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Ask the Hip&Knee Surgeon

Online Health Chat with Carlos Higuera Rueda, MD

August 12, 2013


Description

Chronic hip or knee pain can change your life by limiting your ability to walk, sit comfortably, exercise or perform normal daily activities. Pain in the hip can be caused by osteoarthritis, bursitis or hip fractures, while pain of the knee can occur from tendonitis, ligament tears or osteoarthritis among other diagnoses. Normal aging also affects your joints. If a hip fracture is severe enough, especially if it is present along with osteoarthritis, your physician may suggest a hip replacement. A knee replacement, similarly, may be recommended in those with severe medical conditions—particularly if it results in bone on bone wear without cushioning.

When hip and knee pain interferes with your ability to move and live comfortably, it’s time to seek medical advice for a diagnosis, and to discuss your treatment options.


About the Speaker

Carlos Higuera Rueda, MD, is an associate staff orthopaedic surgeon in the Orthopaedics and Rheumatology Institute at Cleveland Clinic. Dr. Higuera specializes in hip and knee replacement surgery, hip muscle-sparing techniques, clinical outcomes research and predictive modeling.

Dr. Higuera completed his adult reconstructive orthopaedics fellowship at Thomas Jefferson University Hospital in Philadelphia and a biomechanics research fellowship at Johns Hopkins University School of Medicine in Baltimore. He completed his residency in orthopaedic surgery and his general surgery internship at Cleveland Clinic. Dr. Higuera graduated from Pontificia Universidad Javeriana School of Medicine in Bogota, Columbia.


Let’s Chat About Hip and Knee Surgery


Hip Symptoms

WN: Can groin pain be an indicator of a hip problem?

Carlos_Higuera,_MD: Yes, you should have a physical examination and x-rays of the hips to confirm that the pain is really coming from the hips. There are multiple other causes of groin pain including inguinal hernias.

jimlu800: Is there any other way to treat severe hip joint arthritis if there is not much groin pain?

Carlos_Higuera,_MD: The pain of hip osteoarthritis can be in the groin or buttocks. Evaluating your x-rays will be helpful to establish what type of pathology you have on the affected hip.

ChuckMax: I have started to have pain in my left hip area, specifically where a man would carry his wallet. This is where I have carried my wallet for 45 years. Now I have serious pain in that area and going down my left leg. The pain prevents me from walking any distance other around the house. Now I am not doing my morning walks. Do you think carrying my wallet there and sitting on it for so many years has or could have caused a problem?

Carlos_Higuera,_MD: Yes, it may have irritated your piriformis muscle and, therefore, your sciatic nerve. You need to stop carrying your wallet in that pocket. However, you need an evaluation with x-rays and physical exam to confirm that this is the source of your problems.

Sans2: I had X-Stop® spinal surgery (minimally invasive back surgery for lumbar stenosis) on July 1 that reduced some of my back pain, but I am still having severe pain in my left hip and leg. X-rays that were taken three weeks after surgery did not show arthritis, but some small spurs. Is it normal to have this much pain after six weeks, and what other treatment would be available? I take anti-inflammatory medications and I was given a steroid shot on August 5, but it has not seemed to help me so far. I really do not think I need hip replacement surgery, but what else can I do to reduce the pain?

Carlos_Higuera,_MD: The only way to give you good advice is to evaluate you with x-rays and a physical examination. I am not sure if your leg pain is coming from your back or the hip unless you have this evaluation. A good way to know if your pain is coming from your hip is to have an image-guided (or ‘fluoro-guided’) steroid injection of the hip. This means that needs to be done under x-ray (fluoroscopy). If you get improvement after this—even if it is for just a couple of hours, that means your pain is really coming from your hip and not your back. Regardless, I would not advise any hip surgery until at least three months after your back surgery.


Medications for Hip Pain

Rascal1: Since I turned 64 years old, I have had increasing pain in my back and left leg. I thought it was some sort of sciatica, but my doctor said it was more likely my hip. Can you suggest over-the-counter medications and exercises I can do to help ease the pain? Is there a website or book with information that you recommend?

