Frequently Asked Questions

Easing The Pain

What are the analgesics prescribed for?

The primary purpose of an analgesic is to relieve pain. Some patients use aspirin, an analgesic that also reduces joint inflammation. The most commonly used analgesic, acetaminophen, is relatively effective and has few side effects. Acetaminophen does not contain aspirin, however, so it doesn’t relieve joint inflammation. For this reason, acetaminophen is less likely to be used with rheumatoid arthritis and other types of arthritis that cause inflammation, and more likely to be used to treat osteoarthritis and fibromyalgia.

The main side effect of analgesics is a slight risk of dependency that can occur if the drugs are used for long periods of time.

What can you tell me about NSAIDs?

Nonsteroidal anti-inflammatory drugs (NSAIDS) are the most frequently used medications for arthritis. They are often used to treat osteoarthritis, rheumatoid arthritis, gout, juvenile arthritis, and bursitis. Some are available by prescription only, while others (such as aspirin, ibuprofen, and naproxen) can be purchased over the counter.

NSAIDs help reduce redness and swelling and relieve pain. The type of NSAID that your doctor recommends for you will depend on several factors:

  1. The type of arthritis you have
  2. The degree of pain and inflammation
  3. How your body reacts to the NSAID
  4. Other medications you are taking

As with all medications, there are side effects that can occur with NSAIDs. The most common side effects include constipation and stomach irritation (ranging from indigestion and heartburn to development of stomach ulcers if symptoms are left untreated). For this reason, your doctor will monitor you carefully, and you should report any symptoms immediately.

When would a doctor prescribe corticosteroids?

Corticosteroids are similar to the hormone, cortisol, which occurs naturally in the body. Corticosteroids reduce painful inflammation in joints, but because of potentially serious side effects, they are rarely used as a first choice for long-term treatment.

Corticosteroids are almost never used to treat osteoarthritis, and when they are prescribed for rheumatoid arthritis, it is generally to relieve severe symptoms while waiting for another drug, such as an NSAID, to reach an effective level. If they are used for a longer period of time, they are generally used in lower doses.

Are there any medications that can help people with fibromyalgia?

Fibromyalgia is often mistaken for chronic fatigue syndrome because the patients never feel fully rested. Fibromyalgia, affecting deep muscle tissues and their attachments to bone, is extremely painful. A number of drugs that are not generally used to treat other types of arthritis may be prescribed for fibromyalgia, including antidepressants and antianxiety drugs.

Taken in smaller doses than for depression, these drugs can give patients the type of deep sleep they need, which contributes to pain relief and increased energy. Muscle relaxants can also promote sleep and ease painful muscles. Possible side effects vary depending on which type of medication is taken. You should discuss with your doctor the side effects of the drug prescribed for you.

Do I have to take drugs to relieve arthritis pain?
Arthritis patients have found that they may benefit from a number of other pain management techniques that do not involve medication. The most popular are:

Sleep
Exercise
Stress Management
Massage Therapy
Relaxation Therapy
Biofeedback
Hot/Cold Treatment

Is it true that sleep can be a factor in arthritis pain?

Not getting a good night’s sleep is a problem for many people with arthritis. If your pain continually awakens you, you may never reach Stage 3 sleep – the deep sleep that’s needed for true rest. And your fatigue can worsen your pain. There are many sources of information about getting a better night’s sleep – magazine articles, books, web sites, etc., and you should consult with your doctor, nurse, or therapist.

Understanding Arthritis

What is Arthritis?

Arthritis is the number one cause of chronic disability in the United States. Affecting nearly 40 million Americans, it refers to more than 100 diseases that cause pain, stiffness and swelling from the inflammation of a joint or the area around joints.

What is Osteoarthritis?

Osteoarthritis is the most common type of arthritis affecting about 16 million Americans, usually middle-aged and older people. This is a noninflammatory degenerative joint disease characterized by the breakdown of the joint’s cartilage. The exact cause of osteoarthritis is unknown.

