Knee Replacement in Elderly Patients Shown to Improve Balance

Multiple benefits to surgery reported for patients with advanced osteoarthritis

New Orleans, LA – Total knee replacement (TKR) successfully relieves pain and improves function in patients with advanced knee arthritis, according to a study presented today at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The surgery also significantly improves dynamic balance among elderly patients.

Impaired balance and increased tendency to fall are common complaints among the elderly suffering from severe osteoarthritis (worn cartilage). The purpose of the study was to determine whether TKR had any effects on balance measures, in correlation with functional balance and quality of life. This is especially important because falls are the leading cause of injury for senior adults in the U.S., and hip fractures that result from falls can be lethal for elderly patients.

“Balance is critical to the elderly, especially those with knee problems. This study reinforced our hypothesis about how an osteoarthritic patient’s function is compromised not only due to pain, but also by balance,” said Leonid Kandel, MD, study author and orthopaedic surgeon, Department of Orthopaedic Surgery, Hadassah Mount Scopus Hospital, Jerusalem, Israel.

The study examined 63 patients, with a mean age of 73, who had total knee replacements and participated in follow-up evaluations after one year. The study measured accurately static and dynamic balance with a new computerized system called the Balance Master. The study found:

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New Study Finds Low Mortality Risk Following Knee and Hip Replacement

Risks Lower 26 Days After Surgery

Rosemont, IL – Total hip and total knee replacement surgeries are highly successful and very common procedures for people experiencing pain associated with degenerative joints. With a new hip or knee, and postoperative care prescribed by their doctors, most patients are able to regain a more active lifestyle with considerably less pain.

According to a new study published in the January 2010 issue of The Journal of Bone and Joint Surgery (JBJS), the risk of early postoperative mortality – or death following surgery — was slightly increased for the first 26 days after the elective surgery. The risk of mortality was estimated to be 0.1 percent.

The size of the study and the precise statistical tools used show the increase in early postoperative mortality was highest immediately after the operation. Then, 26 days after the surgery, the increased risk of death was negligible.

“Previous studies suggesting that increased mortality exists for as long as 60 or 90 days post hip or knee replacement surgery may be wrong,” said lead author of the study, Stein Atle Lie, PhD, MSc and professor in the Department of Surgical Sciences at the University of Bergen, Norway who led the study with colleagues from the Department of Orthopaedic Surgery, and the Norwegian Arthroplasty Register at the Haukeland University Hospital in Bergen, Norway. “We believe the risk is tied to a much shorter duration.”

The study included data on 81,856 patients with a total knee replacement and 106,254 patients with a total hip replacement from the Australian Orthopaedic Joint Replacement Registry and the Norwegian Arthroplasty Register. Only patients between 50 and 80 years of age with osteoarthritis were included.

The study found the most important risk factors for increased early postoperative mortality were:

* Male gender; and
* Age, older than 70 years old.

“This very low postoperative mortality after hip and knee replacements should be reassuring for patients considering these surgeries,” explains study co-author Lars B. Engesaeter, MD, PhD and Head of Norwegian Arthroplasty Register, Haukeland University Hospital in Bergen, Norway.

People considering hip or knee replacement should talk to their orthopaedic surgeon about any added risk in relation to their age and follow recovery guidelines closely. Other questions to consider prior to surgery can be found at www.orthoinfo.org.

“We conducted this study to help people contemplating hip or knee replacement,” continues Dr. Lie. “As with all surgeries, there is some increased risk of postoperative mortality. However, we were pleased to find the mortality rate is so minimal — less than one percent — following hip and knee replacements.”

Source: American Academy of Orthopaedic Surgeons

For more information about hip and knee replacements or any other orthopaedic procedure please feel free to contact us that Doctor Juan Sanchez Pulgar will be glad to help you.

Timing of surgery for knee injuries may not affect outcomes

Rosemont, Ill – Multiple-ligament knee injuries resulting from traumatic knee dislocations – such as high impact car accidents or certain sports are uncommon, and the optimal timing of surgical repair or reconstruction has not been definitively established.

According to a new study published in the December 2009 issue of The Journal of Bone and Joint Surgery (JBJS), patients who undergo surgery more than three weeks after a multiple ligament knee injury (called chronic intervention treatment) may have comparable outcomes to those who undergo surgery within three weeks of injury (called acute intervention treatment) with regard to knee stability. Additionally, researchers found that early mobility is associated with better outcomes than immobilization in those patients who are treated within that three week time period.

“After a review of the available literature, we found that chronic intervention provides results that are at least as good as acute intervention, despite some recent studies showing that acute intervention may be better,” said lead author of the study William R. Mook, MD, who conducted the study with colleagues from the Department of Orthopaedic Surgery at the University of Virginia in Charlottesville.

Dr. Mook and his colleagues surveyed 24 retrospective studies that included 396 knees treated surgically for the most severe multiple-ligament knee injuries. Patients were managed either acutely, chronically, or with a combination of both interventions, which is called staged treatment. The researchers also studied whether the patient’s leg should or should not be mobile or immobilized after surgery.

The study found that:

* patients receiving acute intervention had less stable knees and were not able to bend their knees as far as those who were treated with chronic intervention; and
* patients who underwent staged procedures (treatment from both the acute and chronic intervention stages) reported better outcomes than those treated just early or late.

“The reasons for this are not clear. The patient population is heterogeneous, and surgery can be delayed for a variety of reasons. It is difficult to tell which procedures were delayed intentionally and which were delayed due to other medical reasons occurring as a result of their initial injury,” Dr. Mook said.

