MRI Can Spot Early Signs of Knee Arthritis: Study

WEDNESDAY Dec. 2, 2015, 2015 -- MRIs can spot the warning signs of knee osteoarthritis in people who have normal X-rays, researchers report.

They looked at 849 people, average age of 60, who showed no evidence of arthritis in either knee in X-rays. They were deemed at high risk due to factors such as being overweight or having a history of knee injuries.

The Northwestern University team also assessed cartilage damage, bone marrow lesions and meniscus tears on MRI images taken three years apart. If the MRIs showed worsening damage during that time, the patients were at increased risk of developing knee arthritis or symptoms such as pain, stiffness and/or swelling.

Depending on the type of lesion revealed by MRI, the risk of developing knee arthritis within three years was three to 20 times greater, the researchers said.

"These worsening lesions are an early warning sign and an opportunity to intervene before a person develops the debilitating disease," lead investigator Dr. Leena Sharma, a rheumatologist and professor of medicine, said in a university news release.

"If we employ aggressive prevention strategies in persons with these lesions before they develop knee osteoarthritis, we may be able to delay disease development or alter its course," she added.

Those preventive measures include weight control and avoiding potentially harmful physical activity.

Anesthesia for Orthopedic Surgery

When people think of surgical anesthesia, they typically think of general anesthesia. However, local anesthesia can block sensation to a smaller area for the purposes of surgery or other medical procedures. Both general and local anesthesia can be used for orthopedic surgeries and are described below.

People who smoke, abuse alcohol, or have other medical conditions are at a greater risk of complications regarding anesthesia. Patients concerned about their individual risks should talk to their doctor.

General Anesthesia

Typically, general anesthesia is administered through a needle in the vein of the patient’s arm. The patient is rendered unconscious—often referred to as being “put to sleep”—and does not feel pain. Patients under general anesthesia are closely monitored for changes in blood pressure, heart rate, and breathing.

Sometimes a patient can choose whether to have general or local anesthesia during surgery, but often the medical needs of their procedure dictate this choice.

Local (or Regional) Anesthesia

This type of anesthesia can be used instead of or in combination with general anesthesia. There are two types of regional anesthesia:

• Spinal and epidural anesthesia techniques anesthetize the entire lower half of the body. The anesthesia is administered between vertebrae and affects the spinal cord. Spinal anesthesia is administered with a needle and goes into the fluid that surrounds the spinal cord. Epidural anesthesia is administered continuously through a catheter into the outermost area of the spinal canal, known as the epidural space. People are most familiar with the epidural technique because of its frequent use in childbirth.

• Peripheral nerve blocks target the specific limb on which the surgeon is operating. This approach can stop sensation at the nerve roots, where nerves branch off from the spinal cord. For example, a nerve block may be administered to the lumbar plexus—a group of nerves that emerge through the lumbar spine and provide sensation to a leg—for a hip replacement.
Peripheral nerve blocks have become more common in recent years as medical technology has made them more precise and reliable.
 A peripheral nerve block can be administered before surgery and used in combination with general      anesthesia. Local anesthesia may be used for a brief time following surgery. This allows a patient to emerge from general anesthesia and regain consciousness without pain.

  

Patient-controlled Intravenous Analgesia

Pain must be controlled following surgery. Post-surgical pain differs from patient to patient. To account for these pain variations, hospital patients are sometimes given control of their own pain medication. The patient presses a button on a patient-controlled analgesia (PCA) pump, which then administers analgesia through an IV. The pump is programmed to deliver doses specific to the patient, so there is no risk of overdose.

Stress Fracture

Stress fractures are small breaks in a bone that occur due to overuse or repeated application of force to a particular bone. It is commonly seen in the bones of the lower limbs in sports persons or military recruits.

Normally, a fracture occurs following an obvious trauma to the bone. However, in the case of stress fracture, an obvious trauma is absent. Normal human bones continuously undergo a process of remodeling. In this process, any small damage that occurs to the bone is replaced by new bone, thus maintaining the normal structure as far as possible. In some people like athletes who undergo rigorous workouts, the bones especially of the lower limbs do not get enough time to rest and repair. This results in the formation of small cracks in bones that are subject to extreme stress, resulting in a stress fracture. The occurrence of a stress fracture may be favored by the presence of predisposing factors like osteoporosis or hormonal issues that may further weaken the bone.

Like other fractures, symptoms of stress fractures include pain, tenderness and swelling in the affected area. The pain increases when additional stress is applied to the part and may be relieved with rest.

Stress fractures are diagnosed using imaging tests like MRI and bone scans. The patient is treated with resting the affected part and painkillers. Surgery may be required in some cases.

What are the Causes of Stress Fractures?

