Joint Replacement: Risks vs. Benefits

How to decide if a hip or knee replacement is right for you.

After a skiing injury 30 years ago, Bert Pepper, MD, got osteoarthritis in his left knee. "I stopped skiing and gave up tennis, running, and other sports that are tough on the knee," he says. "I turned to speed-walking to stay fit, but the knee kept me from walking at a good pace."

As his pain got worse and walking became harder, he looked into having a knee replacement. It's not a decision to make lightly, says Pepper, who is a psychiatrist. "It's a major life event. You have to be prepared to lose a few months to pain after surgery, limited mobility, and vigorous rehabilitation." And like any surgery, it's important to weigh the risks and benefits carefully.

An Exercise Fix for Knee Osteoarthritis

Jerry Wade used to love bird-watching with his wife, an avid birder. "I'm not a birder myself, but I like being active and getting out there with her," he says. "Bird-watching puts you into natural areas and some rough terrain -- it's not an easy physical activity." But in the fall of 2005, the 66-year-old Columbia, Mo., resident, who had retired in 2000 from a career in community development, started noticing "pains and twinges" in his knees. A visit to his doctor in January 2006 brought...

Read the An Exercise Fix for Knee Osteoarthritis article > >

"There are two main reasons to have a joint replacement," says Charles Bush-Joseph, MD, a professor of orthopaedic surgery at Rush University Medical Center. "The best reason is pain relief."

During a hip or knee replacement, a surgeon removes the painful, damaged surfaces of the joint and replaces them with plastic or metal implants. This gets rid of the pain, because the diseased cartilage and bone are no longer there.

The second reason is to improve joint function, Bush-Joseph says, but these results are less predictable. After a joint replacement, many people can walk more easily. Some may be able to ride a bike or play golf. But there are no guarantees.

Joint replacements carry the same risks as other major surgeries. This includes the risk of dangerous infections or blood clots. People with heart conditions, poorly controlled diabetes, or weak immune systems are the most vulnerable. Surgeons use antibiotics and blood thinners to try to prevent some complications.

The other major risk is that the new joint may not work as well as hoped. Weakness and stiffness are common problems, particularly in the knee. "Patients who don't actively rehabilitate will not regain the maximum range of motion," Bush-Joseph tells WebMD. For best results, knee surgery patients should stick to their rehab schedule of exercise, rest, and medicines.

Less common problems include an implant that becomes loose or dislocates. And it's important to know the implant could wear out after about 20 years. That means you may need another joint replacement down the road.

Joint replacement may be the right choice if you're in a lot of pain and other treatments haven't helped enough. But you want to be sure the joint is the true source of pain, says Michaela M. Schneiderbauer, MD, an orthopedic surgeon with the University of Miami Miller School of Medicine. "The source could be something other than the joint itself, even if arthritis is visible on an MRI."

If you actually have nerve or muscle pain, a joint replacement won't help, Schneiderbauer says. Your doctor can tell the difference by doing a careful physical exam and by asking you questions about your pain. "Be cautious if a doctor tells you you need a hip or knee replacement without doing a physical exam," she adds.

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Knee Replacement Often Beneficial for Rheumatoid Arthritis: Study

Patients did as well as those with osteoarthritis, but same did not hold true for hip replacement

By Maureen Salamon

HealthDay Reporter

THURSDAY, June 20 (HealthDay News) -- The common belief that rheumatoid arthritis patients don't benefit from knee replacement surgery as much as those with the more common osteoarthritis has been challenged by the findings from a pair of studies by New York City scientists.

Researchers from the Hospital for Special Surgery also found, however, that rheumatoid arthritis patients who underwent a total hip replacement didn't fare as well as those with osteoarthritis, though they did experience improvements in pain and function.

"One thing that we can clearly pull out of this research is that the levels of pain and function among those with rheumatoid arthritis were so much worse preoperatively at the point they approached joint replacement," explained rheumatologist Dr. Susan Goodman, the lead author of both studies. "They may be postponing or not getting to surgery until they're really in a much worse state. Perhaps that's one of the explanations for the results . . . perhaps it's their generalized disease. We really just don't know yet."

Goodman presented the research last week at the European League Against Rheumatism's annual meeting in Madrid, Spain. Research presented at scientific conferences has typically not been peer-reviewed or published and is considered preliminary.

Affecting one of every five adults, along with 300,000 children, arthritis is the leading cause of disability in the United States, according to the Arthritis Foundation. Osteoarthritis, the most prevalent form, progressively breaks down cartilage in the joints due to wear and tear, while rheumatoid arthritis is an autoimmune disease marked by inflammation of the membranes surrounding joints. Along with bringing chronic pain, both types can result in joint destruction.