What is Fibromyalgia?
Fibromyalgia is the second most common type of arthritis affecting 3.7 million Americans, mostly women; 70 to 90 percent of people who develop this disease are women aged 20 to 50. Fibromyalgia is a disease involving pain in muscles or joints with no clinical signs of infection. It is often misdiagnosed as chronic fatigue syndrome, and usually does not require surgery.
What is Rheumatoid Arthritis?
In some types of arthritis, such as rheumatoid arthritis, the synovium becomes inflamed. This inflammation causes chemicals to be released that thicken the synovium and damage the cartilage and bone of the affected joint. This leads to inflammation of the synovium causing pain and swelling.
What causes arthritis?
The causes of the 100 types of arthritis are unknown. Because there are so many different forms of arthritis, the causes are likely to vary. Scientists are currently examining how the roles of major factors including genetics and lifestyles affect the development of arthritis.
What changes occur in the cartilage of an arthritic hip?
In a healthy hip, cartilage cushions the area surrounding the hip ball and socket to allow easy movement without pain. In an unhealthy hip, the cartilage is damaged or worn away causing pain from bones rubbing and grinding together.
What changes occur in the cartilage of an arthritic knee?
In a healthy knee, cartilage protects and cushions bone surfaces that come together at the joint allowing bones to move without friction. In an unhealthy knee, cartilage is damaged or worn away causing pain from bones rubbing together.
What are some of the symptoms of arthritis?
Pain from arthritis can be continuous or intermittent. Pain may occur after activity or exercise but it may also happen even if you’ve been resting and still for a period of time. Pain may be concentrated in one spot or you may feel it all over your body. Joints may feel stiff and difficult to move. Daily chores such as climbing stairs and opening cans may become a challenge. You may notice that pain is more severe during certain times of the day or after performing certain tasks. Some kinds of arthritis cause swelling or inflammation. The skin over the joint may appear swollen and red, and feel hot when touched. Arthritis may also cause fatigue.
How can I know if I have arthritis?
Early diagnosis and treatment tailored to an individual’s needs are crucial in slowing or preventing damage to joints. Only a physician can determine if you have arthritis and what type it is. Arthritis is diagnosed based on the overall pattern of symptoms, medical history, physical exam, x-rays and lab tests.
What are the treatment options for arthritis?
Because there are so many types of arthritis, each type of arthritis has different symptoms and treatments. The good news is that many things work to help control arthritis. Care for arthritis often involves more than one type of treatment. Treatment may vary over time and may be different depending on the kind of arthritis. Consult your doctor to discuss the best treatment options for you.

Vacationing with Arthritis

Talk With Your Physician
Before you depart, talk with your physician. Your physician can offer advice about what to do if inflammatory arthritis flares and can review your medications. If you have a joint replacement, your physician can provide you with a patient identification card, which may be needed to go through security at the airport, as your implant may set off the alarm.
Your doctor may have vacation destination suggestions that other arthritis patients have taken.
Hotel Accommodations
Select a hotel that is close to the area where you will be spending much of your time. If you will be shopping, see how close you are to the shops and restaurants you’ll visit often. If you enjoy the beach or pool, ask for a room closer to these hotel amenities.
Find out if the hotel has a shuttle. If it does, find out where it goes and how often it operates.
Reserve a room that has bathroom handrails to make getting in and out of the shower/bath tub easier.
Rental Cars
When renting an automobile, request a vehicle that has power steering, power brakes, power locks and windows, cruise control, and power side-view mirrors. Most vehicles come standard with these options, but it is wise to double-check.
Packing

Pack your belongings in luggage that has wheels.

Pack comfortable walking shoes.

Pack plastic bags to make ice packs and a heating pad to relieve flare-ups.

Pack a raised toilet seat and a long-handled grabber if you use these items at home. It may be easier to pack these items if you travel by car

Pack your pillow to make your sleeping environment more familiar.

Use fanny packs and bags with straps. It is suggested that bags with straps be carried across the chest.

Carry small bills to tip those who assist with your luggage.

Pack more than enough medication to last you through your trip. You may want to take copies of your prescriptions, your doctor’s name and telephone number, a brief medical history, and a list of your medications and how often you take them. This will be important if you need medical care during your vacation.