Carlos_Higuera,_MD: Anti-inflammatory medicines purchased over-the-counter (OTC) such as ibuprofen (Advil®) or naproxen (Aleve®) are the initial medications used to help with inflammation that may be causing the hip pain. Occasionally, a steroid injection is necessary to settle the inflammation down.
You may download our guide to hip pain and find information on treatment options at: www.clevelandclinic.org/lp/hip_pain/index.html


Total Hip Replacement Surgery

jimlu800: Typically, how many cc blood will be lost during a total hip replacement?

Carlos_Higuera,_MD: Around 300 to 500 cc of blood is usually lost.

BrentW: What is the typical recovery time for a hip replacement surgery?

Carlos_Higuera,_MD: Six weeks to three months is the typical recovery time.

jimlu800: For a total hip replacement, which one is better between posterior and anterior surgery?

Carlos_Higuera,_MD: The anterior approach has a shorter recovery time and less risk of dislocation. However, it should be performed by a surgeon that has experience (more than 50 cases or so) to decrease potential complications.

Meurer: X-rays have shown that both of my hips are bone-on-bone. I also have degenerative discs and I do physical therapy. At what point do I consider having hip replacement? Neither hip really hurts, but I have lost my range of motion. I have piriformis and iliotibial band pain that has improved with physical therapy. What factors should influence my decision?

Carlos_Higuera,_MD: The main issue to influence your decision is the pain and limitation you may be experiencing mainly on the groin. If you do not have any groin pain, it is possible your pain is coming more from your back. However, before you move forward with any surgery you should be evaluated with x-rays and a physical examination to confirm your pain source.

Elby: I had hip surgery in 2011 and I am still suffering due to my back.

Carlos_Higuera,_MD: You need to be evaluated by a spine specialist to have a diagnosis. I cannot offer you advice just with this limited information.


Bilateral Hip Replacement

Meurer: If both hip joints need to be replaced, can they be done at the same time?

Carlos_Higuera,_MD: Yes, you need to be younger than 65 years old and healthy (no cardiovascular disease, diabetes, renal or liver disease, lung disease, etc.) Also, you cannot be obese (i.e., BMI higher than 35). It is uncommon to do bilateral hip replacements at the same time. Usually they are staged three months apart.


Hip and Knee Replacement

DVAVRO: I am a 59-year-old male who is slightly overweight, but otherwise in reasonable shape. If I needed a hip and knee replacement, could they be done? Is it advisable to have them done at the same time?

Carlos_Higuera,_MD: What is your weight and BMI (body mass index)? If it is less than 35 and you have no health issues, there is a possibility to have simultaneous bilateral knees or hips done. However, before moving forward with this, you need to have an evaluation with x-rays and a physical examination.


Total Hip Replacement vs. Hip Resurfacing

jimlu800: Which is better hip resurfacing or total hip replacement?

Carlos_Higuera,_MD: Overall, total hip replacement has less chances of having complications than resurfacing.


Loosening of Total Hip Replacement

Tamar: I had a right total hip replacement in March 2007 and a left total hip replacement in January 2008. In September 2012 I began experiencing pain in my left leg when getting up after sitting for a period of time. It was better after I walked a while. There is no pain when I am standing or walking—just when I get up from sitting or lying down. My x-rays in January 2013 compared to my last x-rays in January 2010 showed a small crack in the cement and indicated possible loosening. The x-rays I had on August 8 showed no change. My orthopaedic surgeon wants me to stay in touch and see him again in February 2014. I'm experiencing some stiffness, but no pain to speak of so pain medications are not needed. I am able to carry on with my normal activities with some limitations. With loosening, is revision surgery is the only option? If it is in fact loosening, what can I do to slow down the process? I am 79 years old, in good health except for paroxysmal atrial fibrillation for which I take warfarin, but no other medication. From what I've read, hip revision surgery is more complicated and riskier.

Carlos_Higuera,_MD: Unfortunately, if there are signs of loosening on the x-rays, there is not much conservative treatment that will help you. Probably limiting your weight bearing may help to prevent further progression of this loosening. This means, using a cane or a walker. You will need revision surgery sooner rather than later. An important issue is that before the surgery, infection always needs to be ruled out. For this you need at least some blood work including CRP (c-reactive protein) and ESR (erythrocyte sedimentation rate) values. If these are elevated, then you will need an image-guided hip aspiration.

In general, cementless revisions have better long-term outcomes than cemented ones. If you have a loose femoral stem that is cemented, it should be revised to a cementless one. The best way to give you better advice is looking at your x-rays.


