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FAQs

Office and Appointments

What are your office hours?

Our hours vary from site to site. Simply contact us and we will schedule an appointment for you at the office site that is most convenient.

How do I get to your office?

1. Hospital for Joint Diseases Orthopaedic Offices

303 2nd Ave. Rutherford Place

(patient entrance 240 E 18th Street off of 2nd Ave)

New York, NY 10003

2. Brooklyn Heights Offices

142 Joralemon Street

Suite 14D

Brooklyn, NY 11201

3. Bay Ridge Orthopaedic Offices

533 Ovington Ave

Brooklyn, NY 11209

4. Long Island College Hospital Orthopaedic Offices

97 Amity Street

Brooklyn, NY 11201

Detailed directions with all modes of transportation as well as maps can be retrieved from this web site in the office info section.

Is it possible to fill out forms before I come to the office?

Yes. Click here to download patient forms.

What insurance plans are accepted?

Virtually all insurance plans are accepted. Call 212-598-ORTHO (6784) if you have any other questions. You can also contact us via e-mail through this web site. We will respond to your medical or non-medical inquiries within 1 business day.

What should I bring to my appointment?

Bring your insurance card, a referral from your PCP (Primary Care Provider) if needed (if you have questions about this our office staff can help you). Many patients prefer wearing comfortable, loose clothes such as shorts, instead of the paper gowns available in the office. This allows easy access to the extremities for examination.

How long will it take to get an appointment?

I make every attempt to see patients within 1-2 days of contact with our office. Urgent conditions will be seen sooner.

What types of services are offered through your office?

We provide treatment of all types of orthopaedic injuries. This includes treatment of fractures, sports injuries, complex knee, shoulder and elbow injuries, artificial joint replacement, and cartilage replacement surgery. We also provide rehabilitative services and physical therapy through our offices.

How do I make an appointment at your office?

Call the main office number, which is liked to all of our offices, 212-598-ORTHO (6784) between 9-5pm Monday-Friday to schedule an appointment. After hours, leave a message and we will get back to you next am. You can also e-mail us through this web site and we will get back to you immediately. Please have your insurance card available when contacting us.

Injections

What is a rooster cartilage injection?

A Rooster cartilage injection is an injection of a substance called Hyaluronic Acid that is known as Synvisc and Hyalgan. Such injections are cleared by the FDA. It is used as a lubricant in the knee joints. It is given to patients through a series of three injections that is given over a three week period of time.

Can you please tell me about the injection for knee arthritis to replace your cartilage. What do you think of this treatment?

Hyaluronic acid is a natural component of cartilage and joint fluid. It helps to maintain the structure of the cartilage tissue and also serves as a lubricant in joints. Studies indicate it suppresses joint inflammation. Recently, hyaluronic acid injections have been approved in this country.

The use of hyaluronic acid first was used in veterinary medicine to treat osteoarthritis in dogs and horses. The use in humans has been extensively studied in Europe with reported improvements in overall condition in patients. Clinical trials in the United States showed that some patients experienced pain relief one week after the third injection of hyaluronic acid; for others, it was after the fifth. Pain relief often lasted for six months.

Surgery Instructions

What medications should I stop prior to surgery?

Please consult your medical doctor on what medications should be stopped prior to your surgery. Please discontinue any over the counter meds, as well as herbal supplements 1-2 weeks before surgery. Many medications can interfere with blood clotting below is a partial list of medications that should be stopped before surgery.

1. Aspirin and Aspirin containing products and coumadin need to be stopped 1 week before surgery

2. Non steroidal anti-inflammatory medications (NSAIDS) which include Motrin, Indocin, Nalfon, Naprosyn, Naprelan, Arthrotec, Tolectin, Feldene, Voltaren, Mobic, Dolobid, Lodine, Relafen, Daypro, Advil, Aleve, Ibuprofen should be stopped 48 hours prior to surgery
Please consult medical doctor before you stop any prescribed medication.

You may continue to take the new Cox-2 inhibitor drugs Vioxx, Celebrex, and Bextra up to and through surgery.

How long will I stay in the hospital?

It depends on the procedure performed. For general knee, shoulder, elbow, and ankle arthroscopy surgery, you will go home the same day. For rotator cuff repair and anterior cruciate ligament reconstruction, you will stay for one night. Larger cases, such as total knee and hip replacement, you will be in the hospital 3-5days possibly followed by one week in inpatient rehabilitation. Prior to your surgery, we will give you more detailed information.

What should I wear the day of my surgery?

Wear shorts or loose fitting pants when you are scheduled to have knee or ankle surgery. For shoulder/elbow surgery, loose fitting shirts are excellent.

How long will surgery take?

It depends on the procedure performed. We will inform you of the approximate procedure time. Please remember that the operative time does not include anesthesia time and operating room setup time.