Traveling Through the Airport

Allow plenty of time to get to your gate.
Courtesy shuttles and wheelchairs are also available at airports to reduce your walking distance.

If you are walking, frequent rest periods can help.

Check your luggage through to your destination with the ticket agent. Only carry on the airplane the things that you need. If you have to carry luggage, you may find the luggage carts beneficial. These are typically inexpensive, and at some airports, if you return the cart to a “cart station” you are refunded the cost of the cart. There are usually baggage carries or porters at airports that will carry your luggage for you to the ticket counter. Be prepared to tip the porter, usually about $1 per bag. Take advantage of curbside check in, which further reduces how far you will need to carry your luggage.

During Vacation
Whether you are sightseeing, cruising, shopping, or laying poolside, it’s time to relax and enjoy!

If you have flare ups, follow your doctor’s instructions, which may include using an ice pack or heating pad or taking medication for relief.

Call your doctor if you experience unusual symptoms.

Most importantly, do not over-do it. Take breaks and enjoy the scenery. Remember you’re on vacation!

Guide to Hips

Teach me a little about the hip.
The hip joint is commonly known as a ball and socket joint and is formed where the rounded head of the thigh bone joins the pelvis. The joint is surrounded and lined by cartilage, muscles, and tendons. It relies on these tissues for support, stability, and ease of movement.
What is total hip replacement?

In a total hip replacement surgery, the painful parts of the damaged hip are replaced with artificial hip parts called a prosthesis, a device that substitutes or supplements a joint. The prosthesis consists of steel components: a socket, ball, and stem. The outer shell of the socket is usually made of metal and the inner shell consists of plastic, or the entire socket may be plastic. When the metal ball is joined with the socket, the new hip can allow for smooth, nearly frictionless movement.

Two Types of Hip Fixation
There are two main types of fixation philosophies-cemented and porous. Both can be effective in the replacement of hip joints. The physician (and the patient) will choose the best solution that is specific to the patient’s needs.

1. Cemented Hip Implants

The cemented hip implant is designed to be implanted using bone cement (a grout that helps position the implant within the bone). Bone cement is injected into the prepared femoral canal. The surgeon then positions the implant within the canal and the grout helps to hold it in the desired position.

2. Porous Hip Implants

The porous hip implant is designed to be inserted into the prepared femoral canal without the use of bone cement. Initially, the femoral canal is prepared so that the implant fits tightly within it. The porous surfaces on the hip implant are designed to engage the bone within the canal and permit bone to grow into the porous surface. Eventually, this bone ingrowth can provide additional fixation to hold the implant in the desired position.

How do I prepare for hip replacement surgery?
If you and your surgeon decide that total hip replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will help to ensure that other health problems you may have, such as diabetes or high blood pressure, will be identified and treated before surgery.

You doctor may suggest that you lose weight and initiate an exercise program. If you smoke, be sure to speak with your doctor about it, as smoking can dangerously increase surgical risks and slow down the healing process.

You should also finish any dental work that may be underway to prevent germs in your mouth from entering the bloodstream and infecting the joint.

Taken in smaller doses than for depression, these drugs can give patients the type of deep sleep they need, which contributes to pain relief and increased energy. Muscle relaxants can also promote sleep and ease painful muscles. Possible side effects vary depending on which type of medication is taken. You should discuss with your doctor the side effects of the drug prescribed for you.

What happens during hip replacement surgery?
On the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia.

The surgery usually takes two to four hours, although this is dependent upon the severity of the arthritis in your hip. In the operating room, a urinary catheter will be inserted and left in place for one or two days. Compression stockings and pneumatic sleeves will be put on both legs.

The procedure is performed through an incision over the side of the hip. The ball-end of the thighbone (femur) is cut and replaced with the new metal ball and stem component. It may be stabilized with or without cement. The damaged surface of the socket is smoothed in preparation for the insertion of the new socket. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be cleaned and covered with dressings. You will also find small drainage tubes coming out of the hip to drain fluid from the wound.

You will be sent to the recovery room and as the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. You will also be given pain medication and will find a foam wedge or pillows placed between your legs to help hold your joint in place. When you are fully conscious, you will be taken back to your hospital room.