Activity Following Hip Replacement

Aliciaines: I live alone and I will be having hip replacement surgery in the near future. Since I don't want to go to a rehabilitation facility, I need to plan ahead. In a bad case scenario, what kind of help do I need and for how long? What kind of equipment do I need to get? How do I need to modify my house and furniture? When will I be able to drive? For how long will I need help bathing?

Carlos_Higuera,_MD: If you are young and independent, the amount of help you need is limited. You just need someone to cook your food and help clean the house. You should be able to do the majority of activities of daily living including showering. You may need a higher toilet seat and a walker. Avoid seating on very low chairs or sofas to prevent dislocation of the joint replacement. You need to practice operating a motor vehicle in a parking lot to check your reflexes, and you cannot be taking any pain killers if you can drive. Everybody is different, but usually the recommended time before you can drive after a hip replacement varies between four to six weeks.

carolm: How long will I be required to follow the restrictions on bending and twisting after surgery?

Carlos_Higuera,_MD: I assume you are referring to after hip replacement. You have to be careful performing those maneuvers, especially during the first three months after surgery. However, you should be careful doing those for the rest of your life.


Exercise After Hip Replacement

figme: Can a person run after healing from hip replacement?

Carlos_Higuera,_MD: Generally, we do not recommend running after hip replacement surgery. At least three months of recovery is advisable.

godown: How long after left hip surgery can you start playing golf again?

Carlos_Higuera,_MD: After hip replacement surgery we recommend three to six months of recovery and therapy before returning to golf activities. This is due to the hip rotation required with a proper golf swing.


Hip Osteoarthritis Prevention

dogma: Can hip osteoarthritis be prevented?

Carlos_Higuera,_MD: Yes, Having a healthy weight is paramount to decrease the risk of hip osteoarthritis. Also, stay active with exercises that are low impact on your hips. This means walking, bicycle, swimming and elliptical exercise. I would advise you against running.


Exercise with Hip or Knee Condition

chrisms: What can I do before surgery to make my surgery a success, such as weight loss, muscle strengthening, etc.? I am overweight and am struggling to take some of it off. However, if I work hard to strengthen my leg muscles, will that help compensate the extra weight?

Carlos_Higuera,_MD: What type of surgery are you having—hip or knee replacement? For both, the only thing you can really do to help with your recovery is weight loss. You can do stationary bicycle or elliptical if you can tolerate it.

PIA: I am a 54-year-old male with a history of extensive running. I now need both hips replaced per my orthopaedic surgeon. I am working to delay this to accommodate some work responsibilities. I have discovered that biking is pretty tolerable. (The hardest part is getting on and off the bike.) Would this type of exercise make my situation worse?

Carlos_Higuera,_MD: No, biking is great exercise for both your hips and your knees. Also, elliptical and swimming are pretty good.

mmann: I have mild hip and knee arthritis. I am 58 years old. My physical therapist told me to never use a stair climber because it is bad for the knees. Do you agree?

Carlos_Higuera,_MD: Yes, I will recommend you to use an elliptical instead. You can also do stationary bike, walking and swimming.

beachreader: I have been diagnosed with sciatica, and do regular exercises for the piriformis muscle. Although this helps, it seems like using the stairs causes a lot of pain in the hip. Would walking up and down stairs aggravate the hip pain and the sciatica?

Carlos_Higuera,_MD: Yes, they can. Stair climbing can make them worse. I would advise you to have a physical examination and x-rays to confirm your pain is coming from your hip and/or sciatica?


Knee Symptoms

paulie: What does it mean if your knee ‘locks up’?'

Carlos_Higuera,_MD: That means that your knee gets blocked during its range of motion and you cannot move it even if you try. This can reflect a meniscal tear or a ‘loose body’ (i.e., a piece of loose cartilage moving around) in your knee. The best way to rule out these causes is a physical examination and an MRI.

snickers57: I've had several back surgeries. In the past two years I've had problems with my right knee. It sort of locks in place, and is so very painful I can't walk or put weight on my leg. To resolve the problem I have to press on my knee cap and the sound of bones cracking is awful. When the pressure is released, I can walk again. This happens quite frequently throughout the day. What could be the problem, and can it be repaired? I am waiting for another back surgery. What I'm wondering is whether my back is out of alignment. Could this be causing stress on my knee and causing this pain?