When should I arrive at the hospital?

Prior to surgery, our office staff will inform you of your surgery time and when to arrive at the hospital.

Where should I go for my surgery?

When you schedule surgery through our office, we will inform you which hospital your surgery will be performed at. As a conveience to you, Dr. Jazrawi operates at New York University (Tisch) hospital and Hospital for Joint Diseases in New York City as well as Long Island College Hospital and several other hospitals in Brooklyn. Depending on availability, you may schedule your surgery at either of these hospitals.

What should I be concerned about?

Things to be concerned about are: fevers, draining incision sites, numbness or tingling in the extremity, increased pain in the limb. Please contact us if these problems arise.

How long should I take pain medication?

You will be given a prescription for pain medicine. You should take the medicine before participating in physical therapy and before bedtime. You should try to cut down on the amount of medication taken each day after the operation.

When can I return to work or school?

Your doctor will dictate when you can return to work or school depending on the operation and your speed of recovery.

When do the stitches get removed?

The stitches will be removed in our office, at 10 to 14 days after the operation.

When can I stop using the crutches/ sling?

We will tell you when to discontinue the sling or crutches. This depends on the type of your operation.

Do I use heat or ice after the operation?

After the operation, you should use ice packs intermittently on the site. Never put ice directly on the skin. Use ice for approximately 20 minutes 3 times per day. Ice helps with inflammation, swelling, and pain control.

When do I start physical therapy after surgery?

You will usually start physical therapy within I week after the surgery.

When can I drive after surgery?

You cannot drive until we give you permission to do so. Once given permission you should go to an empty parking lot to practice before getting on the roads.

How do I get prescriptions refilled?

Call the office during working hours (212-598-ORTHO (6784)) or email us with pharmacy telephone number and medication information.

After my artificial joint replacement, do I need to take antibiotics if I have other surgical procedures?

Dental: Amoxicillin 2g by mouth 1 hr prior to procedure

Podiatry: Amoxicillin 2g by mouth 1 hr prior to procedure

Dermatology: Amoxicillin 2g by mouth 1 hr prior to procedure (If penicillin allergic use Azithromycin 500 mg)

Urinary Tract Procedures: Ampicillin 2gm/Gentamycin 80 mg iv 30 min prior to procedure and Amoxicillin 1.5 g by mouth every 6 hours for 2 days

GI procedures: Same as urinary tract

Gynecological procedures: Same as urinary tract

Pap smear, cataract surgery: None

Can I shower after surgery?

You may shower 3 days after the operation. No soaking of the site under water in a bathtub, pool, or whirlpool. Place waterproof dressing over operative site when showering and do not let water directly hit wound until healed.

What is arthroscopic surgery?

Arthroscopy surgery involves the use of a small camera and fiberoptic equipment to look inside your ankle, shoulder, elbow, knee, or hip. The arthroscope is inserted into the joint via small incisions about a _ inch. The arthroscope allows us to work inside joints without performing big incisions decreasing post-operative pain and accelerating postoperative rehabilitation.

Can you explain the incisions made on my knee during knee arthroscopy?

Arthroscopic surgery in the knee generally requires two 1/4-inch incisions. These portal incisions are made on either side of the knee cap. One portal is used to place the cameral in the knee. The other front portal is used to pass instruments into the knee to perform the surgery on the meniscus cartilage.

What type of rehabilitation and physical therapy is required after surgery?

Therapy will usually differ from case to case based on the nature and size of the tear. However, the therapy usually lasts between six to nine weeks where it is divided into three parts. First, the physical therapies that are carried out with the therapist for about three weeks where the patient will have the arm in a sling and with the help of the therapist, he will move the patient’s arm. Then, the active assisted part starts where it would last for the next three weeks, in this part of recovery, the sling will be removed and the patient will get to start doing exercises by him self to maintain the shoulder movement which will help in using the muscles in the area which will speed up the healing process. Finally, the last part of therapy lasts for three weeks as well, it contains some strengthening exercises where the therapist will add some weights to the exercises to build the muscles and gain range of motion faster.

Shoulder

Is it possible to tear a rotator cuff after having a RC reconstruction surgery?

Yes, it is possible to tear the rotator cuff again either due to a trauma or maybe the quality of the tissues were not so great which caused them not to repair or heal.

How successful are the shoulder replacement surgeries?

This type of surgery is very successful. It gets rid of arthritis and allows you to be pain free with regaining of full range of motion which will allow you to go back to your regular daily activities. Studies have shown that this type of surgery has longevity of 15-20 years.

Does shoulder replacement occur?

Yes, even though it is not so common. People who receive such a surgery require conservative care. It is taken place when the x rays shows presence of arthritis that is accompanied with pain. Sometimes only the ball requires replacement, while in other cases the ball and the socket need to be replaced to gain great results.

