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When Should I Have My Knee Replaced?
Why you should have your knee replaced is almost always a straightforward matter: to eliminate pain and to improve your quality of life. However, owing to our active lifestyles and unique backgrounds, the question of when to opt for knee replacement surgery can be a little tougher to discern.Rather than waiting for your knee to give you a painful prompt, you might first ask yourself what you want to get out of a knee replacement. Some people are willing to forgo joint-intensive sports like running and tennis, so they can hold off on replacement surgery in the short-term. Others, however, would rather lick a newt than take a break from the courts, so they opt for a knee replacement earlier in life.
Knee replacements should have a life span of at least 15 – 20 years; at that point about 85-90% are still in great condition. Individuals who opt for an early knee replacement—i.e., someone still in their fifties—will likely require another replacement procedure down the road. If that’s a factor in your decision, then it’s worth considering that individuals who receive a new knee in their seventies can expect the prosthesis to last a lifetime.
There are, however, other factors that everyone should consider when thinking about a knee replacement procedure. If you have a history of diabetes, hypertension, or heart disease, then it is recommended you might want to have the surgery before these issues progress and make surgery more risky.
Similarly, obese individuals should consider weight loss programs and then have their knee replacements done earlier to prevent complications that can arise during surgery and also enable them to get active and keep weight off.
Amid all of our varied lifestyles and personal histories there’s one thing that certainly does not matter: the type, or brand, of knee replacement. There are lots of different knee replacements, but they’re all pretty much the same. If there is a best type, then it’s the one that your surgeon is most comfortable with. Just like a chauffeur who drives a BMW every day, he simply knows his BMW better than a fellow chauffeur knows his Mercedes. In the end, they’re both luxury cars. So it is with knee replacements.
And just as a chauffeur knows how to maintain his car’s performance so too should you be nice to your knee; so don’t ever think of treating it like a jalopy.
In short, if you live an active lifestyle and wish to keep it that way, then consider having a conversation with your orthopedist and primary care doctor when you’re still in your fifties, sixties, seventies or even eighties! Regardless of your age, if you have any questions and would like to chat over the possibilities with one of our orthopedists, call or email us today and make an appointment.
A Home Run for A-Rod’s Hip
Baseball star Alex Rodriguez, known to New York Yankee fans as A-Rod, is in the news again. This time around it s not because of his exploits on or off the field, but because of his experiences in the operating room. Just last month, the sports pages reported that A-Rod is planning to undergo arthroscopic surgery at the hip to address a torn labrum. This will be his second surgery.What’s amazing is that despite surgery, he’s expected to be back in full action by mid-summer of next year. How is that even possible for an athlete pushing 40? The answer lies in the non-invasive surgical technique known as arthroscopic surgery.
Readers of this space may know that arthroscopic surgery involves a camera and a couple of small incisions. Knee arthroscopy has been around for decades, but only recently has hip arthroscopy become more widespread. The benefit is that the technique is minimally invasive and allows for faster recovery times than traditional methods.
Hip arthroscopy is the method of choice for repairing labrum tears. The labrum is the soft tissue bumper that encircles the socket of the ball-in-socket hip joint. Labrum tears can cause reduced athletic performance and lead to varying levels of discomfort. If you’ve ever experience a torn labrum, you know something’s wrong but you may not know what, exactly, is the problem.In fact, A-Rod had the same issue when doctors were initially trying to diagnose what was sapping his performance near the end of the recent season. An MRI of his hip revealed the labrum injury.
There are two ways the labrum can become injured: it can either fray or tear. A frayed labrum occurs from repeated strains and the normal wear of physical activity. Torn labrums are usually the result of some sort of trauma, be it a hyperextension of the hip joint or a bad fall. The sensitive imaging techniques of MRIs allow doctors to diagnose these slight injuries and then recommend a course of treatment.The first-line treatment for labrum tear is physical therapy, which can help strengthen the surrounding muscles and tissue to allow the body to compensate for small tears. If there’s still pain, however, arthroscopic surgery may be recommended. The good news is that arthroscopic surgery is a same-day procedure, meaning you’re in and out of the hospital on the same day. Recovery can take some time, but using A-Rod as an example, you can get back to high-level activity within about 6 months—and that’s a timeline for a professional athlete. The weekend warrior could get back to normal workouts in about half that.