Carlos_Higuera,_MD: It is hard to tell just with this description. You need to be evaluated with a physical examination and x-rays to give you better advice.


Chronic Patellar Instability

beachreader: My knees dislocate when I walk or if I step or turn wrong. I become off balance if move too quickly. I have had this condition all of my life, and I am 59 years old. When I was young, I was told this could be fixed with experimental surgery that would 'tighten' the ligaments and muscles around the knee cap. When I was younger, I could slip it back into place with some pain and some slight swelling, but as I get older it doesn't slip back in. I have to force it in, so I no longer do the exercises I used to do. I am very careful, but it still happens. On a scale of one to ten, the pain when it is dislocated is a 20. After I put back in place, it's a seven for about four hours. Is there any surgery that would correct this? Both knees are affected.

Carlos_Higuera,_MD: If you have chronic patellar instability you need to be evaluated because depending on the cause of the instability the treatment options are different and there is a significant variation. You need a physical examination, special x-rays and probably a CT scan to evaluate the angle of your patellar tendon, and the type of patella and trochlea that you have.


Meniscus Tear of the Knee

WN: I have a right knee meniscus tear that is documented on MRI. Can a meniscus tear heal on its own? Can I cause more damage if it is not repaired now? Some days it bothers me a lot and other days not so much.

Carlos_Higuera,_MD: A meniscal tear will not heal on its own. However, if the symptoms are not severe, you do not need surgery right away. If your symptoms are not bad, especially ones related with ‘blocking or giving way,’ then waiting will not necessarily cause any more damage. The best way to give you better advice is doing an evaluation of your MRI and a physical examination.

WN: Are there any treatment options to repair/heal a torn meniscus other than surgery? What is the average recovery time if knee surgery is needed?

Carlos_Higuera,_MD: Yes, usually, a torn meniscus in someone older than 30 years old is treated with partial menisectomy. This means, removing the area with the tear. Repair after that is age is not recommended, given that healing is poor and chance of re-tears are high after surgery. The recovery time after arthroscopy partial menisectomy is approximately three to six weeks.


Effects of Excess Weight on Knee Surgery

swmary3: I am almost 75 years old and in relatively good health except for my bad knees. I try to stay active managing the pain with injections and pain pills. But it is getting worse and worse. I am somewhat overweight. How will this affect my surgery and rehabilitation?

Carlos_Higuera,_MD: Being overweight increases the risk of complications after knee replacement, including infection. This also will make your rehabilitation more difficult. Weight loss prior to surgery is generally recommended.

Randyosu:I am a 57-year-old male who is six foot and six inches tall and 450 lbs. I am  in the process of losing weight. I have osteoarthritis in both knees that are bone-on-bone. I take tramadol and naproxen for pain. I had a Synvisc-One® injection last Monday and I am hoping for good results. I sleep well, but my pain is intermittent. I would self-report the pain level as 3 to almost 5 range. I know that at 57 years old doctors try to avoid knee replacement until later in life if at all possible. A physician assistant told me that in his group practice, the doctors will not operate until I lose more weight. I hear that, but what if I had to have it? Am I left to suffer from this pain and lose my job? The research that I found does not support any notion that mortality rates on obese patients vary dramatically from any other patients. I am trying hard to lose a respectable amount of weight pre-replacement. I am scared that if I run out of time, my life will crumble as the doctors will not do anything. Can you give me any encouragement that the medical establishment will not turn its back on me?

Carlos_Higuera,_MD: Unfortunately, knee replacements are not design to carry such a high weight and can break after placement. Also, the issue is not increased mortality, but an increased risk of complications, including infection and thrombosis, after knee replacement. The idea of holding off performing knee replacements in obese people is getting broader because literature and research are showing that the risks are too high to overcome the benefits of the surgery. So, it is not that the medical community is giving its back to you; the issue is that there are not good answers at the moment for a patient like you.

Bariatric surgery can be a good option for you, if you need to lose a significant amount of weight and then proceed with a knee replacement. Do not get discouraged, I have had patients like you in the past. They have lost weight and then had a knee replacement with good results.