What is shoulder impingement syndrome?

Shoulder impingement is a term used to describe pain that occurs with overhead movements as the rotator cuff and overlying bursal tissue get pinched between the shoulder blade and ball of the shoulder. There are several reasons why this happens.

Some people are born with a tight space for the rotator cuff tendon and bursal tissue to maneuver. The slightest bit of inflammation in this area will cause pinching of the rotator cuff tendon in this space. Some older individuals develop bony spurs over time, which decreases the space available for the cuff to move resulting in pinching of therotator cuff and bursa by the spur creating pain.

Injections into this space can alleviate the inflammation and increase the available space for the rotator cuff to move. Special X-ray views can view the bony spurs and see if a tight spaces id present. A magnetic resonance image study (MRI) is sometimes ordered if initial treatment is ineffective since it can determine how severe the rotator cuff tendon is being pinched off or if its torn. Arthroscopic surgery is utilized if injections, therapies and anti-inflammatories are ineffective.

How is shoulder impingement treated?

Treating the inflammation should be treated with anti-inflammatory or a cortisone injection. Then the muscles should be treated through rehabilitation and if all fails, and then a surgery should be considered.

What is a frozen shoulder?

Frozen shoulder refers to the medical term Adhesive Capsulitis. It is divided into two different forms, where in the first form, the cause is not known. However, in the second form the cause is usually predicted through an open heart surgery or an injury. This type can be treated by getting enough rest, performing some exercises to gain as much range of motion as possible. If none of the above treatments work then an arthroscopic shoulder surgery may be required.

What types of surgeries are available for correcting an impingement on a rotator cuff tendon?

Most of should pain results from impingements which is caused by a spur that presses on the rotator cuff tendons causing pain. The best way to get rid of this tendonitis is to have an arthroscopic surgery where the spur is removed and the tendons are smoothed. Fixing the rotator cuff by repairing that area will result in reduction of pain which will eventually heal and fade away.

How is a rotator cuff treated?

Non operative care does not usually treat a rotator cuff that may be confirmed by x rays and MRI scans. Performing a surgery to repair the torn area would be performed to repair and reattach the torn area to the bone. Open repair surgery is always more recommended over arthroscopic repair.

What are rotator cuff tears?

The rotator cuff muscles and the tendons control the pivoting of the shoulder joint. The tear is caused when a hole arise in the rotator cuff from trauma or injury. It occurs more often in patients over age forty. Such patients will suffer from pain that elevate after performing overhead exercises and activities. Such pain may lead to limitation of motion and may lead to weaknesses. In addition to pain patients will suffer from shoulder weakness, tenderness and loss of motion

What are some treatment types of a separated AC injury?

Wearing a brace or a sling is the best option till pain is declined. Then start to use the arm as you can. This way the pain will decrease but the separated bone will not be put back in place. Another option is to use a special brace that can hold the collar bone in place. Such braces are not recommended or favored by patients since they require the patient to wear them for eight weeks straight, which can cause some soreness of the skin.

The other option is having a surgery that can correct the AC separation. This procedure requires an incision in the shoulder where bones and ligaments are held together using specific devices, screws and pins. After the ligaments heal, the screws and pins may be removed. Such a procedure is a successful option since it can be done at any time which leads to great results.

I am 17 y/o male and dislocated my shoulder wrestling. I saw a doctor who wanted to operate on my shoulder to fix the torn labrum. What does this mean and do I need the surgery?

Dislocating your shoulder means that you disrupted the normal contact between the head of the humerus (ball) and the glenoid (socket) of the shoulder joint. The age at which you dislocate your shoulder becomes important when considering treatment. The younger you are, the more likely you will re-dislocate your shoulder. Some studies report as high as a 90% chance of redislocation for patients under 20 y/o. The likelihood of you failing non-operative treatment is high. Surgery corrects the problems by repairing the tissue that was torn with the dislocation, the labrum, which acts like a bumper on the socket preventing the humerus (ball) from popping out.

Elbow

Swelling developed in the back of my right elbow several months ago. It is only tender when pressure is applied to it. How do I reduce the swelling?

Swelling in the back of the elbow occurs from a condition known as olecranon bursitis. The bursa is a tissue sac that pads or cushions the tip of your elbow or more specifically the olecranon. The olecranon is the pointed end of the bone in the back of your elbow. When the bursa becomes inflamed from Repeated trauma or friction inflames the bursa resulting in it being filled with fluid. Once the inciting factors are eliminated or reduced and anti-inflammatory medication started, the swelling will usually subside in a few weeks If persistent the fluid can be removed with a needle.

My son is 12 years old and is a pitcher for his Little League baseball team and the quarterback for his football team. He has been complaining of pain on the inside of his elbow and in his shoulder.

