Tuesday, September 27, 2022
HomeSurgeryWhich Surgery Is Worse Knee Or Shoulder

Which Surgery Is Worse Knee Or Shoulder

Hip Replacement Surgery Recovery

Shoulder Replacement Compared to Hip or Knee Replacement

The success of your hip replacement surgery will depend in large measure on how well you follow your orthopedic surgeons instructions regarding home care during the first few weeks after surgery.

Your hospital stay will typically last from 1 to 4 days, depending on the speed of your recovery. Before you are discharged from the hospital, you will need to accomplish several goals, such as:

  • Getting in and out of bed by yourself.
  • Having acceptable pain control.
  • Being able to eat, drink, and use the bathroom.
  • Walking with an assistive device on a level surface and being able to climb up and down two or three stairs.
  • Being able to perform the prescribed home exercises.
  • Understanding any hip precautions you may have been given to prevent injury and ensure proper healing.

If you are not yet able to accomplish these goals, it may be unsafe for you to go directly home after discharge. If this is the case, you may be temporarily transferred to a rehabilitation or skilled nursing center.

When you are discharged, your healthcare team will provide you with information to support your recovery at home. Although the complication rate after total hip replacement is low, when complications occur they can prolong or limit full recovery. Hospital staff will discuss possible complications, and review with you the warning signs of an infection or a blood clot.

Wound Care

Diet

Activity

Your activity program should include:

How your new hip is different

Protecting your hip replacement

An Interview With Dr Mark P Figgie

The success of any surgical procedure is dependent upon a multitude of factors including the patient’s overall health, their ability to adhere to a physical therapy regimen and the surgeon’s skill, to name just a few. But for patients with inflammatory arthritis, a range of systemic diseases involving the immune system, surgery involves a particularly complex set of considerations that arise from both the illness itself and the medications used to treat it.

In patients with inflammatory arthritis the immune system “perceives” the cartilage of the joint as foreign substance. The synovium, a layer of tissue that lines the joint and provides a lubricating fluid that also delivers nutrients to the cartilage, becomes aggravated and overgrows. An inflammatory response follows and the cartilage erodes, causing pain, stiffness, and eventually destruction of the joint, to the point where the bone rubs against bone. Conditions that fall into the category of inflammatory arthritis include:

In recent years, medical treatments for these conditions have expanded considerably. Drugs that reduce inflammation, those that suppress the immune response, and a group of biologic agents called DMARDs , have helped many patients with inflammatory arthritis control their symptoms and eliminated or delayed the need for surgery on joints damaged by disease.

When A Knee Replacement Is Needed

Knee replacement surgery is usually necessary when the knee joint is worn or damaged to the extent that your mobility is reduced and you experience pain even while resting.

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Knee joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis. This is an age-related wear and tear type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
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    So Here You Are Years Of Treatment Maybe A Past Surgery You Still Have Pain Why

    Many times a patient will come into our office with advancing osteoarthritis of the shoulder. When they describe their shoulder pain they say things like:

    • My shoulder is barking at me today, or
    • My shoulder is letting me know it is there.

    When we manipulate their shoulder to test for range of motion and we all hear the audible pops, clicking, and grinding, sometimes the patient tells us My shoulder is talking.

    Intuitively these people know that their shoulder is talking to them. Do they understand what their shoulder is saying? Do you?

    A Patient Who Would Be Considered A Good Candidate For Prolotherapy

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    In this x-ray image, we see a patient who would be considered a good candidate for Prolotherapy. The overall architecture and integrity of the shoulder have been maintained in the joint. There is some loss of joint space. Because the overall shoulder structure has been maintained and the patient exhibited a full range of motion in his shoulder, this patient was considered a good candidate for Prolotherapy.

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    Technical Details Of Total Knee Replacement

    Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.

    Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.

    Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.

    Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.

