Falls Archives

Treatment Options for Knee Arthritis

Last month I attended a lecture titled, “State-of-the-art Treatment Options for Knee Arthritis” given by orthopedic surgeon, M. Mike Malek, MD at the Inova Fairfax Hospital. If you suffer from chronic knee pain or osteoarthritis of the knee, then this lecture provided pertinent information.

Dr. Malek first explained that this did not include rheumatoid arthritis which is a systemic disease. Osteoarthritis is a joint problem and a wear and tear problem. It is a degenerative problem that becomes arthritis. Part of osteoarthritis could be genetic and part of it is acquired. The knee is the least protected joint in the body and the most commonly injured.

As a wear and tear problem, the surfaces of the knee become pitted, eroded, uneven, and painful. This has to go on for 18 to 24 months before showing any changes on an x-ray.

Osteoarthritis symptoms include:

  • Pain
  • Loss of range of movement
    • Going up and down stairs
    • Unable to get off the toilet seat or couch
    • Night pain and stiffness
    • All day and night pain and stiffness

Causes include the following:

  • Excessive wear — weight is a major problem
  • Sport injury
  • Age
  • Obesity
  • Deformity — bow leggedness makes it worse
  • Work-related injury
  • Major trauma
  • Weak quadriceps
  • Lack of vitamin D

There is no laboratory test for osteoarthritis. There are 208 joints in the body and any joint can be affected, but the knee is the most common.

What are your treatment options?

  • Activity modification (One person said he’s a runner and he has knee problems. Dr. Malek said to find something else).
  • Physical therapy
  • Anti-inflammatories (NSAID) (Everything has side effects).
  • Cortisone injections
  • Visco supplementation (Joint fluid therapy — hyaluronic acid — something your knee produces).
    • There are five companies in the US that use rooster combs
    • Euflexxa is the only one that’s synthetic
  • PRP (protein-rich plasma)
    • Your own blood is taken and the Growth Factor is injected back
    • Athletes get on a regular basis
    • Makes healing faster
  • Bracing — customized about $1,200
  • Arthroscopy with or without HTO (High Tibial Osteotomy)
  • Arthroplasty — open surgery

With a knee replacement you will never have the full range of motion. Unicondylar knee replacement is a possibility for bowed legs. Only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement.

The bottom line is your age, activity, use, and abuse of your knee will determine the length of how long your knee will last. However, you have a variety of treatment options for knee arthritis. Remember that nothing will last forever, not even knee replacement surgery. For more information, check out Dr. Malek’s Web site: http://kneesurgeryfairfax.com or http://kneeman.com.

See also a post I wrote last month about arthroscopic knee surgery.

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Arthroscopic Knee Surgery

A couple of weeks ago, I had arthroscopic knee surgery because of a fall more than a dozen years ago. It was partially exploratory to determine the next step as well as to “clean it up.” The next two weeks will determine my options, but total knee replacement is not necessary.

In order to go through this surgery, I had to get a second opinion and while the second doctor determined that surgery is necessary, it was his opinion that a total knee replacement should be considered “just in case” I might need one down the road. On the other hand, my world-renowned knee specialist said you never replace anything that’s in good condition and basically, other than my knee cap, my knee is in very good condition. But the most important lesson in this is to prevent falls in the first place and to prevent arthritis from creeping in.

Fitness expert Sonia Gow, in a previous post, shared her expertise about why people fall. She mentioned that falls are not a normal part of aging.

Did you know that falls are a leading cause of hospital admissions for people over 65? For those over 65, one in three will experience a fall each year. According to the Centers for Disease Control and Prevention, 20 to 30 percent of the falls result in injuries such as lacerations, hip fractures, and head traumas with hospital bills averaging nearly $18,000 per patient.

According to Mary Tinetti, M.D., professor of internal medicine at the Yale School of Medicine, the more chronic health conditions you have, the more likely you are to suffer a fall.

  • Diabetes can worsen vision and desensitize nerves in the feet.
  • Depression can increase risk of falling.
  • Many medications cause dizziness and affect balance, especially sleep aids.

Other diseases causing a higher rate of falls include:

  • Circulatory disease
  • Chronic obstructive pulmonary disease
  • Arthritis

Yoga and tai chi which has slow, rhythmic movements can help you with your balance. Don’t forget to strengthen your arms too since you can use them to steady yourself. Find a personal trainer or borrow/buy a DVD to help you.

