Risk of Blood Clot Formation During Joint Replacement Surgery Increases in Certain Patients

Clots more likely to form in patients with cardiovascular disease, smokers and the elderly

Rosemont, IL - When tennis star Serena Williams underwent emergency treatment for a pulmonary embolism earlier this year, the world’s attention was drawn to this often fatal medical condition which, although surprisingly not uncommon, is unfamiliar to most men and women. A common risk factor associated with clot development is surgery; particularly hip and knee replacement surgery.

Pulmonary emboli, or blood clots in the lungs, occur when a clot that forms within veins elsewhere in the body – often in the lower legs or other limbs – breaks free and travels to the lungs, where it can cause serious complications. Pulmonary emboli can occur in patients of any age and common factors associated with an increased risk of clot development include:

• oral contraceptive use;
• cardiovascular disease;
• prior clot formation;
• clotting disorders;
• family history of clots; or
• advanced age.

A new study focusing on the occurrence of clots in knee replacement patients and published in a recent issue of the Journal of Bone and Joint Surgery (JBJS) indicates that despite treatment with blood thinners prior to and immediately following joint replacement surgery, the risk of clot formation is still relatively high in certain patients.

“The rate of knee replacement has increased substantially worldwide, and continued increases are anticipated in the future,” said study author Alma Pedersen, MD, PhD. “The formation of clots, including pulmonary emboli, is a serious complication in patients undergoing knee arthroplasty. Prophylactic measures, such as the use of blood thinners around the time of surgery, are used to reduce the occurrence of clots, but their effectiveness in routine clinical practice following surgery is more uncertain.”

Study Details and Findings
The authors evaluated 37,223 knee replacement patients who had surgery between 1997 and 2007, looking for evidence of post-surgical embolism in the 90-day period following surgery.

The authors found 441 patients (1.2 percent) were hospitalized for blood clots during the 90-day period following knee surgery. An in-depth evaluation of these patient records revealed the following risk factors associated with clot development:

• advanced age (older than 80 years of age);
• history of cardiovascular disease;
• history of previous clot; or
• increased number of accompanying medical conditions.

The study also revealed the number of patients admitted to Healthcare fascicilitator with clots following knee surgery has increased since 1997, which Dr. Pedersen noted is most likely due to advances in diagnosis which have enabled physicians to identify clots before they cause serious problems. The study also notes that individuals who have a knee replacement surgery due to rheumatoid arthritis have a lower risk of clots than those with other conditions. However, in all patients, the risk can be diminished slightly by replacing only one knee at a time, rather than both.

Although knee surgery is still a generally safe procedure, which enables thousands of men and women each year to regain mobility lost to injury or illness, patients should be aware of the risk of post-surgical clotting and talk with their physician about the possible use of blood thinners and follow-up evaluations that may help to identify clots which may be treated before they cause problems. Although blood thinners are typically prescribed only during hospitalization, the study suggested that physicians consider extending the duration of blood thinner therapy into the weeks following surgery.

“Despite the use of blood thinners, patients undergoing knee arthroplasty continue to remain susceptible for clot formation for several weeks following surgery,” Dr. Pedersen said. “Future studies should focus on the improvement of prophylaxis following hospital discharge, particularly among elderly patients and those with a history of cardiovascular diseases or previous clot formation.”

 

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work.

More about joint replacement surgery and blood clot formation:
As the bones are prepared for the new joint in a replacement surgery, tiny microfragments of bone and tissue can become dislodged and enter the bloodstream, “hooking” on vessel walls where they can allow additional debris to accumulate. Eventually, this debris can form a clot large enough to impede the normal flow of blood, sometimes causing discomfort, especially in the lower legs, one of the more common areas of clot formation. Most individuals, however, experience no symptoms of the forming clot. If the clot becomes dislodged from the vessel walls, it can travel through the blood stream, eventually lodging in the lungs. In addition, long periods of immobility prescribed for patients undergoing these surgeries can cause blood flow to slow down, increasing the of clot formation in these patients. If a patient develops swelling, redness or pain in the leg following discharge from the hospital, you should contact your physician.