What can I expect after surgery?

When you are back in your hospital room you will begin a gentle rehabilitation program to help strengthen the muscles around your new hip and regain your range of motion. On the day of surgery you may be asked to sit on the edge of the bed and dangle your feet. You will also learn how to protect your new hip while doing daily activities.

As soon as possible, usually within the next 24 hours, your physical therapist will help you start walking a few steps at a time. As you heal you will progress from walker to crutches and then a cane. Before you are dismissed from the hospital, an occupational therapist will also show you how to perform daily tasks at home with your new hip. For example, he or she will instruct you on how to go to the bathroom, how to dress yourself, how to sit or stand, how to pick up objects and many others.

After about two to four days, or when your surgeon determines that you have recovered sufficiently, you will be discharged. You may be transferred to a rehabilitation facility for a few more days, as determined by your surgeon. Upon returning to your home, you will need to continue taking your regular medications and continue exercising as directed by your surgeon or physical therapist. Walking, remaining active and practicing the required exercise are the quickest ways to full recovery.

How long will a joint replacement last?

Longevity of the prosthetic hip varies from patient to patient. It depends on many factors, such as a patient’s physical condition, activity level, and weight, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient’s life.

Today, total hip replacement has become a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic hip can do and how much activity it can withstand. As with any mechanical joint, the ball and socket components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the hip joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Talk with your doctor about the following points, and how they might affect the longevity and success of your hip replacement:

Avoiding repetitive heavy lifting

Avoiding excessive stair climbing

Maintaining appropriate weight

Staying healthy and active

Avoiding “impact loading” sports such as jogging, downhill skiing and high impact aerobics

Consulting your surgeon before beginning any new sport or activity

Thinking before you move

Avoiding any physical activities involving quick stop-start motion, twisting or impact stresses

Avoiding excessive bending when weight bearing, like climbing steep stairs

Not lifting or pushing heavy objects

Not kneeling

Avoiding low seating surfaces and chairs.

Guide to Elbows

Teach me about the elbow.
The elbow is a hinge joint consisting of three bones. The upper portion of the hinge is at the end of the upper arm bone (humerus), and the lower portion is the top of the two forearm bones (radius and ulna) which are side by side. All three of these bones are in contact with each other. The joint is surrounded and lined by cartilage, muscles, and tendons that provide support, stability, and ease of movement.
What is range of motion?
The elbow joint allows for the extension, flexion, and rotation of the arm. The range of motion is dependent upon the proper articulation of the elbow joint.
What is elbow replacement?
In elbow replacement surgery, the painful surfaces of the damaged elbow are replaced with artificial elbow parts. One part fits into the humerus (upper arm), and the other party fits into the ulna (forearm). The two parts are then connected and held together by a pin. The resulting hinge allows the elbow to bend.
How do I prepare for elbow replacement surgery?
If you and your surgeon decide that total elbow replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will ensure that other health problems you may have, such as diabetes or high blood pressure, will be treated before surgery. Your doctor, or a staff member, will advise you about the things you can do to prepare for your hospital stay, and your rehabilitation after surgery.
What happens during elbow replacement surgery?

On the day of surgery, an intravenous tube will be inserted into your unaffected arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your elbow will be scrubbed and sterilized with special solution.

The procedure is performed through an incision over the elbow that will expose the joint. Special, precision guides and instruments will be used to cut the ends of the humerus (upper arm bone) and ulna (forearm bone), and prepare the bone to accept the implant. The implants are then inserted and fixated in place with a special kind of opoxy cement for bones. The two parts of the hinge are then brought together and secured with a pin. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. The surgery usually takes one to three hours, although this depends on the severity of the arthritis in your elbow.

A sterile bandage will be placed over the wound, and you will be sent to the recovery room where you will be carefully monitored. As the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. Your arm will be in a splint, and it may be wrapped in an ice pack to help control pain and swelling. You will also be given pain medication. When you are fully conscious, you will be taken back to your hospital room.

What can I expect after surgery?