    Anesthetic

    Length of total knee replacement surgery

    Pain and pain management

    Will Delaying Surgery Make Me Worse

    The answer to this question is ‘no’ for many people with painful joints, particularly if the pain came on gradually over time. While you should still tease this question out with your GP, it is safe and probably wise for the most part to wait some time before consulting a surgeon.

    Firstly, because we know trying lower risk treatments, such as exercise and weight loss, in advance of surgery is the best approach for most types of joint pain. Secondly, many of these conditions naturally improve over time, shown by studies where a ‘wait and see’ approach showed similar improvements over time to surgery or physiotherapy.

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    Preparation For Total Knee Replacement Surgery

    Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.

    Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.

    Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.

    Costs

    The surgeon’s office should provide a reasonable estimate of:

    • the surgeon’s fee
    • the degree to which these should be covered by the patient’s insurance.

    Total Knee Replacement Surgical Team

    The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.

    Finding an experienced surgeon to perform your total knee replacement

    Some questions to consider asking your knee surgeon:

    • Are you board certified in orthopedic surgery?
    • Have you done a fellowship in joint replacement surgery?
    • How many knee replacements do you do each year?

    How Soon Can I Ride A Bike After A Shoulder Replacement

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    After the first week to 10 days, its fine to begin using a stationary bike to keep your cardio activity going, but avoid treadmills and elliptical, as you can easily lose your balance and really hurt yourself. You should also be moving your hand and elbow a decent amount during this time to avoid stiffness.

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    Serious Shoulder Replacement Side Effects And Risks Vary Depending On Age

    The new study analyzed the outcomes of over 58,000 elective shoulder replacements for arthritis over a 19-year period in Great Britan. The results? While all age groups were found to have a risk of shoulder replacement failure, men aged 59 and under fared the worst with 1 in 4 requiring revision surgery , and the risks of revision surgery in all age groups were highest within five years post surgery. Other complications associated with the surgery included respiratory infections, UTIs, acute kidney injury, pulmonary embolism , heart attack, and all-cause death , and these resulted in hospital admissions for 46 of every 1,000 surgeries. In these cases, older patients were most affected.

    Interestingly, not only were the numbers of serious complications high in this study but the actual number of shoulder replacements performed increased each year, 5.6-fold over the 19-year period. Prior to this study, the general thought was that serious complications following shoulder replacement were uncommon, but this study found quite the opposite, and this was particularly true in younger shoulder replacement patients.

    In the 85 and older group, the stress of a such a major surgery may explain the shoulder replacement side effects and some of these high complication and mortality rates. But why are younger patients experiencing shoulder replacement failures at such a high rate?

    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.

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    The Shoulder Becomes Highly Inflamed

    Back to the research, we cited above :

    • In the two groups of patients examined and divided by less severe and more severe osteoarthritis and rotator cuff tear, measurements of the patients:
    • Cytokines ,
    • growth factors
    • and angiogenic biomarkers to determine if and how much blood vessel making activity was happening
  • Findings: Well-known inflammatory factors such as interleukin 8, tumor necrosis factor , and interleukin 1 were considerably elevated in synovial fluids of the patients.
  • .
  • The joint inflammation highly enhanced insulin-like growth factor 1 and transforming growth factor 1 in the synovial fluids and serum.
  • The toxic situation is shown by upregulated inflammatory factors that have created oxidative stress throughout the shoulder).
  • Finding The Right Doctor

    Knee Replacement Surgery for Knee Arthritis

    If you are considering a reverse total shoulder replacement in Ohio, the first step is, of course, finding a doctor you can trust. If you are in need of an evaluation of your options for shoulder replacement, please contact us to schedule with consultation with Dr. Kovack. Dr. Kovack has experience handling reverse total shoulder replacement and he can advise you on the best option according to your specific situation. No two patients are the same, and we are always dedicated to ensuring each patient is treated with special attention and concern to their specific problem. Dr. Kovack can help you determine if reverse total shoulder replacement is the right solution for your shoulder pain. He will outline exactly what your options are and what the procedure would involve for you. Dont endure chronic shoulder pain needlessly, find the solution for your shoulder issues with Dr. Kovack.