More about pulmonary embolism:
According to data from the American Thoracic Society, pulmonary embolism is a common complication of hospitalization and contributes to 5 to 10 percent of deaths in hospitalized patients. Some studies have estimated that more than 1 million Americans experience pulmonary embolisms each year, with 100,000 to 200,000 of these events being fatal.

 

Reference : http://www.healthcanal.com/surgery-rehabilitation/19160-Joint-Replacement-Sur...

Knee Replacement Patients Thrive for Decades, New Study Suggests

Knee replacement patients may leave surgery with a lot of fear about their long term health and physical capabilities, but a new survey suggests that those fears could be quite far from reality.

A survey from researcher John B. Meding, MD, was presented during the annual meeting of the American Academy of Orthopaedic Surgeons in San Diego this week.

The survey analyzed the daily life of 128 different knee replacement patients treated at Meding's practice and who had surgeries more than 20 years ago. The findings were that of those surveyed, living an active lifestyle including activities like swimming, biking and walking was quite possible. With an average age of 84 years, 70% of his patients surveyed said that they could walk the distance of five city blocks. On the other side of the results were just 3 participants of the 128 who felt as though they lived a life confined to their home.

It's worth noting that the type of knee replacement surgery could also be a factor in Meding's study. Meding and his research partners chose to isolate their focus on one type of procedure, called a "primary cruciate-retaining surgery," to help minimize differences.There are various healthcare fascillitator for such type of health related problems to overcome.

 

Read more : http://www.thirdage.com/news/knee-replacement-patients-thrive-decades-new-stu...

Joint replacements mean better life for some, but they aren't the first option, doctor says

By Megan Hart | The Muskegon Chronicle

 

Phyllis Deiters knew she had to do something when she couldn't lift her right arm high enough to shampoo her hair.

The 82-year-old Roosevelt Park woman had had two surgeries on the muscles and tendons surrounding her right shoulder and did physical therapy for about a year, but all measures failed to relieve her pain or let her lift her arm higher than her chest. So she decided to try what she thought was a more drastic measure: having a total shoulder replacement.

“Not being able to use my arm, you can't live like that,” she said.

Now, about four weeks after her surgery, she can wash her hair again and is starting to regain normal function.

Greg Lindstrom | Muskegon ChroniclePhyllis Deiters, 82, performs an exercise with the help of Kevin E. Sprague, P.T., of Diversified Physical Therapy, in her Roosevelt Park home on July 20. Deiters does the rehabilitation exercises, which help increase range of motion in her shoulder, three times per week. She had reverse total shoulder surgery on June 23.  

“That's one thing checked off my list,” she said. “I'm just waiting to drive the car.”

Mercy Hospital in Muskegon performed 249 shoulder replacements in 2010, along with 311 hip replacements and 596 knee replacements.

Nationwide, shoulder replacements are less common than knee ad hip replacements. There were 10.3 total hip replacements, 10.9 partial hip replacements and 23.0 total knee replacements per 10,000 people in 2006, according to the National Center for Health Statistics, and those numbers are expected to increase because of the aging and increasingly overweight U.S. population.

Dr. Jeffrey Recknagel of Orthopedic Associates of Muskegon, Dieter's orthopedic surgeon, said he recommends patients wait as long as they can before getting a joint replacement, because the plastic components of a new joint deteriorate over time. Dieter's type of joint typically lasts about 10 years, he said.

“I usually send patients away with the idea, live with it as long as you can and you'll know when you're ready,” he said.

The “ready” point varies because patients have different pain tolerances and goals, Recknagel said. Some want to get back to playing sports, while others just want to do everyday tasks.

“There's something to be said for replacing a joint while you're still young enough to enjoy it,” he said.

Greg Lindstrom | Muskegon ChronicleDr. Jeffrey Recknagel demonstrates one of his shoulder replacement models at Orthopedic Associates of Muskegon.  

The key to healthy joints is a healthy lifestyle overall, Recknagel said. Supplements can help somewhat, he said, but they don't keep joints mobile.

“The best thing to do to preserve those joints is to stay active,” he said.

For shoulders, that means simple exercise like “windmill” motions with the arms, reaching across the front of the body and touching the back. For knees and hips, it can just mean walking and maintaining a healthy weight to minimize stress on the joints.