This is a very common problem and is directly related to the amount of throwing. It is referred to as Little Leaguer’s elbow and shoulder. It results from the tension forces placed on the growth plates in the shoulder and elbow. Typically the symptoms develop over a period of a few weeks. In most cases a period of rest followed by a supervised throwing program (obtained through our office) with monitored pitch counts is effective in relieving symptoms. X-rays and evaluation by a physician is necessary if symptoms persist.

What is tennis elbow? Do treatments such as bracing, therapy, medications and injections work?

Tennis elbow, or lateral epicondylitis, is the term used to describe pain on the outside (lateral aspect) of the elbow. It is caused by repeated stress on a tendon that attaches to a bone in the elbow called the lateral epicondyle. The tendon initially becomes inflamed followed by tendon degeneration which causes swelling, weakness and loss of motion.

Most patients are helped with anti-inflamatories, bracing, and injections. Greater than 95% of people respond to theses non-operative treatments. Surgery is reserved for those patient failing non-operative treatments. The surgery, when performed under the appropriate conditions, involves removing the degenerative tendon and is associated with a 95% success rate in diminishing pain.

Knee

I was told by friend that magnets helped her knee arthritis pain. Do they work or are they a hoax?

Magnets theoretically work based on two principles. First, blood has an electrical charge. Thus, magnets can theoretically increase blood flow to particular region of the body which speeds up healing time. Second, nerve fibers also have an electric charge. Theoretically, magnets produce an electromagnetic impulse that is thought to interrupt electrical transmission of pain impulses along nerves. While all of this is unconfirmed and theoretical, most people experts agree that magnets are safe. Contraindications include pregnancy, patients with pacemakers or bleeding disorders. Please contact our office if you interested.

I am training for a marathon and I run about 20-30 miles every week. For the past month, I have developed pain in the mid- to distal portion of my shins. The pain is so bad at time that I have to stop running. Do I have shin splints?

The pain you are experiencing in your lower legs could be the result of either a stress fracture, compartment syndrome, or shin splints (MTSS-,medial tibial stress syndrome). Stress fractures are very common among runners. Usually they occur in the proximal or distal thirds of the leg. Symptoms include localized point tenderness and pain, swelling, and increased warmth. Another cause of lower leg pain is tendinitis or inflammation of the outer soft tissue covering a bone called the periosteum (also known as shin splints or MTSS (medial tibial stress syndrome). Exercise-induced compartment syndrome is another condition that causes pain and soreness in the lower leg after running or jogging. Pressure builds in the compartments that contain different muscle groups during jogging causing pain. When one stops running, the pain subsides as the pressure increase dissipates.The pain usually subsides and the pressure dissipates when you stop running. Differentiating between stress fractures, MTSS, and exercise induced compartment syndrome can often be challenging. A good history including reviewing changes in training schedule, evaluating running surfaces and shoe wear is important. Observing the individual walk and run to spot excessive pronation (in-turning of the foot) can help to provide clues as to the source of symptoms. Lastly, studies including x-rays, bone scan, and MRI may be needed to confirm the diagnosis.

I have been concerned about a clicking noise on the in my knee. What is causing this?

Painful clicking in the knee can come from several sources.

  • Plica which is a thickened area of knee joint capsule can be traumatized and enlarge to the point that it pops as it slides over the knee during knee flexion
  • Iliotibial band is a wide tendon that crosses the outside of the knee. Pain and snapping in this tendon occurs predominately in runners and is usally related to running inclines or hills
  • Knee cap sliding out of place can occur when there is abnormal lower extremity alignment.
  • Meniscus tears

Symptomatic clicking and snapping in the knee should be evaluated early as correction may prevent significant injury or damage from occurring.

I heard that there are various grafts that can be used when reconstructing the anterior cruciate ligament (ACL). Can you tell me the pros and cons of each of the graft choices.

The potential graft sources include: patella tendon, hamstring tendons, quadriceps tendon, and allograft tissue. The gold standard for ACL reconstruction has been bone-patella tendon-bone autograft tissue. A bone plug from the knee cap with the connected patella tendon and a contiguous bone plug from the tibia are removed through a small incision. The tendon is then passed through the knee arthroscopically and fixed with screws via the bone plugs. Hamstring tendons are also removed from the same leg that is operated on. The tendons do not have an associated bone plug and are fixed with soft tissue screws and variety of other devices.

Benefits of the hamstring grafts are the minimal amount of morbidity associated with removal of the tendons as opposed to the patella tendon graft which has an increased incidence of pain in the front of the knee associated with kneeling. However, hamstrings lack the secure bone to bone fixation that the bone-patella tendon-bone grafts. However, this has been recently challenged with newer, improved graft fixation devices for hamstring tendons.