Knee Replacement Surgery

Dynamite: I am an 85-year-old male who has led a very active life until a few years ago when my knees prevented me from moving properly on the tennis court. I used to play doubles three times per week. Since I stopped playing tennis, I have become sedentary and find that I can no longer walk around a grocery store, wait in line, or even stand up and wait while a theater is emptying. In other words, I cannot stand nor walk more than five minutes. Walking a short distance to the mailbox seems to be my limit. I am thinking of a knee replacement, but am concerned about the after effects of general anesthesia. Also, I'm not sure that a knee replacement is the answer—or if there is an answer. My pain is not great, but I know when I should stop walking or my legs will give out. Do you have any suggestions about how to improve my life by allowing me more mobility? I talked to a local orthopaedic surgeon while I was still playing tennis (although slowing down on the courts), and he said he would not suggest a knee replacement just to go out to play tennis, but I am now more limited in my activities and wonder if a replacement would help? My x-rays show bone-on-bone.

Carlos_Higuera,_MD: If your knees are bone-on-bone, a knee replacement will definitely will help you.

nutzy: My husband is 67 years old and has suffered for several years with knee pain caused by rheumatoid arthritis. He still manages by taking NSAIDS (nonsteroidal anti-inflammatory drugs). Two doctors already recommended knee replacement surgery (not partial), but he has his doubts. How long you advise to postpone that surgery, or how long is too long to wait?

Carlos_Higuera,_MD: If your husband is too limited on his activities, then this has to be done sooner rather than later. There are not specific times for this. Usually, we recommend having it done within six months of evaluation, but not later than that. If he waits too long, his muscles and bone quality can get worse, which would make the surgery and the recovery more difficult

pattyann72: I am a 72-year-old woman, retired and anticipating knee replacement. What is the optimal time of year to have this surgery? Do you glue both ends of the prosthesis to the bones, so I can walk on it immediately?

Carlos_Higuera,_MD: There is not a specific time of the year that is better than other times. It really depends on your schedule and convenience to have some help at home after the surgery to help you with recovery. If this is not possible, then there is no difference on the time of the year. I use glue on both parts of the prosthesis, so you can walk right away after surgery.

emadler: Do you do the minimally invasive method in knee replacement, or have you improved upon that method?

Carlos_Higuera,_MD: The minimally invasive concept has changed throughout the years. I do a standard approach with limited dissection of the soft tissue. This means I do the surgery in a way that I see what I need to see to do it appropriately. The minimally invasive concept is a term that has been used for many years for marketing purposes. Studies about this have not shown a real difference in terms of outcomes, but they have shown an increase in complications with this method


Bilateral Knee Replacement

choicewords77: Is it advisable to get two knees replaced at same time, or to have one knee done and then the other? Both of my knees have been determined as needing replacement. I am a 71-year-old female in otherwise good health. However, my legs are in weakened condition due to little walking, etc. due to knee pain.

Carlos_Higuera,_MD: If you are healthy, they can do simultaneous knee replacements. However, the literature shows that the risk of complications such as infection is higher in patients older than 65 years old.

don060557: Both of my knees need to be replaced. Is it best to have them done at the same time or schedule them for different times? If they should be done at different times—what is recommended wait period before I have the second one done?

Carlos_Higuera,_MD: Generally speaking, if you are older than 65 years old and you have heart conditions, then a simultaneous bilateral knee replacement is contraindicated (prevented). In that case you would need to have the worse knee done first, and then wait for three months before getting surgery on the second knee. Overall, the risk of getting complications is less when you a have them staged for at least three months between surgeries.

rkchuey: I am 84 years old. I am only able to walk in my house with a walker. I fell again last week. Both of my knees have bone-on-bone arthritis. I received injections in both knees in December 2012 and June 2013. The last shots did not work at all.
What do you recommend? I had a heart attack with a bypass surgery at the age of 61 years old.

Carlos_Higuera,_MD: You probably need staged bilateral knee replacements starting with the knee with more pain first. After a three-month recovery, you can have to second knee done. You will need a physical examination and x-ray evaluation before moving forward with surgery. You will also need a medical optimization and clearance by a cardiologist before the surgery.

Grannyscott: I had bilateral knee replacement 12 years ago. (I am now almost 85 years old.) Now both of my knees, but especially the right one, feel ‘tight’ almost all the time. It becomes worse with stress like walking uphill. My x-rays show the implants are OK, but my surgeon says the plastic shields may need replacing. What is the outlook for this if I do nothing? I cannot conceive of this surgery at my age!