When less intensive measures like exercises and steroid injections fail, though, it may be time for shoulder replacement surgery, Recknagel said. Despite the term “replacement,” doctors don't remove the whole joint, but resurface the bones.

Most of the time, surgeons put a plastic socket on the shoulder blade and replace the top of the upper arm bone with a metal half-sphere, which fit together like a “golf ball on a tee,” Recknagel said. In some cases, like Dieter's, the surgeon has to put the socket on the arm and the ball on the shoulder blade because of damage to the rotator cuff.

Dieters said the replacement was less painful than she expected, and she is recovering faster than she did from her previous shoulder surgeries. She still takes prescription pain medication once daily and uses ibuprofen as needed.

“It's amazing it's not more painful,” she said.

She has physical therapy three times a week. The exercises include touching her forehead and the side of her head, and tracing figure eights on a table with her arm.

“I would recommend (people with shoulder problems) to do it if they want to keep the use of their arm, and by use I mean lifting dishes out of the cupboard, shampooing your hair,” she said.

 

Above info is taken from : http://www.mlive.com/news/muskegon/index.ssf/2011/07/joint_replacements_mean_...

 

Joint replacements mean better life for some, but they aren't the first option, doctor says

By Megan Hart | The Muskegon Chronicle

 

Phyllis Deiters knew she had to do something when she couldn't lift her right arm high enough to shampoo her hair.

The 82-year-old Roosevelt Park woman had had two surgeries on the muscles and tendons surrounding her right shoulder and did physical therapy for about a year, but all measures failed to relieve her pain or let her lift her arm higher than her chest. So she decided to try what she thought was a more drastic measure: having a total shoulder replacement.

“Not being able to use my arm, you can't live like that,” she said.

Now, about four weeks after her surgery, she can wash her hair again and is starting to regain normal function.

Greg Lindstrom | Muskegon ChroniclePhyllis Deiters, 82, performs an exercise with the help of Kevin E. Sprague, P.T., of Diversified Physical Therapy, in her Roosevelt Park home on July 20. Deiters does the rehabilitation exercises, which help increase range of motion in her shoulder, three times per week. She had reverse total shoulder surgery on June 23.  

“That's one thing checked off my list,” she said. “I'm just waiting to drive the car.”

Mercy Hospital in Muskegon performed 249 shoulder replacements in 2010, along with 311 hip replacements and 596 knee replacements.

Nationwide, shoulder replacements are less common than knee ad hip replacements. There were 10.3 total hip replacements, 10.9 partial hip replacements and 23.0 total knee replacements per 10,000 people in 2006, according to the National Center for Health Statistics, and those numbers are expected to increase because of the aging and increasingly overweight U.S. population.

Dr. Jeffrey Recknagel of Orthopedic Associates of Muskegon, Dieter's orthopedic surgeon, said he recommends patients wait as long as they can before getting a joint replacement, because the plastic components of a new joint deteriorate over time. Dieter's type of joint typically lasts about 10 years, he said.

“I usually send patients away with the idea, live with it as long as you can and you'll know when you're ready,” he said.

The “ready” point varies because patients have different pain tolerances and goals, Recknagel said. Some want to get back to playing sports, while others just want to do everyday tasks.

“There's something to be said for replacing a joint while you're still young enough to enjoy it,” he said.

Greg Lindstrom | Muskegon ChronicleDr. Jeffrey Recknagel demonstrates one of his shoulder replacement models at Orthopedic Associates of Muskegon.  

The key to healthy joints is a healthy lifestyle overall, Recknagel said. Supplements can help somewhat, he said, but they don't keep joints mobile.

“The best thing to do to preserve those joints is to stay active,” he said.

For shoulders, that means simple exercise like “windmill” motions with the arms, reaching across the front of the body and touching the back. For knees and hips, it can just mean walking and maintaining a healthy weight to minimize stress on the joints.

When less intensive measures like exercises and steroid injections fail, though, it may be time for shoulder replacement surgery, Recknagel said. Despite the term “replacement,” doctors don't remove the whole joint, but resurface the bones.