This literature review suggests the following:

* Surgical reconstructions within three weeks of the injury and those performed later provide comparable knee stability.
* In patients treated within three weeks of injury, early mobility (compared with immobilization) is associated with better outcomes. However, early surgery is highly associated with range-of-motion limitations.
* Patients reported better outcomes and fewer range-of-motion limitations with a combination of acute and chronic procedures. However, additional treatment for joint stiffness may be required in these patients.
* In patients treated within three weeks of their injury, more aggressive rehabilitation may prevent the need for additional treatment for joint stiffness.

Previous studies have indicated that early treatment provides better outcomes, but that may not be the case. “Although recent evidence suggests that acute intervention is superior to chronic interventions in all outcomes, we found that chronic intervention may provide knees with equal stability as those managed acutely,” Dr. Mook concluded.

Source: American Academy of Orthopaedic Surgeons

For more information about Orthopedics and Traumatology Treatments in Argentina don’t hesitate to contact us.

Information about the Minimally Invasive Surgery

For this technique the surgeon creates a surgical field and the surgery is performed using small instruments and a high-definition camera to provide magnified images on a monitor.

An inert mesh is used in the affected area to reinfoce the adominal wall without generating tension. The surgery can thus be performed with three incisions of 3 to 5 mm each, and the detailed, magnified images allow the suregon to perform the surgery with great confidence, minimizing complications.

How is the surgery performed?

On the Day of Surgery:

Typically, the patient is admitted to the hospital during the morning and after the surgery, the patient stays under supervision in the recovery room until he/she is fully awake. After a variable period of observation, the patient is discharged on the day of the surgery or the following day.

After the Surgery:

You will be able to perform normal activities having to avoid big efforts. Physical activities can be resumed within 15 to 20 days after the surgery.

Benefits of this type of surgery:

Less pain: Faster healing time and less pain.

Maximum comfort: quicker return to normal activities.

Aesthetic: Less noticeable scars (2 to 4 mm).

Shorter Hospital Stay: Hospital discharge within 12 to 36 hours.

Procedures performed using the minimally invasive technique:

General Surgery: Inguinal Hernia, Vesicle, Appendix, Gastro-Oesophageal Reflux Disease, Small and Large Intestine Diseases, and so on.

Endocrine Surgery: Thyroid, Parathyroid, and Suprarenal Glands, and so on.

Other Specialties: Gynecology, Urology, Traumatology, and so on.

Mini Invasive surgeries are performed by Doctor Norman Jalil and Doctor Juan Sanchez Pulgar

Nearly 40 Percent of Americans Reel From Heel Pain

While foot problems such as bunions, corns and dry, cracked skin affect many Americans on a daily basis, one particular ailment—heel pain—stands out among foot disorders, according to a new survey by the American Podiatric Medical Association (APMA).

The 2009 APMA survey, which polled close to 420 Americans aged 18 and older, found that 39 percent of adults have experienced heel pain more than any other foot ailment within the last 12 months. Additionally, nearly 60 percent of respondents believed they suffered heel pain while wearing ill-fitting footwear. However, 64 percent of respondents said they had not yet visited a medical professional—such as a podiatrist—to diagnose and treat their heel pain.

“Heel pain is a detrimental foot ailment that affects millions of Americans every day, and foot pain of any kind is not normal,”. “If detected early, most types of heel pain—including the most common, plantar fasciitis—can be treated with non-invasive treatment options. However, the longer one waits to have their heel pain evaluated, the more difficult it is to successfully treat.”

Sixteen percent of Americans surveyed regularly experience heel pain. Wearing shoes that fit well, wearing the proper shoes for each activity, not wearing shoes with excessive or uneven worn heels or soles, and stretching foot and ankle muscles properly before exercising are several ways to avoid heel pain altogether. However, visiting a podiatric physician, also known as a podiatrist, as soon as foot pain is experienced drastically improves the chance of finding a solution for heel pain.

Get any foot procedure done by Doctor Juan Sanchez Pulgar

Foot surgery

Source: www.apma.org

El Dr. Juan Sánchez Pulgar se une al equipo de Sublimis

Sublimis, organización dedicada a  servicios y tratamientos médicos de alto nivel, les informa que el Doctor Juan Sánchez Pulgar, especialista en Cirugía Traumatológica y Ortopédica, se ha incorporado a nuestro equipo médico.

El Dr. Sánchez Pulgar se egresó de la Universidad Católica de Córdoba y  ejerce su profesión desde 1980. Es Miembro Titular de la Sociedad de Ortopedia y Traumatología de Córdoba desde Agosto 1985 y Miembro Titular designado por la Asociación Argentina de Ortopedia y Traumatología desde el 2001.

Además ha sido reconocido como especialista en Ortopedia y Traumatología por la Facultad de Medicina de la Universidad Nacional de Córdoba,  la Asociación Argentina de Ortopedia y Traumatología Infantil y por la Sociedad Argentina de Ortopedia y Traumatología.  También fue ganador del “Premio Anual SAMECIPP” otorgado por la Sociedad Argentina de Medicina y Cirugía del Pie y Pierna en el año 2006.

Sánchez Pulgar  participo como panelista/relator especialista en Cirugía Traumatológica y Ortopédica en conferencias en Argentina, Brasil, Chile, Colombia, Costa Rica, México, Panamá, Perú, Uruguay, Venezuela, entre otros países.