Total Knee Replacement Saves Money, Improves Sex Life

Orthopaedic Surgeons Joel Buchalter and Doug Fauser Respond to New Research,

Offer Tips to Optimize Recovery

Carmel, NY, October 2013 - Recent studies on total knee replacement (TKR) surgery indicate the procedure pays off in important ways in both the wallet and the bedroom. The research highlights why seeking TKR can be a valuable decision for those with diseased and damaged knee joints that cause chronic pain and dysfunction, according to Joel S. Buchalter, MD, FAAOS and Douglas J. Fauser, MD, FAAOS, founding partners of Somers Orthopaedic Surgery & Sports Medicine Group.

New research published in the Journal of Bone and Joint Surgery found that knee replacement surgery saves between $10,000 and $30,000 per patient over their lifetime in increased earnings and fewer missed workdays. Meanwhile, a study presented in March 2013 at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that the sexual functioning of those who had TKR or hip replacement surgery improved by 90 percent.

"More than 27 million Americans live with osteoarthritis, the most common reason for knee joint replacement surgery," says Dr. Buchalter, a board-certified orthopaedic surgeon. "These studies clearly demonstrate that the benefits of this surgery extend much farther than eliminating pain - a top reason for seeking the procedure - and also enhance patients' productivity and quality of life."

The desire to stay active is fueling the growth in joint replacement surgeries nationwide, along with an aging population. TKR surgery is expected to be performed on 3 million patients annually by the year 2030, up from 600,000 in 2009, according to the Agency for Healthcare Research and Quality. During the procedure, also known as knee arthroplasty, a surgeon excises damaged bone and cartilage in the knee area, replacing it with an artificial joint made of metal alloys, high-grade plastics and polymers.   

Studies quantify professional, personal value of TKR

The Journal of Bone and Joint Surgery study showed that the societal benefits for knee replacement patients of working age greatly outweigh the combined cost of the surgery and rehabilitation compared to non-surgical treatments for osteoarthritis. More than 90 percent of those who undergo TKR experience a dramatic reduction of knee pain and significant improvements in the ability to perform common daily activities, according to the AAOS.

"Almost half of TKR patients are now under age 65, with most still in the workforce," says Dr. Fauser, also a board-certified orthopaedic surgeon, "so these cost benefits can obviously add up quickly."

The sexual functioning study presented at the AAOS meeting, which included 174 men and women (average age 58), found that 49 percent had suffered from reduced libido prior to knee or hip replacement and 53 percent felt their arthritis had hurt their sexual self-image. After surgery, 81 percent of those whose sexual activity was previously affected had noticed an improvement in the frequency of sexual activity.

"Few people think about the effect knee replacement surgery might have on their sex lives," explains Dr. Fauser, "but this research clearly shows that eliminating their pain can markedly improve their enjoyment."

How to optimize surgical outcomes

As with any surgery, patients' attitudes and efforts toward recovery can optimize the process when literally getting back on their feet after TKR, Drs. Buchalter and Fauser agree. They offer these tips for patients to boost their recovery:

• Watch for signs of infection, such as fever, chills, surgical site drainage or increasing knee swelling or tenderness.
• Create a living space on one floor of your home for several weeks after surgery to avoid stairs.
• Install safety bars or handrails in your bathroom and on stairways.
• Remove all loose carpets and cords around your home.
• Keep "enthusiastic" pets away until you have healed.
• Continue physical therapy as recommended and slowly resume normal household activities.
• Avoid high-impact activities such as jogging, skiing, tennis and sports that involve contact or jumping until your doctor approves.

"There is much that patients can do to take the lead in their own recovery after TKR surgery," says Dr. Buchalter: "The combination of proactive healing and favorable research results makes TKR a great choice to improve patients' lives."      

Note that both Drs. Fauser and Buchalter are concerned for the growing Medicare population as reimbursements to surgeons who perform these operations on a routine basis may no longer be able to offer these services to Medicare patients if the reimbursements from the government drop any lower. Medicare pays them less than $1200 per surgery which includes 3 months of aftercare with increasing bureaucratic demands. This is little thanks for such a successful and valuable procedure.