Intense physical activity or improper exercise techniques are the common reasons for the appearance of a stress fracture.

Causes of stress fractures include:

• Rigorous physical activity without adequate intervening rest periods
• Prolonged periods of stress on a particular bone
• Use of improper equipment or lack of good training while exercising or participating in sports
• Excessive weight-bearing activities

Knee Strengthening Exercises to Try at Home !!

Knee pain is one of the most common complaints heard by doctors, and it can be an impediment to a healthy and active lifestyle. There can be a wide variety of causes including cartilage tears, ligament injuries or arthritis. The best way to repair knee injuries and prevent future injuries from occurring is by strengthening the muscles that support the knee. Try the following exercises, which can all be done in the comfort of your own home:

Straight Leg Lift

This exercise will strengthen the muscles in the front of your thighs. Lie flat with one leg straight in front of you and the other leg bent. Using your thigh muscles, slowly lift your straight leg until your foot is 12 inches above the floor. Hold that position for 5 seconds, then slowly lower your leg back to the floor. Continue for 15-30 repetitions, increasing the reps as you gain strength over time. Then, switch legs and do the same for the other side.

Leg Dips

This exercise will strengthen your thighs, hamstrings and glutes. Stand between two chairs placed with their backs toward you. Holding onto the backs of the chairs for balance, plant your weight on one leg and lift your other leg slightly in front of you. Slowly bend the knee of your weight-bearing foot to lower yourself down a few inches, pushing your weight onto your heel. Hold for 5 seconds, and then slowly straighten back up. Switch sides and do the same on the other leg. We suggest doing 15 repetitions per leg.

Leg Raises

This exercise strengthens your quads and hamstrings and increases knee mobility. Sit on a firm chair with your feet on the floor and your knees bent at a 90-degree angle. Slowly lift one foot off the ground and raise it straight in front of you. Hold for 5 seconds and then slowly lower. Continue for 10 repetitions, then switch legs and do the same for the other side. As your strength increases, consider adding ankle weights.

Upcoming Joint Replacement Surgery? Your 13 Most Common Questions Answered.

Q: Joint Replacements: What Are the Basics?

A: If you've decided to have a joint replacement, you probably have many questions. But you need answers, so you can get back to your activities and life! First, the basics: in joint replacement surgery part of your arthritic or damaged joint is removed and replaced with a metal, plastic or ceramic device called prosthesis. The prosthesis is designed to replicate the glide of a healthy joint. Joint replacement surgeries are common and occurring in younger patients; in 2011, almost 1 million total joint replacements were performed; most commonly the hip and knee. Other joints, such as the ankle, wrist, shoulder and elbow can be replaced too.

Q: Why Do I Need A Joint Replacement?

A: Dealing with the pain of a worn down or injured hip or knee joint can take its toll. It's physically and mentally draining to deal with the constant ache and avoid daily activities. Joint replacement surgery involves removing the damaged joint and replacing it with new, shiny parts. It's a fairly common surgery, so you may know others who have had these operations. Reasons for joint replacement include:

• ·         Joint pain, stiffness due to arthritis
• ·         Negative affect on quality of life
• ·         Bone damage from accident or injury
• ·         Medical treatment failure
• ·         Joint deformity

Q: What's Involved In Hip Replacement Surgery?

A: You'll arrive at the surgery center, most likely early in the morning for a hip replacement. You are usually given a general anesthetic and spinal or local pain medication to keep you asleep and control pain. An incision is made into the skin and through the muscles to reach the hip joint. The diseased bone and cartilage are removed, but the healthy parts of the joint are left intact. The surgeon replaces the head of the femur (thigh bone) and hip socket (acetabulum) with new, artificial parts. These new parts allow a more natural gliding motion of the joint. The surgery usually lasts 2 to 3 hours, but varies. You'll stay in the hospital for a few days, most likely.

Q: What's Involved With a Knee Replacement?

A: With a knee replacement, the surgeon will remove the damaged knee joint and resurface the knee joint with a piece made of metal and plastic. The new joint is attached to the intact bone with surgical cement, or it may also contain uncemented pieces, which grows to a porous surface on the bone. The replacement joint is usually made of 3 components: 1. tibial (shin bone) component; 2. femoral (thigh bone) component; 3. a patellar (kneecap) component which prevents the kneecap from rubbing against the thighbone. Surgery can last 1-3 hours; you'll be in the hospital for 1-3 days but may be a candidate for outpatient surgery, too.

Q: How Will A New Joint Affect Me?