Most of the time, surgeons put a plastic socket on the shoulder blade and replace the top of the upper arm bone with a metal half-sphere, which fit together like a “golf ball on a tee,” Recknagel said. In some cases, like Dieter's, the surgeon has to put the socket on the arm and the ball on the shoulder blade because of damage to the rotator cuff.

Dieters said the replacement was less painful than she expected, and she is recovering faster than she did from her previous shoulder surgeries. She still takes prescription pain medication once daily and uses ibuprofen as needed.

“It's amazing it's not more painful,” she said.

She has physical therapy three times a week. The exercises include touching her forehead and the side of her head, and tracing figure eights on a table with her arm.

“I would recommend (people with shoulder problems) to do it if they want to keep the use of their arm, and by use I mean lifting dishes out of the cupboard, shampooing your hair,” she said.

 

Above info is taken from : http://www.mlive.com/news/muskegon/index.ssf/2011/07/joint_replacements_mean_...

 

Which Countries Require Proof of Yellow Fever Vaccination?

By Nancy Parode, About.com Guide

Question: Which Countries Require Proof of Yellow Fever Vaccination ?

If you plan to visit one or more of the countries listed below, be sure you have been vaccinated for yellow fever before you leave home. According to the Centers for Disease Control and Prevention, yellow fever vaccinations and boosters are good for 10 years.

Answer:

Countries Requiring US Visitors to Show Proof of Yellow Fever Vaccination Before Entry:

• Angola


• Benin


• Cameroon


• Central African Republic


• Costa Rica, if you have visited sub-Saharan Africa, Bolivia, Brazil, Colombia, Ecuador, Peru or Venezuela


• Côte d'Ivoire (Ivory Coast)


• Democratic Republic of the Congo


• Djibouti


• Equatorial Guinea


• French Guiana


• Gabon


• Gambia, The


• Ghana


• Guinea


• Kenya


• Lesotho


• Liberia


• Maldives, if you are arriving from a yellow fever zone


• Mali


• Mauritania


• Mauritius (vaccine is not required, but border agents may demand proof)


• Mozambique


• Niger


• Oman, if you are arriving from a yellow fever zone


• Republic of the Congo


• São Tomé and Principe


• Senegal


• Sierra Leone


• South Africa (vaccine must be administered more than 14 days prior to arrival)


• Sri Lanka, if you are arriving from a yellow fever zone


• Suriname, if you are arriving from Brazil, French Guiana or Guyana


• Swaziland


• Togo


• Uganda


• Venezuela


• Zambia, if you are arriving from a yellow fever zone


• Zimbabwe, if you are arriving from a yellow fever zone

 

Above info is taken from: http://seniortravel.about.com/od/seniortravelbasics/f/Which-Countries-Require...

 

Electronic medical records system

The electronic medical records system has only recently started being used by hospitals in India and is used for keeping track of medical information such as the practice management system. 

 The best thing that EMR software has to offer is interoperability. This function allows different EMR software operating facilities to communicate, exchange data accurately, effectively and consistently in real time. This function also allows EMR software using physicians, pharmacies and hospitals to share patient information in real time. 

This is because there is a lot of work to be done when transferring older patient medical records to the new EMR software. This means remaking all the data on paper and changing it to electronic data. A large percentage of physicians, when asked said they are much less satisfied with the use of scanned document images than that of regular electronic data. One of the biggest issues that appear when trying to change the classic ways to the new EMR software way is the costs. Apart from the price of the software itself, hospitals need to have the proper tools for it as well. Also a lot of physicians find it more difficult to use EMR software than regular pen and paper.

Orthopedic treatment in India

Orthopedics is one of the common procedures for which international patient often travel to India, orthopedic surgery and orthopedic treatment in India is available at state-of-the art medical centers.

With fully-equipped operation theatres, expert orthopedic surgeons and the back-up support of labs and blood banks, Orthopedic hospitals in India provide comprehensive treatment for ortho related disorders.