When you are back in your hospital room, you will begin a gentle rehabilitation program to help relax the muscles around your new elbow. On the day of surgery you may be encouraged to get out of bed and take a few steps. You will continue to receive pain medication as needed, and your bandage will be removed about two days after surgery.

Depending on your specific situation, you will probably remain in the hospital from one to three days. Your elbow area may be warm and tender for several weeks. Before you are dismissed from the hospital, your physical therapist will show you how to perform the rehabilitation exercises that are important for your recovery.

How soon can I return to normal activities after surgery?
Successful joint replacement surgery may relieve your pain and stiffness, and allow you to resume some of your normal daily activities as instructed by your doctor. While you are recovering, you should not lift more than one pound with the operated arm. Even after you have fully recovered from your surgery, you will still have some restrictions. Normal daily activities for elbow replacement patients do not include contact sports, “jamming” activities such as hammering, heavy or repetitive lifting, or activities that put excessive strain on your elbow. Your doctor may advise you not to lift anything that weights more than five pounds. Although your artificial joint can be replaced, a second implant is seldom as successful as the first.
How long will an elbow replacement last?
Longevity of the prosthetic elbow varies from patient to patient. It depends on many factors, such as a patient’s physical condition and activity level, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient’s life.

Today, total elbow replacement is becoming a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic elbow can do and how much activity it can withstand. As with any mechanical joint, the components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the elbow joint is used. Activities that place a lot of stress on the joint implants, as may be the case with more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the components can lead to the necessity for revision surgery to replace the worn parts, or all of the parts. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Guide to Knees

Teach me a little about knee anatomy.

Your knee joint is made up of three bones. Your thigh bone (femur) sits on top of your shin bone (tibia). When you bend or straighten your knee, the rounded end of your thigh bone rolls and glides across the relatively flat upper surface of your shin bone. The third bone is often called the kneecap (patella), which is attached to the muscles that allow you to straighten your knee. Your kneecap provides leverage that reduces strain on these muscles.

What is total knee replacement?

In total knee replacement surgery, the parts of the bones that rub together are resurfaced with metal and plastic implants. Using special, precision instruments, your surgeon will typically remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place.

The surface of the femur is replaced with a rounded metal component that comes very close to matching the curve of your natural bone. The surface of the tibia is replaced with a smooth plastic component. This flat metal component holds a smooth plastic piece made of ultra-high-molecular-weight polyethylene plastic that serves as the cartilage. The undersurface of the kneecap may also be replaced with an implant made of the same polyethylene plastic.

How do I prepare for knee replacement surgery?
If you and your surgeon decide that total knee replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by an internist or your regular doctor.
What happens during knee replacement surgery?

On the day of surgery, a small tube (intravenous line) will be inserted into your arm. This tube will be used to administer antibiotics and other medication during your surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your knee will be scrubbed and sterilized with a special solution.

The surgery will begin with an incision over the knee that will expose the joint. When the bones are fully visible to the surgeon, special, precision guides and instruments are used to remove the damaged surfaces and shape the ends of the bones to accept the implants.

The implants are then secured to the bones. It might also be necessary to adjust the ligaments that surround the knee in order to achieve the best possible knee function. When the surgeon is satisfied with the fit and function of the implants, the incision will be closed.

A special drain may be inserted into the wound to drain the fluids that naturally develop at the surgical site. A sterile bandage will then be applied, and you will be taken to the recovery room, where you will be closely monitored. Your surgery will likely take between one and three hours, depending on your individual circumstances.

As your anesthesia wears off, you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breath deeply to help clear your lungs. You will also be given pain medication. When you are fully awake, you will be taken to your hospital room. Your knee will remain swollen and tender for a few days.

What can I expect after surgery?
When you are back in your hospital room, you will begin a rehabilitation program that will help you regain strength, balance, and range of movement in your knee. This program will be designed specifically for you. It may include a machine, called a continuous passive motion machine that automatically moves your leg to help reduce stiffness.