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    Preparing For Your Surgery

    Before you get your new shoulder, youâll likely get a full physical exam and X-rays or other imaging tests so the surgeon can get a look at the joint.

    Talk to your doctor about any other conditions you have and any medications you take. Youâll have to stop taking certain drugs, especially narcotic painkillers, several weeks before surgery.

    You may have to cut back on drinking and get more exercise, too. If you smoke, youâll be asked to quit. Scientists have found folks who smoke are more likely to have complications from joint replacement surgery than those who don’t.

    Donât eat or drink anything after midnight on the night before your operation.

    The procedure takes about 3 hours. Doctors will give you drugs to put you under during the surgery.

    Youâll want to be sure you have some help with your daily routine lined up for a few weeks after you come home from the hospital. You wonât be able to move your arm very much. If you donât have a relative or friend who can help you out, you might want to check into a rehabilitation center until you can do more things on your own.

    You may also want to move some things around at home to make them easier to get to while you recover.

    What Happens At The First Appointment For A Shoulder Replacement Surgery

    Your consultation visit and initial appointment with the orthopedic surgeon will include a series of x-rays, a physical examination and a thorough review of your medical history.

    • The physical exam will help the surgeon determine the source of pain and also the decrease in range of motion.
    • X-rays reveal bone spurs, damaged joint surfaces and any narrowed joint spaces. If there was a trauma or injury to the shoulder, the x-ray will assist your healthcare provider with evaluating whether the fracture can be fixed or if your shoulder will need to be replaced.
    • Detailing a history of your shoulder problem includes describing for the surgeon the degree of pain with activity, limited use, loss of motion and pain at rest, prior treatments including medications, injections, physical therapy and previous surgeries.

    With this information and, together with your family, you and your orthopedic surgeon will determine the next best steps.

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    Preparing For Hip Replacement Surgery

    Medical Evaluation

    If you decide to have hip replacement surgery, your orthopedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such a cardiologist, before the surgery.

    Tests

    Several tests, such as blood and urine samples, an electrocardiogram , and chest x-rays, may be needed to help plan your surgery.

    Preparing your skin

    Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopedic surgeon for treatment to improve your skin before surgery.

    Blood donations

    You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.

    Medications

    Tell your orthopedic surgeon about the medications you are taking. He or she or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.

    Weight Loss

    If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.

    Dental evaluation

    Urinary evaluation

    Social planning

    Home planning

    Revision Surgery For Humeral Component Revision

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    Removal of a Humeral Implant

    In some instances removal of the head of a modular component is sufficient to accomplish the desired revision including gaining access to the glenoid.

    Often, however, revision requires removal of the entire humeral component. Extraction of a humeral prosthesis can be straightforward in the case where there is radiolucency in all 7 zones between the humeral endosteum on one hand and the prosthesis and any cement used to fix it on the other.

    Our approach to prosthesis removal begins with the removal of soft tissue bone ingrowth and cement from around the humeral head or, in the case of a modular prosthesis, from around the collar and from around the fins of the prosthesis.

    If the prosthesis cannot be removed easily at this point, enough bone in the area of the bicipital groove is cut to allow the positioning of a bone tamp parallel to the shaft with one end beneath the collar or head

    The elbow is flexed to 90 degrees and the arm is stabilized to the thorax while the surgeon strikes the bone tamp so that a longitudinal impact is applied to the proximal prosthesis along the axis of the humeral shaft. If reasonable impact does not dislodge the prosthesis, a longitudinal humeral osteotomy is started in the bicipital groove.

    If a secure cement mantle remains after humeral component removal, the new humeral component with a smaller diameter can be cemented into the old mantle.

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