 

Major surgeries performed are

 

Joint Replacement

Hip Resurfacing

Hip replacement

Knee surgery

Knee Arthroplasty

Hand Reconstruction

Arthroscopic surgery

Trauma and Fracture surgery

Much more cost-effective and highly efficient medical treatment in India

The hospitals in India are accredited by NABH and the Joint Commission International, and are equipped with well qualified doctors, and supporting staff like nurses and technicians. Highly efficient and experienced doctors own super specialty hospitals that provide the opportunity for best health care services available in the country. Another main aspect that contributed to the increased medical tourism in India is the much affordable medical services, in addition to being cost-effective and highly efficient, thus benefitting those concerned about the rising healthcare costs.While extreme expertise is proven in the fields of orthopedics, dentistry, cardiac surgery, pediatrics and cosmetic surgery,  it has also evidenced the interest of tourists in ayurvedic treatments pioneered through Kerala, where natural and mental therapies are used to cure the patients. Homoeopathy and naturopathy are other popular medical services liked by international medical tourists. In addition, the tourists also get to enjoy sightseeing, and some post operative treats, as part of some attractive medical tourism packages.

                                      

Medical tourism in India provides Hope for Nigerians seeking treatment

Medical tourism in India provides affordable and quality healthcare and resources that offer choices for up to date, state of the art medical technology that may increase quality of life, life expectancy and preventive care for Nigerians.

Why choose  India for surgery?

India has one of the best qualified professionals in each and every field and this fact has now been realized the world over. Regarding medical facilities, India has one of the most competent doctors and world class medical facilities. With most competitive charges for treatment, India is a very lucrative destination for people wanting to undergo treatment of certain medical problems. India offers world class medical facilities, comparable with any of the western countries. India has state of the art hospitals and the best qualified doctors. With the best infrastructure, the best possible medical facilities, accompanied with the most competitive prices, you can get the treatment done in India at the lowest charges. 

Nigerian citizens are very sensitive towards their health requirements. Since the medical infrastructure is not so highly developed in Nigeria, patients prefer to travel abroad for medical management. This has been the case in past also when only the rich and the affluent traveled to USA and Europe for healthcare. With India emerging as one of the 

medical hubs of the world, just like patients from other countries, patients from Nigeria have also now started coming to India for all health and medical related issues.

Medical tourism is one of the rising industries in India

In the next 5 years to come, the Indian medical tourism market is said to grow double the size of any other medical tourism market. India provides medical tourism at an affordable rate in comparison to the other countries in the west. The facilities are world class and the patients are taken care of by the medical centers properly. Hence, India is a good bargain when it comes to medical tourism. 

There are several benefits of medical tourism in India. The biggest among them is the cost. Medical treatment in India is offered at a lower cost than any other developed country in the world. Their air ticket expenses and accommodation expenditure, even if they are put up in a luxury hotel will not be more than their expenses in USA or UK. Patients will be able to save at least 50% of their cost if they choose India over other developed countries.

The second advantage is that of good medical facilities and talented and experienced pool of professionals in the medical field. The high rate of investment in medical research in India and its history of subsidized medical education have created some of the most efficient medical professionals in the world. Many of such talented medical professionals have years of experience in treating patients in the western countries. Hence, they are well acquainted with the medical problems of people there. They use their experience and expertise sitting in India to treat international patients.

The infrastructure in terms of private hospitals is excellent in India. Some of the best private hospitals are situated in India with the latest technology. Some have affiliations with John Hopkins and Harvard Medical Schools. Hence, they have the set up to take care of international patients who are conscious about quality treatment. Language is not a barrier in India as a large cross section of people can understand and speak international languages in India. The Indian government is also extremely supportive of medical tourism. The government has issued special visa for international patients who travel to India for treatment. The government is investing heavily in various projects under medical tourism which will build hospitals for the patients and budget hotels for their relatives. 

India has always encouraged medical tourism. Patients from middle- east and south- East Asian countries have arrived in India with their medical problems. Even people from UK have travelled to India under medical tourism. Only the USA-India medical tourism seems to be new phenomenon. Doctors enjoy a good position in the Indian society and are all powerful when it comes to any kind of medical decisions. Patients in UK, US and Canada are familiar with Indian doctors because there are several Indian doctors practicing those countries. Hence, they can expect the same amount of dedication in the doctors whom they have already met and interacted with.