees replaced at different stages, the risk would be 1+1=2, whereas if they had both the knees replaced together simultaneously, then the risk is 1.2. There are no specific complications of undergoing simultaneous knee replacements. The only complication is that this is a major procedure and can occasionally result in more blood transfusions.
Reasons Why A Revision Replacement Is Necessary
Revision replacements are performed for a number of reasons. Some of the more common include:
- Loosening of the implant
- Instability of the knee
- Malalignment of the parts
Many people ultimately have a revision knee replacement because the problem is causing significant pain. While pain can be a problem in itself, a revision knee replacement surgery should not be performed without understanding why the pain is occurring. Performing this type of surgery for pain without an identified cause is unlikely to yield good results. Instead, the cause of the problem with the knee replacement needs to be precisely understood, and there needs to be a plan to address that problem with the implant. An operation without a clear plan to address the problem is unlikely to be helpful.
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Double Knee Replacement Recovery
At an initial consultation with an , you will discuss the pros and cons of a bilateral TKA. If you qualify and decide to proceed, the doctors office will schedule the surgery and provide you with complete pre- and post-op instructions.
You can expect to spend at least one night in the hospital after your surgery. After the surgery, you will begin rehabilitation almost immediately, while youre still in the hospital. You will continue with for several weeks after you go home.
Many knee replacement patients report that their level of post-operative pain is actually lower than the they were experiencing from the arthritis. You can be assured your surgical pain will be managed with medications during the initial recovery period.
Simultaneous bilateral can be a great choice for those with severe, disabling arthritis in their joints. With just a single trip to the operating room, you can literally get back on your feet and enjoy a robust lifestyle again.
Similar Conditions That Affect The Knee
Meniscus tear
Sometimes patients with knee pain don’t have arthritis at all. Each knee has two rings of cartilage called “menisci” . The menisci work similarly to shock absorbers in a car.
Menisci may be torn acutely in a fall or as the result of other trauma or they may develop degenerative tears from wear-and-tear over many years. Patients with meniscus tears experience pain along the inside or outside of the knee. Sometimes the pain is worse with deep squatting or twisting. Popping and locking of the knee are also occasional symptoms of meniscus tears.
Since some of these symptoms may be present with arthritis and the treatment of arthritis is different from that of meniscus tears, it is important to make the correct diagnosis. A good orthopedic surgeon can distinguish the two conditions by taking a thorough history, performing a careful physical examination, and by obtaining imaging tests. X-rays and Magnetic Resonance Imaging scans may be helpful in distinguishing these two conditions.
Knee Joint Infections
Also called infectious arthritis or septic arthritis, a joint infection is a severe problem that requires emergent medical attention. If not treated promptly knee infections can cause rapid destruction of the joint. In the worst cases they can become life-threatening.Symptoms of a knee joint infection include:
- severe pain
- fevers and
Again, a joint infection is a serious condition that requires immediate medical attention.
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How Does Double Knee Replacement Surgery Work
In cases where both the knees are severely damaged and affect your daily activities, your doctor may recommend a double knee replacement surgery.
It is of two types:
- Staged Bilateral Knee Replacement: In this, both your knees are replaced one by one, in two separate surgeries, keeping a gap of a few months in between.
- Simultaneous Bilateral Knee Replacement: In this, both the knees are replaced during the same surgery
Your doctor will determine the procedure that works best for you after considering your underlying medical conditions carefully.
Bunion Both Feet At The Same Time
No two people’s bunions are exactly alike, so your doctor reviews radiographic images to determine what the best courses of action will be, and, because bunions are so complex, often your surgeon does several small procedures at once to correct the bunion and get you back comfortably on your feet. Procedures fall into three primary categories. 1 Q: Can you perform bunion correction surgery on both feet at the same time? It’s possible to do both at the same time, but our surgeons prefer to space it out by at least two weeks. This allows for partial recovery from the first foot, so that we can assess the effectiveness of the surgery before we try the second foot I got bunions on both my feet for many, many years. Never considered surgery. When for some reason they get painful I smear over them a tincture of iodine. Two, three times always enough to get rid of pain 6. Bunion surgery Your physician may recommend surgery for your bunion if, despite the above-mentioned treatments, you still have pain and trouble walking. Bunion surgery readjusts the bone, ligaments, tendons, and nerves in order for the big toe to be brought back to its original position
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How Do You Find Working Together On The Same Patient At The Same Time
Mr Henry BourkeIt is relatively straightforward performing knee replacement once you have the experience of doing a few hundred, however operating with somebody next door to you, requiring the same instruments as you at the same time can be a challenge. It helps that we understand each others surgical techniques and usually we can predict who needs which instrument when. As previously discussed, having a left-hand and right-hand combination of surgeons does help as we do get in each others way less. It has been interesting working together as I have certainly learnt many techniques from Mr Kucheria as it is not often as a Consultant you operate with another Consultant and this has been enormously beneficial. We also have the ability to help each other out as some cases can be challenging and we frequently will ask each others opinions and help each other out during the operation to ensure the surgery is done to the best and highest standard.
Mr Rakesh KucheriaWorking together on the same patient at the same time can be difficult but fortunately, because I am right-handed and Mr Bourke is left-handed this means we do not clash whilst doing the operation.