Somers Orthopaedic Surgery &Sports Medicine Group, PLLC, founded in 1988, is one of the most comprehensive and specialized practices in the region with offices in Carmel, Hopewell Junction, Mt. Kisco and Newburgh. www.somersortho.com

Joel S. Buchalter, MD, FAAOS and Douglas J. Fauser, MD, FAAOS,are board-certified orthopaedic surgeons and founding partners of Somers Orthopaedic Surgery & Sports Medicine Group, PLLC .

Press release courtesy of Melissa Chefec of mcprpublications.com

Big Toe Joint Pain Causes Misery, Disability

Podiatry specialist Dr. Alan Berman offers tips for seniors with big toe joint pain

Carmel, NY, October 2013

Never underestimate the power of a little joint to cause big problems. But that's what can happen to senior citizens suffering from big toe joint pain - often as a result of arthritis - which can not only sour the mood and lessen quality of life, but raises the risk of falling and in many cases proves disabling, according to Alan Berman, DPM, of Somers Orthopaedic Surgery & Sports Medicine Group, PLLC.

Most people associate arthritis with the "big" joints such as the knees and hips. But arthritis, which afflicts an estimated 46 million adults in the United States and 50 percent of those over age 65, comes in many forms, two of which are specific to the big toe joint and are hardly rare. In a 2009 study in the Journal of Foot and Ankle Research, about 16 percent of people reporting symptoms of disabling foot pain identified the big or "great" toe as the source of their woes.

"It's truly remarkable how much misery can result from big toe joint pain," explains Dr. Berman, who specializes in podiatry and also performs podiatric surgery. "Many patients don't like to complain and think they can outwait the problem, but seeking professional advice and treatment is the right approach. There's simply no need to suffer in silence."  

Big toe joint targeted by 2 types of arthritis

No matter what type of arthritis you have, the condition generally includes ongoing joint pain, swelling, stiffness, tenderness, and problems using the joint. But two types of arthritis specifically affect the big toe: gout and hallux rigidus, or rigid big toe.

Gout is an inflammatory form of arthritis, typically affecting older men and resulting from the deposition of uric acid crystals in the joints (but usually targeting the big toe). Acute gout typically shows up as an intensely hot, red and swollen big toe causing excruciating pain. Risk factors for developing gout include:

• Drinking alcohol (beer and liquor more than wine)
• Eating a diet rich in meat and seafood
• Being overweight or obese
• Having high blood pressure

Hallux rigidus, or rigid big toe, results from "normal" osteoarthritis - or joint wear-and-tear - affecting the base of the big toe and is the most common site of arthritis in the foot. Symptoms specific to hallux rigidus include:

• Pain in the joint when you're active, especially when pushing off on toes as you walk
• Swelling around the joint
• A bump (caused by bone spurs) that develops on the top of the foot
• Stiffness in the big toe and the inability to bend it up or down
• An inclination to walk on the outside of your foot to avoid bending the big toe

Most people suffering from gout are in such distress that they're compelled to seek medical help. But Dr. Berman says that hallux rigidus, which may provoke a less-insistent response, is just as important to treat quickly since the bone spurs that eventually form are evidence of advanced disease and are tougher to eradicate.

"If you wait until you see a bony bump on the top of your foot, x-rays will be required to show the location and size of those spurs, which may require surgery to remove," he says.

Many treatment options

For gout, the drug colchicine is typically prescribed, both to treat flares and prevent future ones. Diet and lifestyle measures such as weight loss, avoiding alcohol, and eating less meat and seafood are also helpful. For hallux rigidus, surgery is sometimes recommended to remove bone spurs, fuse bones together in the big toe joint or even replace the joint.