Carlos_Higuera,_MD: Doing nothing is not recommended because if the plastic wears out then the implant can get damaged and then it won’t work properly. Even at your age, surgery is feasible with proper medical optimization and clearance.

SydneyB: Should I still have swelling around my knees after having both knees replaced with titanium. I know that I should lose about 40 pounds, but is there another reason for the swelling? I do have some pain at times, but it is not severe.

Carlos_Higuera,_MD: Swelling can persists for many months after knee replacement, sometimes three or more months. However, the only way to establish if there is another cause of the swelling is being evaluated with a physical exam and x-rays.


Types of Knee Replacement Devices

don060557: What are the different types of knee replacement devices available? Are there any advantages of one over the other?

Carlos_Higuera,_MD: It depends on the pathology that needs to be treated. I would be able to give you better advice after an evaluation of your x-rays and a physical examination. There are many different types of knee replacements. It can be a partial one, where you have just one compartment of the knee replaced. These are good in the sense of giving you a more natural feeling in the knee and a rapid recovery. The bad thing about them is that they get revised more often than total replacements because the other areas of the knee get worn down and need replacements also. Another difference between knee replacements is the type of constraint you use depending on the preservation of the ligaments on your knee. There are no clear outcome differences between ligament preserving or ligament-sacrificing ones. Either one is good. Finally, they can be cemented or cementless, the cemented ones have overall clinical outcomes and longer survivorship.


Knee Cap Arthroplasty

MollyJ: I have severe knee pain that is making it hard for me to get around. I was told total knee replacement would not help because most of the pain is caused by my knee caps, and they no longer do knee cap replacement because they had problems with them. What—if anything—will help me?
Is stem cell for knees going to happen in the near future and be affordable to someone on a fixed income? It's awful to have to live with limited mobility and so much pain.

Carlos_Higuera,_MD: There is knee cap arthroplasty available. You need to be appropriately evaluated and if you are a good candidate, you can have that procedure done. Otherwise a knee replacement can be a good option for you. Stem cell technology is not available yet for this condition.


Knee Replacement and Infection

clee: I had knee replacement surgery a year ago that could not be completed. The surgeon found infection in my knee. He has had me wait a year before another attempt. He will take fluid samples to check before the surgery. My question is, I was on Humira® (adalimumab) for my psoriasis for years, and did very well on it. The surgeon had me discontinue it because of the possibility of immune suppression. Do you feel it would be safe to return to Humira® after the surgery? My psoriasis is flaring up. Also, my arthritis is getting worse. I am hoping returning to Humira® will improve that.

Carlos_Higuera,_MD: It depends on the type of infection you are having. It is very important that your surgeon confirms that the infection is eradicated before proceeding with any surgery. If the infection is eradicated, then you can have the surgery and then restart the Humira® two to four weeks after surgery.


Physical Therapy After Knee Replacement Surgery

nan556: I am wondering if you can recommend a website for physical therapy exercises following knee replacement surgery.

Carlos_Higuera,_MD:  Initially you should be evaluated by a physical therapist to determine your strength, goals and post-operative course for exercise. Everyone is an individual and therefore plans should be adjusted to meet your needs.

For more information about physical and occupational therapists’ services, you may refer to our Orthopaedic/Bone & Joint Rehabilitation website at http://my.clevelandclinic.org/rehab-sports-therapy/treatments-services/orthopaedic-bone-joint-rehabilitation.aspx. Another resource is the American Academy for Orthopaedic Surgeons http://orthoinfo.org/topic.cfm?topic=A00672


Knee Exercises

WN: Is biking beneficial to arthritic knees, even though it is painful to do?

Carlos_Higuera,_MD: Yes, bicycle and elliptical, also swimming are great exercises for your knees.

chrisms: What types of exercises would you suggest pre-surgery to strengthen my leg muscles so to help with my recovery after a double knee surgery?

Carlos_Higuera,_MD: Bicycling is the best exercise for this. It can be a stationary bike.


Bursitis Prevention

dogma: Can you decrease your risk of bursitis?

Carlos_Higuera,_MD: Bursitis where—trochanteric bursitis? ITB bursitis?
In general, you can decrease the risk of bursitis with physical therapy and if you practice a sport, with a good warm-up before the activity.


Degenerative Arthritis Treatment

drmagic69: How can you treat a 32-year-old woman with degenerative arthritis? What medications do you recommend?

