Orthopedic Surgery – Q&A with Dr. Scott NodzoDeveloper2019-04-08T14:52:54+00:00
Orthopedic surgeon Scott Nodzo, MD, answers frequently asked questions about orthopedic surgery
Q: What is the most common knee or hip issue for adults older than 50? A: Hip and knee osteoarthritis continue to be significant sources of pain in adults over the age of 50. The demand for total hip and total knee replacements is expected to increase 174 percent and 673 percent respectively by 2030. Hip pain usually manifests as groin pain or posterior buttock pain that can at times radiate down to the knee. Knee pain tends to be localized to the knee and may result in some patients having pain when sitting for long periods of time, climbing stairs, or even just walking for extended periods of time. Additionally, some patients may have a clicking or catching in their knee due to the wear and tear of cartilage which may cause discomfort.
Q: How is osteoarthritis treated? A: Nonoperative management of arthritis is always tried first. Anti-inflammatories can be prescribed by your primary care physician; however, long-term use should be monitored due to the risk of stomach and kidney problems. Steroid injections into the knee may also be beneficial and provide significant relief of pain symptoms. These can be performed approximately every three months, but it is important to note these injections do not “fix” the arthritis, but rather just help with symptoms. Using a brace has been found to be helpful in some patients and may be tried in certain scenarios. The use of a cane and activity modification such as avoidance of stairs and walking distances may help with daily symptoms. Ice at the end of the day or throughout the day can help with the swelling many people experience with knee osteoarthritis.
Q: How is weight related to osteoarthritis? A: Weight loss is another very important nonoperative strategy to help with hip and knee osteoarthritis symptoms. For every one pound lost from your body, the knee joint experiences 4-5 less pounds of weight through the joint when doing daily activities. This decrease in stress on the knee and hip joint with weight loss can significantly help with arthritis symptoms. Additionally, having a stable and healthy weight decreases the risk of postoperative complications following knee and hip surgery.
Q: With hip or knee issues, are there benefits to doing physical therapy before and after surgery? A: Physical therapy before surgery is helpful for maintaining some joint motion and strengthening the muscles around the hip and knee joint. It is important to note, if therapy is making the symptoms worse it should be scaled back or stopped. Low impact exercise such as swimming, biking, walking and elliptical machines are good activities to perform prior to and after surgery. Physical therapy after surgery is very important and is an integral part of helping patients regain strength and function after knee or hip surgery.
Q: What is the effect of osteoporosis on hips and knees? A: Osteoporosis is a bone condition in which the bone mass is decreased resulting in an increased risk of fracture. In the hip, it can result in hip fractures after minor falls or trauma. In the knee, it may present as stress fractures or small micro-fractures around the joint resulting in pain and a decreased ability to walk. It is important to maintain your bone health and have a routine DEXA scan which evaluates your bone density. Your primary care doctor may recommend supplements of calcium and vitamin D or even medications called bisphosphonates.
Q: What can people do to keep knees and hips in good shape? A: Maintaining a healthy weight and participation in low impact cardiovascular exercises are the most helpful. Joints stay healthy when they move, and immobilization of a joint or inactivity is not good for the joint long-term. No specific supplement has been scientifically shown to improve joint health, but many of my patients have anecdotal good experiences with turmeric and collagen-based supplements. These supplements won’t heal your joints or make them last any longer, but may help with symptoms. Arthritis has a strong genetic component, so it may be unpreventable in certain cases.
Q: Are there exercise tips to keep in mind? A: Low impact exercises are the best exercises for your joints if you are experiencing arthritis symptoms. Exercises where your foot is against a machine like a leg press (closed chain exercises) rather than when it is dangling free (open chain exercises) like a leg extension or curl are the best. If any exercise is causing significant discomfort it should be stopped.
Q: What other care/services do you provide in addition to total hip and knee replacement? A: We are able to take care of some emergency room injuries such as fractures that are able to be splinted and seen by myself in the office.
Q: How does shoe wear affect hips or knees? A: Shoes with good sole and heel support are the best for keeping the foot and ankle in a supported position during walking. If flat shoes or sandals are causing ankle and knee pain it may be helpful to try a good supportive shoe to see if these symptoms improve.
Q: What else should people know before pursuing treatment for joint problems? A: Having good control of your other medical conditions such as high blood pressure, diabetes and any breathing problems is very important prior to any surgical intervention from a surgeon.
Q: When should people visit an orthopedic surgeon? A: Many times, patients are worked up for arthritis with X-rays and the prescription of anti-inflammatories by their primary care physician. Some may even perform knee injections to help with the pain. If your X-rays show significant arthritis and oral medications are not helping the pain, an orthopedic surgeon may be able to help. Once nonoperative management fails, the orthopedic surgeon will focus on operative treatments of your hip or knee condition.
Q: What else would you like people to know about you from a professional standpoint? A: Although hip and knee replacements have become routine in the United States, it is important to remember these are major surgeries. You should try to be as healthy as you can possibly be prior to surgery to decrease the risk of complications from surgery. Smoking has been shown to increase post-operative complications and all efforts to quit smoking prior to surgery should be tried. If you have questions about surgery or would like to talk about your symptoms, we are happy to see you! We have information you can take home which may better help you understand hip and knee replacement surgery.
Q: Anything else you’d like to mention? A: Just because you come to an orthopedic surgeon’s office does not mean you will need to have surgery. Hip and knee surgery are elective procedures, and no surgeon will try to talk you into having a hip or knee surgery. It is good to know all your options to help you make an educated decision about your hip or knee arthritis.