But both gout and hallux rigidus share some common home treatments that can be effective for each. They include:

• Taking anti-inflammatory medications such as ibuprofen
• Using ice packs
• Using contrast baths, which alternates immersion of the affected foot in cold water for 30 seconds with equal time in hot water for a total of 5 minutes, three times per day
• Wearing shoes with a large toe box to avoid pressure on the big toe
• Avoiding high-heeled shoes

"Never think, 'Oh, it's just my toe,'" Dr. Berman says. "When pain in your big toe joint starts becoming a real nuisance, it's time to take action. Speak up and start living your life without pain again."  

Somers Orthopaedic Surgery & Sports Medicine Group, PLLC, wasfounded in 1988 and is one of the most comprehensive and specialized practices in the region.  www.somersortho.com

Alan Berman, DPM, is a board-certified podiatrist with Somers Orthopaedic Surgery & Sports Medicine Group. 

Press Release courtesy of Melissa Chefec of  www.mcprpublicrelations.com

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Could coffee be good for you?

There are plenty of reasons why drinking moderate amounts of coffee could be good for you.  As well as containing antioxidants, research published earlier this year shows that it could help prevent type 2 diabetes and could also help you live longer by reducing your risk of heart failure.

or more reasons why coffee could be good for you, visit:

http://expertscolumn.com/content/why-coffee-could-be-good-you

Is popcorn better for you than fruit and veg?

Popcorn could be healthier than you think and contains more antioxidants than fruit and veg, according to new research. Researchers say that popcorn has a high amount of an antioxidant called polyphenols and contains more of the substance than are found in fruit and veg.
Joe Vinson, Ph.D., says that popcorn only has 4 per cent of water while the polyphenols in fruit are diluted in 90 per cent water.  The findings of the research were recently presented at the 243rd National Meeting & Exposition of the American Chemical Society (ACS) late last week.

The study also showed that popcorn hulls are the healthiest containing a higher concentration of polyphenols and fibre.  So good are they for your health that Dr.Vinson calls them "nutritional gold nuggets".

Dr.Vinson also says:

“Popcorn may be the perfect snack food. It’s the only snack that is 100 percent unprocessed whole grain. All other grains are processed and diluted with other ingredients, and although cereals are called “whole grain,” this simply means that over 51 percent of the weight of the product is whole grain. One serving of popcorn will provide more than 70 percent of the daily intake of whole grain. The average person only gets about half a serving of whole grains a day, and popcorn could fill that gap in a very pleasant way.”

However, it is advised that people be careful of how they serve the popcorn and should avoid using butter or oils to cook it in.

Dr. Vinson said

"Air-popped popcorn has the lowest number of calories, of course."

“Microwave popcorn has twice as many calories as air-popped, and if you pop your own with oil, this has twice as many calories as air-popped popcorn. About 43 percent of microwave popcorn is fat, compared to 28 percent if you pop the corn in oil yourself.”

The doctor also advises that people should also continue to eat fruits and vegetables as they contain vital nutrients that aren't in popcorn.

Popcorn has long been considered a healthy snack provided that it isn't covered with too much salt, fat and doesn't come with added sugars.  Although it is relatively high in carbohydrates, popcorn is also rich in fibre; it also contains B vitamins and Iron.

Heart patients with depression more likely to be readmitted to hospital

Researchers at Tel Aviv University (TAU) say that mental health can play a role in how well a patient recovers after a heart attack.  Patients with depression have 14% more days of hospitalisation and are more prone to future problems including chest pains and cardiac events, leading them to be readmitted to hospital.

During the study, Vicki Myers from TAU's Sackler Faculty of Medicine, Dr, Yariv Gerber and other members of the Israel Study Group of First Acute Myocardial Infarction, carried out research into the links between depression in heart attack patients and hospital admissions for a decade after a heart attack.

As part of the study, the data from 632 heart patients was collected.  The data was taken from patients aged under 65 and admitted into hospital between 1992-1993.  The patients' recovery was then compared with follow-up data taken from 2005.

Researchers state that although a "large percentage" of patients with heart attacks will be readmitted, patients who were even mildly depressed were far more likely to be readmitted.