Your physical therapist will help you perform appropriate exercises. About 24 hours after surgery, you will probably be asked to stand. Within the next 24 hours, you will probably begin to walk a few steps with the help of a walker. You will be discharged as soon as your surgeon determined that you have recovered sufficiently. You can expect to stay in the hospital for about three days after your surgery. You may or may not be transferred to a rehabilitation facility for a few more days, as determined by your surgeon. Your bandages and sutures will usually be removed before you leave the hospital. At home, you will need to continue your exercises. Your physical therapist will instruct you about proper home care, and may continue to work with you.

How soon can I return to normal activities after surgery?
Within six weeks after surgery, most patients are able to walk with a cane. You will probably feel well enough to drive a car within seven to eight weeks after surgery.

In most cases, successful joint replacement surgery will relieve your pain and stiffness, and allow you to resume many of your normal daily activities. But even after you have fully recovered from your surgery, you will still have some restrictions. Normal daily activities do not include contact sports or activities that put excessive strain on your joints. Although your artificial joint can be replaced, a second implant is seldom as effective as the first.

How long will a joint replacement last?
Longevity of the prosthetic knee varies from patient to patient. It depends on many factors, such as a patient’s physical condition, activity level, and weight, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient’s life.

Today, total knee replacement has become a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic knee can do and how much activity it can withstand. As with any mechanical joint, the knee components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the knee joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Guide to Shoulders

Teach me a little about the shoulder.

The shoulder is a ball and socket joint. The ball portion of the joint consists of the rounded head of the upper arm bone (humerus), and the socket portion is made up of a depression (glenoid) in the shoulder blade. The humeral head (ball) fits into the glenoid (socket) creating the joint that allows you to move your shoulder. The joint is surrounded and lined by cartilage, muscles, and tendons that provide support, stability, and ease of movement.

What is range of motion?

The shoulder allows for the rotation of the arm in all directions. The range of motion is dependent on the proper articulation of the humeral head upon the glenoid (shoulder socket).

What is shoulder replacement?
In shoulder replacement surgery, the painful surfaces of the damaged shoulder are resurfaced with artificial shoulder parts. The part that replaces the ball consists of a stem with a rounded metal head. The part that replaces the socket consists of a smooth plastic concave shell that matches the round head of the ball. When both sides of the joint are resurfaced, we call it a total shoulder replacement. However, your doctor may determine that only the humeral side of the joint (ball) should be resurfaced. We call this a partial shoulder replacement.
How do I prepare for shoulder replacement surgery?
If you and your surgeon decide that total shoulder replacement is right for you, a date will be scheduled for your surgery. Several things may be necessary to prepare for surgery. For example, your surgeon might ask you to have a physical examination by your primary care physician. This will ensure that other health problems you may have, such as diabetes or high blood pressure, will be treated before surgery. Your doctor, or a staff member, will advise you about the things you can do to prepare for your hospital stay, and your rehabilitation after surgery.

The surgery will begin with an incision over the knee that will expose the joint. When the bones are fully visible to the surgeon, special, precision guides and instruments are used to remove the damaged surfaces and shape the ends of the bones to accept the implants.

The implants are then secured to the bones. It might also be necessary to adjust the ligaments that surround the knee in order to achieve the best possible knee function. When the surgeon is satisfied with the fit and function of the implants, the incision will be closed.

A special drain may be inserted into the wound to drain the fluids that naturally develop at the surgical site. A sterile bandage will then be applied, and you will be taken to the recovery room, where you will be closely monitored. Your surgery will likely take between one and three hours, depending on your individual circumstances.

As your anesthesia wears off, you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breath deeply to help clear your lungs. You will also be given pain medication. When you are fully awake, you will be taken to your hospital room. Your knee will remain swollen and tender for a few days.

What happens during shoulder replacement surgery?

One the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluid during surgery. You will then be taken to the operating room and given anesthesia. After the anesthesia takes effect, your shoulder will be scrubbed and sterilized with a special solution that removes bacteria from your skin.