How Long Will You Live?

Here’s an eye-opener if you want to know how long you’ll live: find out how fast you walk. I want to share an article from the January 2011 issue of Consumer Reports on Health.

Your walking speed and ability to rise from a chair are surprisingly effective at predicting your longevity. In a study of more than 3,000 healthy retirees, for example, those with the slowest gait were about 50 percent more likely to die within seven years. Take these tests to see how you compare.

Walking Speed: In a hallway, mark start and finish lines six meters (19 feet, 8 inches) apart. Have a partner time you. Walk briskly but don’t run, and stride past the finish line without slowing. Divide the time in seconds by six to get meters per second. Average: 0.9 meters per second for people over 50.

One-Leg Balance: With bare feet, stand with your arms folded across your chest. Raise one foot slightly off the ground and have someone start a stopwatch, stopping when you uncross your arms, move the leg you’re standing on, or touch the raised foot to the floor. (Stand next to a counter or piece of furniture). Average: 43 seconds for 18- to 39-year olds; 40 seconds for 40- to 49-year olds; 37 seconds for 50- to 59-year olds; and 27 seconds for 60- to 69-year olds. (With eyes closed: 9 seconds for 18- to 39-year olds; 7 seconds for 40- to 49-year olds; 5 seconds for 50- to 59 -year olds; and less than 3 seconds for those older than 60).

Chair Stands (for people 70 and older): Stand up from a chair five times in a row as quickly as possible without stopping. Keep your arms folded across your chest, come to a full standing position each time, and sit all the way down each time. The clock should be stopped when your bottom hits the seat the fifth time. Average: 14.28 seconds for women and men.

Sit-ups (for people younger than 70): Lie on your back with your knees bent at a right angle and your feet flat on the floor. Place your hands palms down on the ground next to your body, and with your lower back kept flat on the ground, curl up your shoulders so your fingers slide forward about 3.5 inches, then return your shoulders to the floor. Count the number you can complete in one minute. Averages for women: 25 for women 40 to 49; 31 for those 50 to 59; and 12 for those 60 to 69. Averages for men: 33 for men 40 to 49; 39 for those 50 to 59; and 18 for those 60 to 69.

Practice makes perfect so if these exercises can determine how long you will live and you want to live a long life, it’s time to get moving! A long life to all of you.

St. Mark's Lutheran Church, Springfield, Virginia

In the Metropolitan Washington DC area where I reside, there are many “senior fairs” being held. Last week I attended the Senior Caregiver Forum and Panel Discussion at the Life Center at St. Mark’s Lutheran Church in Springfield, Va. It was their first such event and open to the entire community. I went at the invitation of a friend and I’m glad I did. I left with a wealth of information.

An excellent panel consisting of representatives of the private sector as well as the local government presented valuable information. When the moderator surveyed the audience to see if they had learned something, it appeared that every hand went up.

On the panel were Jean Galloway Ball  (www.elderlaw.com), Barbara Sullivan of Silver Age, LLC, Jennifer Edge of Elderlink/Fairfax County’s Area Agency on Aging and coordinator of Fairfax County’s “Independent Living Project,” and Jeanna Muhoro of the Fairfax County Department of Transportation and transportation specialist for older adults and those with disabilities.

Senior Caregiver Forum & Panel Discussion

It’s not possible to present all that I learned, but I left feeling that we are very fortunate to have an abundance of resources in our community. One of the outstanding resources in Fairfax County is their Independent Living Project. In 2009 it won the Best Practices in Education Award from the Commonwealth Council on Aging and in 2010 it received the Injury Prevention Recognition Award from the Virginia Department of Health. The goal of the program is to help older adults and adults with disabilities stay in their homes and remain independent. It is a program consisting of workshops and classes in a myriad of areas including:

  • Exercise classes
  • Workshops on fall prevention, brain fitness, nutrition, etc.
  • Medication management

Additionally, they offer in-home consultations to identify safety risks and free minor home safety modifications such as grab bars. Click here for more information and once you get to the Web site, click on Events.

Another program that I had not even heard of is Fairfax County’s You Can! Live Well, Virginia! It is a program developed by Stanford University designed for adults with chronic health conditions where they learn to manage their illness and live well. As a wellness advocate, I was very excited to hear about such a program and look forward to learning more about it.

I encourage you to attend any senior fair that might be in your area or research the resources available to you as a senior. You might be amazed at what’s out there.

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