It appears that both options are reasonable options at this point. Quadriceps tendon is another option as well with encouraging results. Allograft grafts are harvested form human donors (who have died) and frozen. The freezing destroys a majority of the infectious agents. However, there is still a risk of disease transmission 1:1,000,000. Use of this graft source is controversial because of the infection risk but the benefit is avoiding harvesting the patients tendon.

During the past two weeks, my knee has been catching and will actually lock up for several minutes. What is your opinion?

There are two types of cartilage in the knee. The articular cartilage which is like the shiny white on the end of a chicken bone and the grisel in the joint which are the menisci. They are C-shaped wafers of cartilage that act as shock absorbers in the knee. The torn meniscus can be aggravated with any twisting motion of the knee. A meniscus tear can enlarge to a point where it will fold on itself and lock into position. Loose bone fragments can also cause the knee to lock. Meniscus tears that do not fit the criteria for repair (depends on location of the tear) are then arthroscopically trimmed to remove the torn segments of the tear to prevent further tearing and locking symptoms.

When are you too old to have your anterior cruciate ligament operated on? Can surgery be done if you are over 50 y/o?

The anterior cruciate ligament, or ACL, is an important stabilizing structure in your knee. (especially for cutting sports such as skiing and tennis). In the past, we were less aggressive in reconstructing the ACL in older patients Treatment included avoiding sports that cause the knee to buckle and utilizing a brace for athletic activity and physical therapy. A brace can offer some prevention against instability and buckling.

However, some patients find it cumbersome and it does not entirely eliminate instability. Arthroscopic surgery can restore stability to your knee by reconstructing the anterior cruciate ligament. Age is a consideration, but a relatively minor factor in the decision-making process. If you are healthy, with few arthritic changes in your knee, and have a desire to continue sports but cannot because of your instability, surgery should be considered.

Someone told me ACL injuries are more common in women than men. Is this true?

There are many reasons for this disparity. Women’s participation in sports has dramatically increased since Title IX of the Education Act was passed in 1972 by Congress. More injuries are occurring because you have more girls participating. As the speed, level of play and intensity of women’s athletic play advances, we have seen a 5-to-1 ratio in ACL injuries when compared to their male counterparts (especially in soccer).

Several biomechanical factors are thought to be responsible. A wider pelvis and an increased ability to hyperextend the knee is thought to influence the position of the knee during landing. Men tend to rely more on their muscles to restrain joint forces, whereas women depend more on their ligaments for supporting and restraining forces of the knee.

Researchers think that emphasis should be placed on training techniques to improve the strength and endurance of thigh muscle groups in women to reduce these injuries. Research is under way to develop training programs to reduce the number of ACL injuries in women athletes and to identify factors associated with increased risk for injury.

I was told that the pain in the front of my knee was ”Jumpers knee.” What is this?

“Jumpers knee” is inflammation of the patellar tendon at its insertion to the lower end of the knee cap (patella.) Also know as patella tendonitis, it results from excessive stress on the tendon at its insertion into the patella causing microtears of the tendon itself. These microtears result in an inflammatory response further weakening the tendon. Continued stress can result in further tearing, inflammation and breakdown of the tendon. Inciting factors usually include running. Factors implicated include training errors (most common), differerences in shoes and surfaces, and variations in anatomy. Non-operative treatment, effective 95% of the time, includes anti-inflamatories, a patella protection rehabilitation program, a correction of training errors. Operative treatment, if necessary, requires surgical debridement of the degenerative tendon, stimulating a healing response.

What is Baker’s cyst? And what type of treatments is available for this case?

A baker’s cyst is a symptom where the knee is filled with fluid. The first treatment would consist of knowing the nature of the injury, what is the cause of the swelling, then performing x rays and MRI is very important. The next step may be arthroscopy surgery where any problem inside the knee maybe fixed and repaired.

If a cartilage tear is present during the surgery it will be repaired, and the baker’s cyst will heal on itself. If the cartilage tear is not present then excision of the baker’s cyst will be successful. However, it may recur if it is related to arthritis.

What is a bone bruise?

Bone bruise is caused by an injury to the body that was not sever enough to cause a fracture instead it causes bleeding and swelling inside the bone. Such a bruise can not be seen through x rays, only through MRI.

What types of therapies are required after an arthroscopic knee surgery?

The most recommended exercises following an arthroscopic surgery are flexibility exercises that will help in gaining the range of motion back. Followed by strengthening exercises that includes leg raises, muscle tightening exercises. Stay away from heavy weights not until the patient can raise his legs without difficulties. In addition to the exercise, cold therapy is always recommended over the hot ones that might cause swelling.

What about Chondrotin and Glucosamine?

These are the building blocks of cartilage. While its controversial whether they are efficacious in relieving pain associated with arthritis, I still recommend them as a first line treatment for arthritis. Unfortunately, they are over the counter meds that are poorly regulated with some brands containing very little of the actual medication. Please contact our office and we will be happy to provide you with a list of reputable brands that can be purchased at your local pharmacy.