If you have a nagging hip injury that hasn’t gotten better for some time, then it’s a good idea to come on down and let us check it out. Even if you’re not A-Rod, we can still make sure you’re back to peak condition and rounding the bases for the company baseball team.That’s something to cheer about.
Running the Town: Training for the NYC Marathon
The diaspora and excitement of New York City’s marathon has turned the first Sunday in November into an annual 5-borough tribute to the sport of running. Runners need not be reminded about properly training for a marathon, yet every year we see hundreds of runner-related issues, and would you believe that 90% of these injuries are due to the increased volume in training in advance of the marathon?What we commonly find are overuse injuries arising from the microscopic strains and tears on soft tissue and bone. A classic overuse injury is the runner’s knee, often caused by too much pressure on the kneecap. As runners ramp up the distance or speed of their training runs, the tissue surrounding the kneecap undergoes a considerable amount of stress because of its central role in anchoring the large muscles of the quadriceps.
Runner’s knee can be a road bump in a training regime, but that’s all it ever should be. Icing your knee and taking anti-inflammatory medicine should be enough to get you back to light exercise, but if the pain persists your orthopedist may recommend some form of physical therapy.
But what about the 10% of runners whose injuries aren’t caused by overuse? Overuse injuries are often aches that go away after about 15 minutes into a jog. If, however, the pain increases throughout one’s run, then it is likely a more serious injury to the underlying tissue. These injuries can creep into one’s daily life. Climbing stairs is painful; sitting and standing becomes an achy chore. These injuries can range from torn ligaments or tendons to stress fractures and should be addressed by your orthopedist at once, especially before any more marathon training.
That brings us to the question of whether you can continue to work out while experiencing one of the above symptoms. The answer ought to be self-explanatory, but if there is ever any doubt it’s best to take a break no matter what and do the proper stretching and icing regime.
What about shoes? We’ve said it before, but the quality of one’s shoes plays an outsized role in keeping your legs in top shape because fresh shoes with the right fit go a long way in preventing overuse injuries.
While training for a marathon, give yourself a minimum of four months in which to prepare, and try not to increase your mileage more than 10% per week. A few smart steps, both physically and mentally, can go a long way to having an injury-free New York City marathon.
But even the best preparation can’t always prevent a few small aches here and there—Manhattan Orthopedic and Sports Medical Group wants to help you in the long run, whether it’s a marathon or a quick lap around the park, we’re here to make sure you keep running.
And running.
And running.
Injuries of a Certain Age: Labrum Tears vs. Rotator Cuffs
For those of us with a few gray hairs, it’s about now in the middle of the summer that all those pickup games from May and June are starting to show their wear. An ache in the knee or a pulled bicep; these are pretty normal for an older sportsman on the weekend pitch. As frustrating as these injuries are, the real rub is how your kids can go full speed all summer long without some nagging pain to remind them of their age.
The tortoise did beat the hare, however, so a little insight into what type of injuries we get at different ages will hopefully lead to a longer and stronger summer season. The most important place to start is with conditioning. Gentle stretching goes along with any type of cardiovascular as a good base, but with games like softball or tennis, resting and icing your favored arm will help you recover faster and guard against the chance of future strains.
Once you start to hit middle age, those strains become measurable. The effects of age on the body are such that older athletes tend to experience bursitis and rotator cuff injuries at a much higher rate than their younger counterparts. Comparatively, younger athletes are affected by injuries such as labrum tears and other such trauma; in other words, there’s usually no doubt about the injury.
The good news is that as long as we stay fit at any age, we can usually sweat the small stuff out with some rest and ice. But as we get older, the small stuff should still be watched. Amazingly, it’s been found that 10% of patients 50 years and older have rotator tears—and most don’t’ even realize it. At 60 years old, that percentage goes up 20%. And at 70 years old, the percentage of people with rotator cuff injuries rises to an astounding 40%.
When a pain persists, it’s always best to see your doctor. If it’s a rotator cuff injury, a quick cortisone shot will sometimes be prescribed for the short term, while some form of physical therapy can provide for a lasting recovery. And while it’s never good to be out of the game, the recovery from a rotator cuff strain or inflamed bursa takes about as long as the recovery of a labrum tear, which often requires MRI’s, therapy, and sometimes surgery. The recovery from a full rotator cuff tear that requires surgery will put you out of the whole season.Staying fit and watching those aches goes a long way to staying in the game, so know your limits. Lamenting the young for their youth is as old as the hills, but that doesn’t mean you can’t compete.
