Simultaneous or Staged Total Knee Replacement

So… you need knee replacement. Should you get them done one at a time or both at once… next

Simultaneous Versus Staged Bilateral Total Knee Arthroplasty

Dr. Jack Cush writing in Rheumnow reported on a metanalysis from 2013 that identified 18 articles which included over 65,000 patients and compared those undergoing single as opposed to simultaneous total knee replacements.

The incidence of mortality was significantly higher in the simultaneous group at 30 days (RR 3.67, 95% CI 1.68–8.02), 3 months (RR 2.45, 95% CI 2.15–2.79) and 1 year (RR 1.85, 95% CI 1.66–2.06) after surgery.

On the other hand there were no significant differences between the two groups with regard to in-hospital mortality R 1.18, 95% CI 0.74–1.88), post-operative deep vein thrombosis, cardiac complications, and pulmonary embolism or infection rates

Thus the higher mortality rate associated with bilateral total knee arthroplasty should impact patient selection for this surgical option.  The good news is that there is no differences in other common complications associated with arthroplasty – infection, thrombotic events, etc.

Comment: Well… there you have it.


Do the immunosuppressive drugs used in rheumatoid arthritis treatment increase cancer risk?  The answer next…

Most immunosuppressive drugs do not significantly increase the risk of breast cancer recurrence

Dr. Lara Pullen writing in Arthritis and Rheumatology reported on a study involving 3 large populations of women with rheumatoid arthritis or inflammatory bowel disease who had undergone surgery for primary breast cancer. What the researchers found was that the risk of breast cancer recurrence in patients who received methotrexate or anti-TNF therapy did not have a significant risk of breast cancer recurrence.

Comment: I think this is reassuring news for clinicians who choose to start methotrexate or anti-TNF therapy in rheumatoid arthritis or inflammatory bowel disease patients with treated breast cancer.


Discover what causes Raynauds Disease.


Your orthopedic surgeon wants to do arthroscopic surgery for your meniscus… better watch out!

Arthroscopic surgery for degenerative meniscus tears increases risk for eventual knee replacement

A recent study published in the journal Osteoarthritis Cartilage showed that patients with osteoarthritis of the knee who undergo arthroscopic surgery for degenerative meniscus tears are at markedly increased risk for potentially having total joint replacement. In the study, 335 patients with osteoarthritis of the knee underwent arthroscopic surgery for degenerative meniscus tears. They were followed for two years.

The authors demonstrated that in patients with knee osteoarthritis, arthroscopic knee surgery with meniscectomy is associated with a 3 fold increase in the risk for future knee replacement surgery.

Comment: Don’t do it if you can avoid it. The meniscus serves of function. It helps to cushion the knee. Any meniscus tissue should be preserved.


Want to hit the gym now. Wait… maybe there’s an alternative… next

A new study says a glass of red wine is the equivalent to an hour at the gym.

Research conducted by the University of Alberta, Canada has found that health benefits in resveratrol, a compound found in red wine, are similar to those we get from exercise.

Resveratrol was seen to improve physical performance, heart function and muscle strength in the same way as they’re improved after a gym session.

According to lead researcher, Jerry Behrens, these findings will particularly help those who are unable to exercise. Discussion over the health benefits of red wine have been well documented. Studies have revealed that those who drink a glass of red wine a day are less likely to develop dementia or cancer, that it’s good for your heart, anti-ageing and can regulate blood sugar.

Comment: And you sweat a lot less too.

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