Carlos_Higuera,_MD: Anti-inflammatory medications are the first line of treatment. If this is not enough, some pain medications such as Tylenol® (acetaminophen) with codeine may help.


Joint Pain Medications

KA: After one steroid injection I am on meloxicam 15 mg once daily. I have no problems with meloxicam, but it does not seem to be reducing the swelling. Are there alternatives I could try? Along with meloxicam 15 mg daily I have been told to take glucosamine chondroitin twice daily (1500/1200 mg each). Is there any harm in doing that? Neither seems to be helping yet. I have been taking them for about a month. Dare I hope?

Carlos_Higuera,_MD: You can try Voltaren® (diclofenac sodium) 75 mg twice daily instead. You need to take it with meals twice a day for at least five to 10 days. Glucosamine chondroitin needs to be the one that has sulfate in it. There is no harm to take them all at the same time. If they do not work, you need to be evaluated to see if you are a candidate for replacement.


Anesthesia During Joint Surgery

Aliciaines: I know that most surgeries are performed with epidural anesthesia. Is the patient awake, or sedated to the point of not feeling anything?

Carlos_Higuera,_MD: It is a spinal, not an epidural. A spinal consists of an injection on the spinal canal. It is simple and safe. It is better to do it this way, because the risk of lung and heart problems during the surgery is less than with general anesthesia. Also, bleeding and thrombosis are less using a spinal. You will be sedated and barely will remember anything from the surgery. You can be sedated to the point that you will not feel or remember anything. This should be discussed further with your anesthesiologist.


Home vs Rehabilitation After Surgery

godown: What has to occur if I want to go home after surgery, instead of a rehabilitation facility?

Carlos_Higuera,_MD: I prefer my patients to go home rather than rehabilitation after surgery. It depends on how you do during the hospital stay. The physical therapist will evaluate you and decide if it is safe to go. You need to have a stable gait and acceptable strength on your upper and lower extremities.


Proper Footwear for Joint Health

j2izzo: I am in the allied health profession. I see many patients who rarely change their shoes, insoles, or even purchase the correct type of shoe for what they need (i.e. walking vs using a cross trainer). In your opinion, how much does the correct footwear and/or updating it frequently help various musculoskeletal knee and hip concerns? If you do believe it is helpful, what type of general recommendations do you provide patients and at what frequency should the footwear and/or insoles be replaced?

Carlos_Higuera,_MD: The literature for hip and knee pathology is limited. However, for foot issues it is recommended that footwear should be change at least every six months. Tennis shoes or shoes with soft soles is the ideal type of footwear to prevent hip and knees issues.


Closing

Moderator: Thank you very much Carlos Higuera Rueda, MD. The answers were great, and I am sure that everyone appreciated your time.

Carlos_Higuera,_MD: You're welcome. These were great questions!

Moderator: To make an appointment with Dr. Higuera or any of the other specialists in our Department of Orthopaedic Surgery at Cleveland Clinic, please call 866.275.7496. You can also visit us online at clevelandclinic.org/ortho


For Appointments

To make an appointment with Dr. Higuera or any of the other specialists in our Department of Orthopaedic Surgery at Cleveland Clinic, please call 866.275.7496.  You can also visit us online at clevelandclinic.org/ortho


For More Information

On Cleveland Clinic

Using innovative joint replacement and bone grafting methods, Cleveland Clinic orthopaedic surgeons reconstruct thousands of hip and knee joints each year. Our specialists care for a variety of joint problems, including joints that have been fractured or damaged by arthritis. Following surgery, specially trained physical therapists provide individualized care to help ensure long-term success. Cleveland Clinic orthopaedists offer both cemented and cementless joint replacement options for reconstruction.

Hip and knee surgery are offered in the Department of Orthopaedic Surgery in the Orthopaedic & Rheumatologic Institute. Cleveland Clinic orthopaedics is ranked best in Ohio and third in the nation by U.S.News & World Report.

Moderator: If you would like more information for hip and knee pain treatment, download our free treatment guides.

Moderator: Cleveland Clinic's Rehabilitation and Sports Therapy Orthopaedic Bone & Joint therapy provides patients with exercises for joint pain, rehabilitation for joint replacement surgery, arthritis and a full range of other orthopaedic problems. Visit the Rehabilitation and Sports Therapy


On Your Health

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult



Contact Information

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

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This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians.  ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.