On Tuesday evening, September 10, community members gathered at Congregation Etz Chaim for the first Navigating the Medical System lecture of the season. Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, welcomed the crowd to the eighth year of this wonderful and informative lecture series.
Dr. Aditya M. Derasari, Associate Director of Total Joint Arthroplasty Orthopedics and Sports Medicine Center at NewYork-Presbyterian Hospital Queens, shared that hip and knee pain is typically caused by arthritis and it is a common problem. “Joints are involved in every activity.” He listed common causes of joint pain, which include rheumatoid arthritis, osteoarthritis, overuse of joints, or injury. Non-surgical treatment involves offloading the joint by using a cane or walker and using heat or ice. Physical therapy, which includes stretching and massage, can also be helpful. Over-the-counter anti-inflammatory pain relievers, like Motrin, Advil, or the generic Ibuprofen, can bring relief. If these measures don’t help, then a physician may prescribe steroids. The problem with steroids, he noted, is there are multiple side-effects with them.
How does a person know if he needs to consider surgery? If the above remedies didn’t work and people are having trouble sleeping at night because of discomfort, they are much less active, and they are letting go of things that are meaningful to them because of the pain, then this is an indication that surgery may be a good idea. “Total hip replacement is one of the most successful operations, with a success rate of over 90%.”
Dr. Derasari went on to explain what the joint looks like with arthritis. A normal joint has shiny smooth cartilage. In an arthritic joint, the cartilage is gone. Friction then creates a cycle of pain, with bone meeting bone, and there is no cushion. After hip replacement, the metal will grow into your bone. The plastic part that is inserted during surgery will wear out after 20-25 years.
He then spoke about knee replacement. The pain can be everywhere. He pointed out that a person can get partial knee replacement. Knee replacement creates a space between bones so you can bend your joints. It allows for smooth, frictionless gliding of the knee joint.
He then spoke about exciting innovations in hip and knee replacement that include use of a robotic arm to assist the surgeon during surgery. This robotic arm is controlled by the surgeon and it helps the surgery be more accurate. This is being practiced all over the world. “The robot dials in and it makes very specific cuts so there are more accurate and precise results.”
Dr. Derasari then detailed what a patient will experience with hip or knee replacement. Recovery is one to two weeks. For the first three to four days, there is pain and swelling. After the first month, the patient will be 78 percent recovered. One year will mark that he is fully recovered. The patient can walk and dance and do low-impact exercise. The surgeon administers x-rays every five years to monitor the condition of the plastic. If he notices that the plastic is wearing out, then he will just have to replace the plastic. This is a much quicker recovery than having to redo the whole surgery.
He noted that if a patient is allergic to nickel, then they can use a nickel-free implant. He shared there is just a one-to-two percent chance of developing an infection in the bone after hip or knee replacement.
There is also a one-to-two percent chance of blood clots. The surgeon will screen a patient to see if he ever had blood clots before. Most people take baby aspirin after the surgery and they don’t stay bed-ridden. This helps prevent blood clots.
As people in the audience raised concerns about possible infection or blood clots after hip or knee replacement, Dr. Breite responded. “People who were totally disabled became abled. I strongly recommend it.”
Next, Dr. Mohit Shukla, rheumatologist at NewYork-Presbyterian Queens, spoke about osteoporosis. He explained that osteoporosis is characterized by low bone mass. Normal bones are dense. Bones in osteoporosis are porous. With osteoporosis, the patient loses bone mass, and so her bones become weak and there is an increased risk of fractures. There can be low-impact or no trauma and people still break bones. The most common sites of fractures are the hip, the spine, and the wrist. He pointed out that 54 million Americans suffer from osteoporosis, and from this group, one in two people is above the age of 50. It is more common in females and it is a clinically silent disease. He shared common signs, which include: losing more than one and a half inches of height. People may look stooped over or hunched. Also, there can be a backache, which indicates a fracture of the spine.
Prevention includes monitoring diet and exercise and preventing falls. He advised people to eat foods rich in iron and calcium, such as milk products and green leafy vegetables. He suggested 1200 mg of calcium and at least 800 international units of Vitamin D, both to be taken daily for those at high risk of fractures. He advises to exercise 30 minutes, three times a week, using weight-bearing exercise like walking or dancing, which will stimulate bones. Swimming is not a weight-bearing exercise. Studies show a reduction in hip fractures for older women who exercised. He noted, “You are never too young or too old to protect your bones.”
Also, avoid excessive alcohol. He then listed some calcium-rich foods, such as milk, yogurt, orange juice, tofu, and cheese. Sunlight, cod liver oil, almonds, raw milk, eggs, and mushrooms are high in vitamin D. To prevent falls, he advised to keep rugs tucked away with no-slip backing, to light walkways well, to install night lights, to watch out for slippery floors, to wear rubber-soled shoes, and also to have your eyes checked.
Dr. Shukla then detailed treatment and testing procedures. Screening is done for all women who are 65 and older. It’s done for men who are 70 and older.
The lecture was followed by a lively question-and-answer session.