Historically, rheumatoid arthritis patients have had worse outcomes after joint replacement surgeries than osteoarthritis patients, according to the study authors, but more effective drugs developed over the last two decades have helped them to better control their disease.

In the first study, Goodman and her team analyzed joint replacement registry data to identify 178 rheumatoid arthritis patients and more than 5,200 osteoarthritis patients who underwent knee replacement surgery. Though rheumatoid arthritis patients had worse pain and function before surgery, patients in both groups had similar satisfaction rates after surgery.

The second study compared outcomes of 202 rheumatoid arthritis patients and more than 5,800 osteoarthritis patients who underwent hip replacement, finding that those with rheumatoid arthritis started out with worse function before surgery and also had worse pain and function scores after surgery. However, rheumatoid arthritis patients were as likely as those with osteoarthritis to experience an overall improvement after hip replacement, though the gains didn't erase the disparity between the two groups.

"The advice to rheumatoid arthritis patients is, really, that you will have significant pain relief [from joint replacement surgery]," Goodman said. "It is an area that needs more study. We're looking forward to assessing more rheumatoid-specific factors."

The research, which looked at participants with active rheumatoid arthritis, is consistent with what Dr. Olivia Ghaw, an assistant professor of medicine in rheumatology at Mount Sinai Medical Center in New York City, sees in her practice.

But Ghaw said she felt the study's two-year follow-up period was perhaps not long enough to confirm if the joint replacement outcomes remained positive for rheumatoid arthritis patients.

"For some of my patients, if their joint is severely destructed, I still do recommend joint replacement," she said. "Ideally, we would love to get their underlying disease under better control. If we can bring their inflammation down, perhaps they can have better results with joint replacement."

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Joint Replacement May Reinvigorate Sex Life

Study shows unsung benefit of the surgery may be the ability to enjoy all aspects of life more

By Barbara Bronson Gray

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Although most people get a total hip or knee replacement to decrease pain and move around more easily, a team of orthopedic surgeons has discovered an unexpected benefit: people enjoy sex more after surgery.

A new study found that total hip or total knee replacement surgery improved self-reported sexual function in 90 percent of patients.

Study author Dr. Jose Rodriguez, director of the Center for Joint Preservation and Reconstruction at Lenox Hill Hospital in New York City, created a survey to learn more about how sexual experience was affected by getting a new joint. He said he thought that if he brought up the topic by asking questions about sexuality, people would respond. And they did. "Most patients won't bring up the topic on their own," he said.

Rodriguez said that many patients fear they'll damage the new joint if they have sex, but don't ask any questions about it. Now he makes a point of telling people, after their operations, that "most of what you want to do -- physical and intimate -- you can do."

Getting total hip or knee replacement may improve overall well-being and self-esteem, which itself can be a turn-on, said Rodriguez. "Anything that causes pain and affects how you move is going to influence sexuality," he explained. After surgery, if you feel you are more sensual yourself, you're going to enjoy having sex, he added.

The study, which is scheduled to be presented Tuesday at the American Academy of Orthopaedic Surgeons annual meeting in Chicago, involved reports about sexual activity done before and after total hip or knee replacement surgery. Male and female patients under 70 years old were recruited from the practices of two arthroplasty surgeons. They were asked to anonymously complete and mail back one survey before surgery and two other surveys at six months and one year after surgery.

Out of 147 people who returned the preoperative questionnaire, 116 returned the six-month survey and 65 also sent back the one-year survey. The mean age of patients was about 58 years; there were 69 males and 78 females in the initial group.

Before surgery, 67 percent of respondents reported having physical problems with sexual activity that included pain and stiffness; reduced sex drive (49 percent); an inability to attain the necessary position (14 percent); and psychological issues such as a lack of well-being (91 percent) and low self-image (53 percent).

After surgery, 42 percent of the patients reported an improvement in interest in sex; 35 percent said they had increased duration of intercourse; 41 percent reported more frequent sex; 84 percent said they had improved well-being; and 55 percent reported having an improved self-image.

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Kettlebells: A Smart Replacement for Dumbbells

By Lynne Anderson
WebMD Feature

Kettlebell workouts are a way to build muscle strength and endurance. What makes a kettlebell workout different from other weights workouts? 

For starters, you work with only one kettlebell at a time. Hoisting the heavy metal bells not only helps strengthen your arms and pecs, but also works your core, heart, and lungs.

"The reason the kettlebell is so great is that there’s offset center of gravity," says Laura Alton, a certified trainer, physical therapist, and Russian kettlebells certified instructor at the Cooper Fitness Center in Dallas.