What is an osteotomy?

When your bones are not aligned properly, they can put increased stress on certain parts of your joints while sparing the rest. An osteotomy is a surgical procedure where we cut the thigh bone or the leg bone and move it to the correct alignment and shift the stress from the arthritic portion of your knee distributing the force across the entire joint and thereby decreases the pain and overall wearing of the joint.

I have arthritis in both my knees It has been recommended that I have knee-replacement surgery. Should both knees be replaced at same time?

Performing both knee replacements under one anesthetic session has gained considerable acceptance. Studies show that when both knee replacements are performed at the same surgery, the complications are not increased compared to replacing one knee at a time assuming the patient does not have significant medical problems Benefits of bilateral knee replacement surgery include a single surgical session and a single rehabilitation period. My approach to replacing both knees is dependent on patient age and medical problems. I discuss with the anesthesiologist how safe it is from a medical standpoint to replace both knees as a patient with multiple medical problems and increased age may have an increased risk of complications with extended surgery. We often make the decision during the surgery depending how the patient is progressing during the surgery.

How long will my knee replacement last?

A knee replacement is made of metal and plastic components. The plastic component usually fails first. The plastic acts as a bearing surface between the metal components and like the treads on a tire wears out with time. The initial knee replacements have a 12-15 year average age of survival with numerous factors influencing final outcome. The newer knee replacements are expected to have better resistance against wear and potentially a longer survival time.

Is it necessary to go to physical therapy after a total knee replacement?

Yes, physical therapy starts the day of the surgery where a physical therapist will aid the patient in walking and making slight movements to prevent any injuries and to reduce pain. He will also show you how to walk by placing the full weight on the new knees, performing light exercises that may include quad sets and ankle pumps that can help in gaining the range of motion. It is very important to stick to physical therapy programs for the first six weeks to three months since it helps patients to perform exercises that will strengthen their knees. The amount and length of physical therapy sessions depends on the amount of pain each patient can bare.

What type of recovery is expected for patients who are diabetic and smokers, who got a knee replacement surgery?

The usual treatment includes a month of walking using a walker, then after a month or two they will start using a cane which will accompany some physical therapy. Being a diabetic and a smoker will slow down the recovery of knee replacement which will lead to a longer recovery period. So it is important to quit smoking and having your diabetes under control before deciding to participate in such a surgery.

Is it normal to have continuous pain after a knee replacement even though the patient had gone through therapy and recovery?

Yes. Some times the pain may last after the surgery due to tendonitis. It occurs when the tendons behind the knee get inflamed causing pain. The best treatment for that is a cortisone shot. Also, pain may occur due to an irritated nerve. Such a case may require removing the nerve.

When is a total knee replacement necessary?

The presence of arthritis determines the decision of the surgery. If the arthritis involves both of the major areas of the knee and pain is still present, then people would request having the surgery. This surgery not only will it get rid of pain but also, it will fix any deformity that may be present to the area such as a bowed leg due to arthritis. After the surgery, patients will be hospitalized for about four to five days, with a rehabilitation time of three to six months, after six weeks you may be able to start some light exercise. Most people will require large amount of blood due to the one they will loose during the surgery, and some nursing home or rehabilitation centers may be beneficial as well.

What is a Repicci procedure?

Repicci procedure is a technique that requires a small incision in the knee where a small metal cap is placed to replace the worn portion of the knee. This wearing off of that piece is caused due to the presence of arthritis in one or more areas in the joint area of the knee. This type of arthritis causes an unbearable pain which results in requesting the knee replacement surgery

What is the best material used for knee replacement surgery?

There are two choices to choose from either titanium or steel. Regardless of the fact that titanium has been considered to be an excellent material used during orthopedic implants, it is clear that it does not work well as a bearing surface when matched with a plastic tibial component. Most orthopedics suggests using cobalt chrome alloy as a bearing surface. The best combination includes titanium for the bone attachment, and cobalt chrome for the bearing surface.

When a knee replacement surgery is recommended?

The presence of knee pain indicates there is a problem with the knee which should be taken in consideration. If the knee pain increases and leads to swelling due to daily activities, it is important to take standing X rays to show which part of the knee is diagnosed with osteoarthritis. If no medication or physical therapy can treat such pain symptoms, then you should visit your orthopedic to discuss surgical and non-surgical treatments which may help you in deciding whether you should be eligible for the surgery or not, based on your pain level, and if such pain is keeping you away from practicing your daily life activities.

What is the difference between a partial and a total knee replacement?