The procedure is performed through an incision over the shoulder that will expose the joint. Special, precision guides and instruments will be used to cut the humeral head (ball) and prepare the bone to accept the implant. The new metal ball and stem are then inserted. If the socket is to be resurfaced, its damaged surface is smoothed and the new plastic surface is inserted. The ball and socket are then joined. When the surgeon is satisfied with the fit and function, the incision will be closed and covered with dressings. A special drain may be inserted into the wound to drain the fluids that naturally develop at the surgical site. The surgery usually takes one to three hours, although this depends on the severity of the arthritis in your shoulder.

A sterile bandage will be placed over the wound, and you will be sent to the recovery room where you will be carefully monitored. As the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. Your arm will be in a sling or brace, and it may be wrapped in an ice pack to help control pain and swelling. You will also be given pain medication. When you are fully conscious, you will be taken back to your hospital room.

What can I expect after surgery?
When you are back in your hospital room, you will begin a gentle rehabilitation program to help relax the muscles around your new shoulder. On the day of surgery you may be encouraged to get out of bed and take a few steps. You will continue to receive pain medication as needed, and your bandage will be removed about two days after surgery.

Depending on your specific situation, you will probably remain in the hospital from one to three days. Your shoulder area may be warm and tender for several weeks. Before you are dismissed from the hospital, your physical therapist will show you how to perform the rehabilitation exercises that are important for your recover.

How soon can I return to normal activities after surgery?
Successful joint replacement surgery may relieve your pain and stiffness, and may allow you to resume some of your normal daily activities as instructed by your doctor. But even after you have fully recovered from your surgery, you may still have some restrictions. Normal daily activities for shoulder replacement patients do not include contact sports “jamming” activities such as hammering, repetitive heavy lifting, or activities that put excessive strain on your shoulder. Although your artificial joint can be replaced, a second implant is seldom as successful as the first.
How long will a shoulder replacement last?

Longevity of the prosthetic shoulder varies from patient to patient. It depends on many factors, such as a patient”s physical condition and activity level, as well as the accuracy of implant placement during surgery. It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient”s life.

Today, total shoulder replacement is becoming a common and predictable procedure. Many patients enjoy relief from pain and improved function, compared to their status before surgery. As a result, some patients may have unrealistic expectations about what the prosthetic shoulder can do and how much activity it can withstand. As with any mechanical joint, the ball and socket components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the shoulder joint is used. Activities that place a lot of stress on the joint implants, as may be the case with more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components. Your doctor will be in the best position to discuss these issues with you, taking into account your particular clinical circumstances, the type of implants used, and your post-surgical lifestyle.

Diet Tips

What can I do to ensure I’m eating a balanced diet?
Physicians recommend seven basic steps for a balanced, healthy diet based on The Food Guide Pyramid developed by the U.S. Departments of Agriculture and Health and Human Services:

Eat a variety of foods
Maintain an appropriate weight
Consume fat and cholesterol in moderation
Consume sugar in moderation
Eat plenty of fresh fruits and vegetables
Use salt and sodium in moderation
Drink alcohol in moderation

Why is calcium important?
A diet low in calcium and Vitamin D increases the risk of developing osteoporosis– a condition where bones become thin and brittle. As calcium is one of the principal factors that helps the body build and maintain strong bones, not getting enough calcium may hinder bone development. Obtaining enough Vitamin D is also important because it aids in absorbing calcium from food. Vitamin D is found in foods such as fortified dairy products and in sunlight.
Arthritis in my hands makes it difficult to cook. What do you suggest?

Several things can be done to make meal preparation easier when joints are sore or swollen. Some include:

Take rests while preparing meals to give joints a break

Use convenience foods once in a while to lower the strain of cooking food

Keep common cooking utensils in an easy-to-reach place

Buy presliced and prechopped vegetables from the grocery store to eliminate work involved in slicing and dicing

Use kitchen appliances such as electric can openers and microwave ovens to ease the burden of cooking

How will losing weight help my arthritis?
Being overweight puts stress on joints, particularly the weight-bearing joints such as the knees and hips. It has a negative impact on mobility. Losing weight can be made fun by engaging in physical activity that is enjoyable. Changes in diet will probably also be necessary, but the payoff is that being at an optimal weight makes people feel happier and stronger.
How will limiting my sodium intake help my arthritis?
Sodium, common in processed, fast foods, causes water retention, as do some arthritis drugs such as corticosteroids. Your doctor may recommend a low-sodium diet for arthritis patients because water retention may cause joints to swell, sometimes restricting movement.