It is also clear that lifestyle choices do play a part in this data.  As Myers explains depressed patients are less likely to take part in rehab.  The data also shows that patients with depression were 20% less likely to take part in exercise, 26% less likely to take part in cardiac rehabilitation and 25% less likely to give up smoking.

Commenting on the study, Myers said:

"The message is that doctors cannot ignore psychological factors in patients who have had a heart attack. Patients who exhibit signs of depression need to be followed more closely, and may need extra help in following lifestyle recommendations. Ignoring this problem weighs heavily on health services,"

Campaign begins to protect children from smoking in cars

The Welsh Government announced a new campaign today aimed at protecting children from the harmful effects of second-hand smoke in cars.

The new campaign has been called "Fresh Start Wales" and urges parents and carers not to light up a cigarette while children are in the car to protect them from the effects of second-hand smoke.  As part of the campaign they'll be advertising on billboards, local radio, bus-backs and shelters.  They'll also be a dedicated website called www.freshstartwales.co.uk

A recent survey suggests that 20 per cent of 11-16 year olds in Wales were exposed to cigarette smoke when they last travelled in a car.

Commenting in a press release, the Chief Medical Officer for Wales, Dr Tony Jewell, said:

"Children are particularly at risk from second-hand smoke, especially in vehicles where a confined space means there is no respite from the harm of the toxic chemicals in cigarettes. Exposure to these chemicals puts children at risk from a range of conditions, including sudden infant death syndrome and asthma.

"There is robust evidence that the level of toxic chemicals is very high in cars, even with a window open. The Fresh Start Wales campaign aims to make people aware that smoking in cars is dangerous for their passengers, particularly children."

The announcement today could be part of a bigger effort to stop children being exposed to cigarette smoke while they are in cars.  Last year, the First Minister of Wales, Carwyn Jones, said the Welsh Government might consider imposing a ban on smoking for cars carrying children if the amount of children being exposed to the potential harmful effects doesn't fall over the next few years.

Commenting on the new campaign in a press release Jones said:

"This campaign is clear in its message: smoking in cars poisons your children.

"Wales was the first UK country to vote in favour of a ban on smoking in public places and if necessary we will not shy away from considering legislation to further protect children from second-hand smoke.

"A ban on smoking in cars carrying children will be considered later in this five-year term of Government if smoking levels do not reduce as a result of the campaign. We have commissioned research to measure levels of smoking in cars and public attitudes towards it, which will be revisited throughout the campaign to evaluate its success."

There is already a similar ban in some provinces in Canada and a number of states in Australia.

Hospital in Houston first to offer new foot drop device

A hospital in Houston has become the first in the area to offer a new rehabilitation system which could help patients with foot drop or drop foot.  The Methodist Hospital says that the system can be used for people that have foot drop through stroke, traumatic brain injury, MS, spinal cord injuries and cerebral palsy.

The system is called NESS L300® Plus System  and it uses electrical stimulation to help reduce foot drop.  Electrical stimulation is often used to help aid this condition and can be used to help build muscles which have atrophied.

Dr. Jenny Lai, section chief of Physical Medicine & Rehabilitation at The Methodist Hospital in Houston, said:

“The condition of foot drop is not only frustrating, but can also cause a great deal of embarrassment because it causes people to trip or fall.”

“The fact that this device allows foot drop sufferers to lift their foot and advance their leg without thinking about it is a very big deal."

A while ago, a similar system was introduced by a NHS hospital which involved implanting a device for patients with foot drop and electrical stimulation products are readily available.  However, patients considering using this form of treatment need to be aware that there are many contraindications and the use of this type of treatment should be discussed with a doctor first.

Lai said:

“People with foot drop tend to lose muscle mass because they cannot properly use their foot."

“We hope this new device will not only stimulate the nerves and help bulk up the muscle enough to increase muscle mass that has been lost, but also give patients more confidence when they walk and a better quality of life.”

Aside from electrical stimulation, there are other options available such as using walking splints.

You can find out more about the system here.