Partial knee replacement is recommended when arthritis is affecting one compartment of the knee either the lateral, medial or between the kneecap and the femur, then the medial or the lateral parts of the knee can be replaced. However, if the arthritis is developed in more than one area, then a total knee replacement will be acquired.

Hip

My 74-year-old mother had a hip replacement in January due to a hip fracture. Four weeks after surgery she began experiencing sharp pains in her thigh. This pain makes it very difficult for her to walk. Could you explain why this pain would suddenly appear four weeks after the surgery? Will it eventually go away?

Thigh pain after hip replacement surgery can come from several sources.

Thigh pain can result from pressure on a nerve at the spine from a herniated or bulging disc as well as a bone spur. Often this pressure is felt in the thigh instead of the back. Scarring around the sciatic nerve as it courses through the back of the hip adjacent to the surgical site can be another source of pressure on the nerve producing thigh pain. The hip replacement may also be the source of your mother’s thigh pain.

An artificial hip is typically made up of a socket and a femoral stem component that fits into the center of the femur. Some artificial hips are secured in the femur with cement. There is less likelihood of thigh pain being produced after surgery when cement is used. When cement is not used, the femoral stem component relies on a tight fit. There are small pores on the side of the femoral stem that allow bone to grow into these small spaces, producing a biologic lock.

This process is very much like healing a bone fracture. If the pain persists beyond six months, it may mean that the healing process is not complete enough to produce a biologic lock. This process is needed to adequately secure the hip replacement. If not, loosening may occur, resulting in pain. Careful follow-up and X-rays can help determine if the healing process is progressing or if the stem component has become loose.

Ankle

I went snowboarding for the first time in February and injured my ankle in a fall. In the emergency room, I was told there was no break, only a sprain. But my ankle still hurts when I push off. Any thoughts as to why I have continued ankle pain?

Ankle injuries are more common in snowboarding than traditional snow skiing. An ankle sprain involves injury to the ligaments, which support and stabilize the joint. Ankle sprains are classified according to the magnitude of trauma to the ligaments. Partial or complete tears of the ankle ligaments that are not properly treated and rehabilitated can result in chronic symptoms of pain and instability. Studies have shown that a high percentage of ankle sprains also involve injuries to the ligaments above the ankle joint.

These ligaments are called the syndesmosis. They hold and stabilize the two bones in the lower leg called the tibia and fibula, which form the roof of the ankle joint.

Ankle pain that occurs when you step and push off is typical of an injury to these ligaments, which we call a ”high ankle sprain.”

If you feel pain in your ankle by squeezing together the two bones in the lower third of your leg, it is likely the syndesmotic ligaments have been injured. Ending your pain symptoms may require treating the injury to the syndesmotic ligaments just above your ankle joint.

Chronic ankle injuries can also result in ankle instability which may need to be treated with a ligament tightening procedure.

I was playing tennis yesterday and as I was chasing the ball, I heard a pop and it felt like someone kicked me in the back of the ankle. I was told I have an Achilles tendon rupture. What is the treatment for this?

The presentation you describe is classic for Achilles tendon rupture. Operative treatment is usually necessary and results in lower re-rupture rate and greater ankle push off strength compared to non-surgical treatment.

Stem cells

Where are stem cells currently being used?

Stem cells are currently being used in both laboratory and clinical settings. Laboratories are using human and animal derived stem cells to conduct in vitro studies as well as in vivo studies with small and large animals. Autologous adult stem cells are currently being used in hospitals and clinics during surgery to aid in the repair of damaged tissues.

Will my body reject the stem cells?

No, adult stem cells are autologous and non-immunogenic.

How do stem cells know what type of tissue to develop into?

The differentiation of stem cells is dependent upon many factors, including cell signaling and micro-environmental signals. Based on these cues, stem cells are able to develop into healthy tissue needed to repair damaged tissue.

For example, multipotent stem cells delivered to damaged bone will develop into bone cells to aid in tissue repair. The exact mechanism of lineage-specific differentiation is unknown at this point.

Are the harvested adult stem cells expanded in a laboratory setting prior to delivery back to the patient?

No, NYU does not use in vitro expansion. The cells are harvested, processed in the operating room and delivered back to the patient at point of care.

Are there different types of adult stem cells?

Yes, there are many types of adult stem cells found in the body that have variable differentiation potentials. The adult stem cells that aid in the repair of damaged tissue are multipotent, mesenchymal stem cells. These are located in bone marrow and adipose (fat) tissue.

How are adult stem cells used in surgical procedures?

Adult stem cells are used to treat patients with damaged tissues due to age or deterioration. During a procedure, stem cells are isolated from the patient, concentrated and delivered back to the site of injury to assist in the healing process.

How does Celling Biosciences obtain adult stem cells for use in cell treatment?

Celling Biosciences currently has systems that rescue adult stem cells from both bone marrow and adipose (fat) tissue. The stem cells are obtained through aspiration procedures during surgery.

