Surgery

Managing Pain and Function Following Joint Replacement Surgery

knee-scar

More than 1 million patients undergo total knee or hip replacement surgeries each year in the US and numbers continue to climb. The trend might be easily explained by an increasing number of elderly people, but reports are showing that there is a growing trend for younger patients to opt for surgery.

No matter how old you are when you go for surgery, one thing is certain: you will feel pain.

For most patients this is not a new sensation. The majority of patients seek joint replacement surgery because they have been living with pain for extended periods of time. It is easy to think that surgery is a quick fix and in some ways it is. The new joint is ready to function immediately and many patients are beginning their physical therapy rehabilitation on the same day as their surgery. But what most people do not expect is how much recovery it will take to overcome the damage caused by the surgery.

The nature of joint replacement surgery involves deep penetration into the body that requires tissue cutting, splinting, stretching, stapling, nerve severing, and bone scraping/removal to name a few. Having a clear understanding of what you are getting into, and how much pain to expect following the surgery, will help you recover quicker and help you manage post-operative pain more effectively.

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Surgeries to Avoid: Knee Arthroscopy for Osteoarthritis

Reasons to think twice before going under the knife

With this procedure a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscal tissue, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee. In a 2008 study, 178 patients with osteoarthritis received either physical and medical therapy without surgery, or therapy plus surgery. After two years the two groups had nearly identical outcomes, reporting less pain and stiffness and more mobility.

Alternatives to surgery

If you have knee pain, “start with the least harmful and invasive treatment and work your way up the ladder,” says Colin Nelson, a senior research associate at FIMDM. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.

by Karen Cheney, AARP The Magazine, July/August 2011

Surgeries to Avoid: Complex Spinal Fusion for Stenosis

Reasons to think twice before going under the knife

With spinal fusion, a surgeon places bone grafts that “weld” two or more vertebrae together to prevent motion and stop pain. The procedure is often used to treat back pain from spinal stenosis, which occurs when the soft tissues between the vertebrae flatten out, creating pressure on the spinal cord or nerves that go to the back, arms, neck, shoulders, and legs. There is little consensus on how best to relieve pain from stenosis, so doctors tend to develop their own preferences, says Richard Deyo, M.D., professor of medicine at Oregon Health and Science University.

Not all surgeries are worth the risk. — Getty Images/Uppercut RF

Not all surgeries are worth the risk. — Getty Images/Uppercut RF

Their top treatment choice increasingly seems to be fusion. Deyo recently studied the records of more than 30,000 Medicare patients who underwent surgery for stenosis of the lower back and found that complex fusion procedures (in which surgeons place bone grafts between multiple vertebrae) had increased an astounding 1,400 percent between 2002 and 2007.

The risks are significant: Those who underwent complex fusion were nearly three times more likely to suffer life-threatening complications than those who underwent less invasive surgery. Previous studies have also found that most fusion patients experience no more relief from their chronic back pain than those who had physical and behavioral therapy. “There is even some evidence that [complex fusion surgery] is worse than other surgeries,” says Floyd J. Fowler Jr., Ph.D., senior scientific advisor for the Foundation for Informed Medical Decision Making (FIMDM). “The vertebrae right above and below the fusion have to do a lot more bending, and it puts stress on your back above and below.”

Alternatives to Surgery

Before considering any type of back surgery, make sure you have exhausted more conservative measures, including physical therapy, cortisone injections, acupuncture, and medications. “Probably less than 5 percent of all back pain requires surgery,” says Arnold Weil, M.D., clinical assistant professor of rehabilitation medicine at Emory University School of Medicine in Atlanta.

by Karen Cheney, AARP The Magazine, July/August 2011

Planning to have surgery? Please read.

In the 2011 world of medicine we have many options open to us as patients. Sometimes, those options are limited by our insurance providers. But within that framework we can still take charge of our needs and find those physicians and ancillary medical personnel who can best help us to maintain our health.

It is of great importance to do our homework when we are trying to find the best person to care for our needs. It takes time and effort. Sometimes we listen to others’ suggestions more than we take the time to investigate for ourselves. If we are considering a surgical procedure, then it is in our best interest to seek other possibilities of solving our problem before we decide that surgery is our best option. Our bodies are fine instruments and need proper care to stay strong and vital. But there are many routes we can take, before the most serious of all: surgery. We can do the best thing for ourselves by going slowly and discovering what paths are open to us.

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