Helpful Exercises

Can exercise really affect my lifestyle?
Americans could significantly improve their health and quality of life by practicing some form of physical activity on a regular basis. According to the Surgeon General’s Report on Physical Activity and Health, regular, moderate physical activity is beneficial in decreasing fatigue, strengthening muscles and bones, increasing flexibility and stamina, and improving an overall sense of well-being.
Is there a specific benefit of exercise for an arthritis sufferer?

Exercise helps to:

  • Keep joints moving
  • Strengthen muscles around the joints
  • Strengthen and maintain bone and cartilage tissue
  • Improve overall ability to do everyday activities
  • Improve health and fitness by:
    • increasing energy level
    • improving sleep
    • assisting weight control
    • improving overall cardiovascular condition
    • decreasing depression
    • improving self-esteem and emotional health
What happens if I don’t exercise?
Lack of exercise contributes to:

  • Smaller and weaker muscles
  • Brittle bones
  • Pain
  • Disfigured joints that stay in one position for so long that the ability to straighten them may be lost
  • Loss of mobility in joints that may become locked in a position if they are not routinely worked
What type of exercise programs should an arthritis sufferer use?
A balanced exercise program is best. It should include a combination of the three main types of exercise:

Range-of-Motion Exercises: These are basic stretching exercises to keep joints supple and mobile by moving them in their “range-of-motion”, the normal distance joints can move in certain directions.
Strengthening Exercises: These are beneficial because they help maintain or increase muscle strength. Common ones include isometric exercises (tightening muscles without moving joints) and isotonic exercises (moving joints without strengthening muscles).
Endurance Exercises: These are beneficial because they strengthen the heart, while making the lungs more efficient and improving stamina. They also help improve sleep, weight loss and your mood. Examples are walking, cycling and swimming.

Before you begin an exercise program, you should consult a physician or a physical therapist, especially if you have not exercised in a while, have had any surgical procedures, or are over age 40.

The surgery will begin with an incision over the knee that will expose the joint. When the bones are fully visible to the surgeon, special, precision guides and instruments are used to remove the damaged surfaces and shape the ends of the bones to accept the implants.

The implants are then secured to the bones. It might also be necessary to adjust the ligaments that surround the knee in order to achieve the best possible knee function. When the surgeon is satisfied with the fit and function of the implants, the incision will be closed.

A special drain may be inserted into the wound to drain the fluids that naturally develop at the surgical site. A sterile bandage will then be applied, and you will be taken to the recovery room, where you will be closely monitored. Your surgery will likely take between one and three hours, depending on your individual circumstances.

As your anesthesia wears off, you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breath deeply to help clear your lungs. You will also be given pain medication. When you are fully awake, you will be taken to your hospital room. Your knee will remain swollen and tender for a few days.

Osteoarthritis

What is osteoarthritis?
A degenerative joint disease, osteoarthritis is one of the oldest and most common forms of arthritis. The disease causes cartilage breakdown found in joints. This breakdown removes the buffer between bones and the resulting bone against bone friction causes pain and eventual loss of movement. Symptoms include joint pain or aching (often after exercise or extended periods of pressure on weight-bearing joints) and limited or eventual loss of range of motion.
How do you get osteoarthritis?
There are a wide array of factors that cause the development and progression of the disease.

Risk factors include:

    What are treatment options?
    The treatment options for osteoarthritis include:

    • Joint and muscle exercises to improve strength and flexibility
    • Weight management to relieve stress on weight-bearing joints
    • Anti-inflammatory drugs for degenerative joint disorders
    • Heat/Cold therapies
    • Synovectomy (surgical removal of inflamed synovial tissue)
      Osteotomy (restructuring of the bones to shift stresses from diseased to more healthy tissue)
      Partial knee replacements (unicompartmental knee – replaces only diseased portion of the joint)
      Total knee replacement (used when severe osteoarthritis is present)

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