Where do adult stem cells come from?

In adults, stem cells are present within various tissues and organ systems, the most common being bone marrow and adipose or fat tissues. Other sources include the liver, epidermis, retina, skeletal muscle, intestine, brain, placenta, umbilical cord and dental pulp.

Are there cancer-causing risks associated with adult stem cell treatments?

No. Where embryonic stem cells have been shown to form teratomas (germ cell tumors), there is no data that suggests adult stem cells have the same potential to promote the development of tumors.

Are there ethical issues associated with harvesting adult stem cells?

No, adult stem cells do not raise ethical questions as they are harvested from the patient’s body.

Does NYU research or use embryonic stem cells in clinical procedures?

No, NYU’s cell therapy systems use only autologous adult stem cells isolated from the patient during surgery. NYU does not participate in embryonic stem cell research or use embryonic stem cells in clinical applications.

What is the difference between adult stem cells and embryonic stem cells?

Adult stem cells are found in mature adult tissues including bone marrow and fat, while embryonic stem cells (ESCs) are not found in the adult human body. ESCs are obtained from donated in vitro fertilizations, which raises many ethical concerns. Because ESCs are not autologous, there is a possibility of immune rejection. Adult stem cells do not raise ethical issues nor pose any risks for immune rejection.

What is Regenerative Medicine?

Regenerative Medicine is a new and advancing scientific field focused on the repair and regeneration of damaged tissue utilizing stem cells.

What are adult stem cells?

Stem cells are unspecialized or undifferentiated cells, capable of two processes: self-renewal and differentiation.

General/Miscellaneous

What is the difference between an MRI and an x-ray?

Only bone or metal can be seen on x-ray. MRI allows the physician to comment on the soft tissue (meniscus, muscles, ligaments) and allows us to determine if these structures are torn. X-rays are better than MRI at evaluating the bony structures.

What is special about the new drugs Celebrex, Vioxx, and Bextra?

These drugs are members of a group of anti-inflammatory drugs called known as Cox-2 inhibitors. They have been shown to be easier on the stomach than traditional NSAIDS(non-steroidal anti-inflammatory drugs) like Motrin. If you have a history of stomach problems or don’t tolerate traditional NSAIDS, these drugs are a good start.

What is Arthritis?

Arthritis is a destruction of a joint such as a knee or a hip. There are different types of arthritis: Osteoarthritis, Rheumatoid Arthritis, Psoriatic, Septic, and Gouty Arthritis.

How is arthritis treated?

There are several different types of arthritis and many ways to treat it. The most common form is osteoarthritis. Initial treatment includes activity modification.

How do I know if I have arthritis?

There are many forms of arthritis, the most common is arthritis. Arthritis occurs when the cartilage covering the bone ends, like the white on the end of a chicken bone, breaks down. The cartilage acts like a cushion for forces that go through joints. Without the cartilage, the bone senses all the pressure and ultimately responds with pain. In addition to pain, there is swelling, stiffness, loss of motion, and potentially crackling and popping when you bend your knee. If you think you have arthritis, please contact the office to schedule an appointment .

What is the difference between Osteoarthritis and Rheumatoid arthritis?

Osteoarthritis is the most common from of arthritis. It is also known as “wear and tear arthritis”. Such a type is caused when the cartilage of the joint wears out due to excessive use in earlier age, old age, or previous injuries that were not treated properly. The first signs of such arthritis are joint pains that get worse with activity; it also gets stiff and swells up due to increase tearing of such joints. The first best treatment of Osteoarthritis is to take some medications to reduce pain. Acetaminophen (Tylenol) is the best pain reliever prescribed. Motrin or Celebrex are also recommended.

Other nutritional supplements are advantageous such as Glucosamine and Chondroitin. The next step is to perform flexibility joint exercises to maintain weight loss. Other modifications that are required to maintain less pressure and weight on the infected area includes using specific type of braces, canes, walkers, wedges or insoles in the shoes. If none of the above treatment plans work, the next plan would include an injection into the joints with either cortisone or hyaluronic acid (Synvisc or Hyalgan). The last treatment option is performing a surgery which could either be an arthroscopy, uni-spacer placement, joint replacement or osteotomy.

On the other hand, Rheumatoid arthritis is known as an auto-immune disorder where the body attacks the lining cells of a joint. It is an inflammatory arthritis where pain and swelling of the joints takes place.

What is a joint replacement surgery?

It is a procedure where the surface of the joint is removed and replaced with mechanical parts, such as allograft, plastic, metal or ceramic parts. Such a technique is widely used to replace hip and knee joint replacements, and it is also used to replace ankle, elbow, shoulder, wrist, fingers, toes and other joints. Surgeons advise patients who have deteriorated joints to seek such a surgery to reduce pain.

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