A: Each person has an individual response to surgery. Most have a successful procedure and their quality of life will be greatly enhanced. Follow all your doctor's directions; including physical therapy, medicines, diet, and at-home exercise programs. Possible complications of a new joint may include infection, blood clots, dislocation, wear and tear, joint loosening, and infrequently, nerve damage. Medicines like antibiotics can be used for infections, and blood thinners are given for blood clots. Most new joints typically last 10 to 15 years, so if you are younger when you have your surgery you may need more than one replacement.

Q: What Happens After Surgery?

A: Your care team at the hospital will have you up and moving your new joint the next day after surgery. Physical therapy will focus on range of motion and strengthening exercises. You will need support at first, like a parallel bar, walker, cane, or crutches to help support your full weight. You are given pain control medications to help with physical therapy, so don't be too worried about that. After surgery it's often easier to prevent pain than treat it after its set in, so request analgesia at the first sign of pain. In 2 to 5 days, you may go home if you have help, or to an extended care facility to re-learn your daily activities like bathing and dressing. You may also have several months of outpatient physical therapy to strengthen your surrounding muscles.

Q: What Other Options Do I Have?

A: If you have an upcoming hip or knee joint replacement, you've probably tried other options first. Over-the-counter (OTC) anti-inflammatory medicines like NSAIDs are usually initial therapy, and local corticosteroid or lubricating shots may provide relief. Physical therapy, walking aids such as braces or canes, and periods of rest may be tried. However, you may get to the point that you can't do regular activities, like bathing, walking upstairs, or even walking down the block. It's at this point that your doctor may recommend consultation with an orthopedic surgeon for evaluation, if you also agree to surgery as a possible solution.

Q: What about A Minimally Invasive Procedure?

A: Minimally invasive surgery uses a smaller incision and can result in less post-operative pain, a shorter recovery time, and a smaller scar. This kind of surgery often requires special equipment not available in all hospitals. Unfortunately not everyone is a candidate for minimally invasive joint replacements. In general, candidates for minimal incision procedures are younger, healthier, not overweight, and more motivated to participate in the rehabilitation process. Ask your surgeon if you are a candidate, if minimally invasive procedures are available in your area, and if there are doctors that are trained in this special procedure.

Q: How Is Pain Managed After Joint Replacement Surgery?

A: Rest assured that every effort will be made to control your post-operative pain. Treating your pain will allow you to more easily start your rehabilitation program, too, which will speed you to your full recovery. Pain management may include:

• ·         IV or oral opioids (like morphine, meperidine), also used in patient-controlled analgesia
• ·         Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen and diclofenac
• ·         Acetaminophen (Tylenol)
• ·         Local anesthetics like lidocaine, bupivacaine, and ropivacaine; may be used in epidural anesthesia.

Q: Should I Be Concerned About Possible Blood Clots?

A: One of the major risks with any surgery, but especially joint replacement, is a clot formation, either a deep vein thrombosis (DVT) or a pulmonary embolism (PE). A DVT is the formation of a clot in a deep vein, often in the leg. A PE is a clot that travels to the lungs and blocks the flow of blood to the lungs and heart. To help prevent a clot, your doctor will prescribe ways to lower your risk:

• ·         Exercises to improve circulation
• ·         Elevation of limbs
• ·         Pneumatic compression and compression stockings
• ·         Medications known as anticoagulants (blood thinners)

Q: What Are Anticoagulants?

A: Your doctor will decide which blood thinner will best protect you from a clot, but how do these drugs work? Anticoagulants don't actually "thin your blood" but block certain coagulating factors that promote blood clotting. Be sure you understand the safe use of your blood thinner by discussing with your doctor and pharmacist, as your risk of bleeding in general will be increased while taking these medications. Depending upon the drug, they can be given either by injection or in an oral pill.

• ·         Coumarins like warfarin
• ·         Low molecular weight heparins like enoxaparin
• ·         Factor Xa inhibitors like Arixtra, Eliquis, or Xarelto

Q: I Wonder What Others Have Experienced.

A: Group support is a great way to gain confidence prior to surgery. Joining the Drugs.com Hip Replacement Support Group or the Knee Replacement Support Group is a great way to discover others with related questions and similar concerns, to read news, and share your own experience. Maybe you have questions about how the stairs or bathing are handled. What are some useful ways to spend your recovery time at home? Do you have questions about medication costs or insurance coverage? Any of these topics can be fair game. But remember, your healthcare provider is always the best source for individual medical and drug information.

Q: Your Job? Ask Even More Questions.

A: Having joint replacement surgery requires preparation. Open communication with your doctor is very important to ensure success. Consider taking a family member or friend to your appointments to lend a hand, provide morale support, and help record answers to questions such as:

·         How do I prevent the most common complications?

·         If I don't have surgery, what is the risk?

·         What will be my restrictions, if any, after I recover?

·         How will my pain be managed?

·         How can I contact you after surgery for an emergency?