ACL: A Celebrity Ligament
When it comes to celebrity injuries, few make the headlines as often or as loudly as an ACL tear. SportsCenter does its part by looping the replays to catastrophic effect, yet it’s the ensuing months of surgery and absence that does its part to turn ACL injuries into the storyline of the teams we follow and the players we watch.
When Tom Brady tore his ACL at the start of the 2008 season, the news reverberated across the NFL, spawning hundreds of articles and countless hours of pundits trying to parse the fallout. For a more recent example we turn to Derrick Rose of the Chicago Bulls. Rose tore his ACL on nothing more than a routine play, but a quick Google search shows over 100,000 results.With all this focus on ACL tears, you’d expect a little more discussion as to whom this particular injury affects and why. We can start by pointing to the types of sports played by Messrs. Brady and Rose. Football, basketball or any sport requiring sharp pivoting motions on the knee place an athlete at risk for an ACL tear. In the classic ACL tear, an athlete plants his foot into the ground and then pivots his knee in the opposite direction, wrenching the knee ligament.
That explains why ACL tears are more common in football and basketball than cycling or running. When the knee is used in an “in-line” motion, little stress is placed upon the ACL. This isn’t to say that certain athletes are exempt from ACL tears; but regardless of the sport there are certain steps one can take to minimize the chance of an ACL injury.
Stretching and lower body exercises are the most effective ways to lower one’s chances of an ACL tear, period. The ACL is an acronym for the Anterior Cruciate Ligament, a ligament that runs diagonally through the center of the knee, stabilizing the knee by connecting the femur to the tibia. Strengthening the muscles that surround the ligament allows for greater stability when dealing with the stresses of sport.There’s no way to fully prevent an ACL tear, so don’t despair if it ever happens to you. Pro athletes often rely on surgery and physical therapy to get them back to peak physical condition. Competitive recreational athletes may also choose surgery if they wish to return to the most demanding sports. For others, surgery may not always be the best option. There are still many exercises and activities one can do with a torn ACL, so before you make any decisions talk to your doctor and figure out what’s best for you. It may make the headlines, but an ACL tear won’t sideline the weekend warrior for long.
A Pitcher of Health: Injury Prevention in Little League
Spring heralds the start of the baseball season—or is it the other way around? Either way, the diamonds are filling up with millions of little leaguers as the new season starts after a long winter. These first few weeks are of particular import because of the new strains on young athletes after the off-season. Little League injuries can be as stressful for parents as they are for their children, so we’d like to offer some background as well as a few tips on how to prevent injury in one of the most injury-prone positions on any baseball team: The pitcher.
So Cool: Skiing, Snowboarding and Safety
Feel that chill? For some, fall is just a precursor to the joys of winding down the slopes on the opening weekend of their favorite ski resort. That’s why getting the most out of a quick trip to the mountains means getting prepared now through exercise and the proper equipment. Read more…
Fall’s Well that Ends Well: Prepping for Winter’s Workouts
The muggy heat of summer is not over yet, but if you’ve taken full advantage of the outdoors this year you might be feeling a season’s worth of activity starting to take its toll. You may not know this, but normal wear and tear is what helps build muscle and strengthen our tendons and ligaments. After a long summer of pick-up games and outdoor pursuits, now may be the time to take a moment to relax, both physically and mentally. Read more…
Outlasting the Aging Process: Strategies for Long-Term Knee Health
Advances in orthopedic medicine, sports sciences, and physical therapy have allowed for sustained, active lifestyles that only keep us healthier and heartier as we swim, bike, volley and swing our way into retirement. In particular, there has never been a better time for knees.
Keeping your knees healthy begins with maintaining motion and strength through regular exercise. The catch-22, however, is that the more we exercise, the more wear and tear builds up, leading to arthritis. Read more…
Shouldering the Burden: The Other Tennis Elbow
Tennis season is undeniably underway for those of us who dust off our rackets when the weather hits 75 degrees. We’ve all heard of tennis elbow, but the muscles and tendons of the shoulder are just as susceptible to inflammation and pain as the elbow. Even if it’s just a light rally with a friend, your swings make repeated demands on the tissue in your shoulder and can cause injury through overuse; the result: tendinitis.
The two most common shoulder injuries for tennis players are tendinitis and bursitis. Bursitis affects the tiny fluid-filled bursa that provides a cushion between the bones and tendons around a joint. Tendinitis is a result of inflammation and damage to the tendons. Read more…
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