That means your body has to work harder to maintain balance. In so doing, you work many different muscle groups -- and get your heart rate up at the same time.

"It's a two-fer; it's like you're killing two birds with one kettlebell," says Riva Rahl, MD, medical director for wellness programs at the Cooper Fitness Center. "If you're doing it appropriately, the benefits are huge."

Kettlebells got their start in Russia, so the story goes, as a farming weight. They're everywhere now. If you're thinking about trying it, you should know these three things:

Technique matters. Think about swinging around a gallon of milk -- the same weight as a beginner kettlebell -- for 30 minutes, and you get the picture. Or think of slinging around a 25-pound bag of potting soil. To avoid injury, you need to know what you're doing.Work with a trainer. They can help you learn how much weight you can use and how to use your kettlebell. "Make sure you use a certified kettlebells instructor," says Alton, who went through what she describes as three “grueling” days of certification training.Look for a smooth handle. Your kettlebell should have a smooth handle. “Your hand can get pretty roughed up by one that’s not smooth," Alton says. Ask your instructor for the weight you will need. If you're buying kettlebells, some people like to buy them in sets of three because with work, it won’t be long until you are moving up to the next weight.

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List of meal replacement shakes for Weight Loss

When it comes to weight loss, people are willing to try all sorts of methods. There are a lot of people who are struggling with their excess weight. People can be seen hitting the gyms or daily walking daily for an hour or do a large number of other activities aimed at reducing their weight. People get more and more conscious about their body now days. They want to look just like their favorite celebrities. It is good to work towards getting healthy and slim.

You might have heard about meal replacement shakes for weight loss if you keep yourself updated on the best methods to lose weight. Meal replacement shakes, as the name suggests, these shakes are consumed instead of meals. While trying to get their weight with meal replacement shakes for weight loss to reduce people not eat but only drinking shakes. We here give you a list of some of the best meal replacement shakes for weight loss.

This is a very delicious meal replacement shake that is loved by a lot of people. It has helped many people to reduce their weight. Shake them, you need a cup milk, two tablespoons of peanut butter, a scoop of vanilla, a quarter of the chopped peanuts and some ice cubes. By mixing these ingredients, this shock created. It is considered to be the best meal replacement shakes for weight loss.

People who like banana liked this meal replacement shake. It is easy to make and it tastes very good. People who wish to lose weight this should shake their add to their diet. This shock, we must have a half a cup of milk, a quarter Cup of freshly brewed coffee, half scoop of protein powder chocolate flavor, and it needs a cup vanilla fat free yogurt, one sliced bananas and two ice cubes.

If you love the taste of both oranges and mangoes, this is one of the best meal replacement shakes for weight loss for you. people love it, because it is very tasty. If you want to make this meal replacement shake you should have 2 tsp of sliced almonds, some ice cubes, some pieces, a scoop of protein powder with cold mango vanilla taste, half a cup of low fat yogurt that peach taste and half a cup of fresh orange juice. These ingredients make a great meal replacement shake for those people who wish to lose weight their.

An Apple a day keeps the doctor away. This is an old but true say. Shaking apple created is also very good for health. If you wish to reduce your weight with this shake then you need a Pack of artificial sweetener, a couple ice cubes, a cup of milk skim variety, a scoop of protein powder that a vanilla taste, half a cup of unsweetened applesauce, a tablespoon sliced almonds and a teaspoon ground cinnamon. Apple Pie meal replacement shake is considered one of the most effective meal replacement shakes for weight loss. Many people have lost their weight by this meal replacement shake to add to their diet.

People who like bananas and milk would love this meal replacement shake. It is very simple to prepare this shake. Anyone can prepare this shake at home on easy mode by having two bananas, one tablespoon of honey, one tablespoon of lecithin, some ice cubes, 2 cup water or milk, two scoops of ice cream, a teaspoon of nutmeg and a scoop of protein powder. All these ingredients make a great meal replacement shake to drink. A lot of people like this from all the other meal replacement shakes for weight loss shake.

Pineapple is a very useful fruit for those who want to get their weight to lose. Pineapple Blast shake meal replacement, would you make a half a cup of pineapple chunks, 12 oz. of water, two scoops of protein powder with vanilla taste and some ice cubes. This shake is definitely one of the most delicious meal replacement shakes for weight loss.

Meal replacement shakes are great when they are used for weight reduction. People should not only dependent this shakes when it comes to weight loss. It's best to use these shakes, while another also makes efforts to reduce weight. People who exercise regularly and consume meal replacement shakes for weight loss would find it easy to lose weight their surplus within a few weeks. It is easy to make at home these shakes and save money by not spending money on meal replacement shakes available in market.

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