Your Knee Your Health

I will share with you what we talk about in the operating room.

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A mini-podcast series on the operating room - what really happens

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Dr. DeCook wrote "The general public would be aghast if they knew that often surgeons and staff who had never worked together before start doing cases together for the first time."

Here I share my thoughts on team, inattention blindness, turnover times and more.

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I wanted to share some statistics and personal experience with suicide and other stress factors.
If you need help please ask for help over and over if you have to.
If you notice someone is in trouble do everything you can to get them the help they need.

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Supplementing with essential amino acids (EAA) after total knee replacement may be helpful. Two studies have shown that supplementing with EAA for one week before and two weeks after surgery, patients had less atrophy of their muscle and it improved outcomes.

Check with your doctor to see if these might be beneficial for you.

The two brands I recommend to my patients are:

Thorne - https://amzn.to/3EiFTWA

Pure Encapsulations - https://amzn.to/38JnI0q

The two articles:

Essential amino acid supplementation in patients following total knee arthroplasty by Hans Dreyer in The Journal of Clinical Investigation in 2013

and

Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty by Hideki Ueyama in The Bone and Joint Journal 2020

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Here I will discuss how knee pain treatment can be similar to the treatment of back pain and how knee surgery recovery is not like the recovery from back surgery.

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Pete Egoscue is a Vietnam vet who had suffered from chronic pain. In the 1970s he devised a method to change postural imbalances with "E-cises" and this has helped many people reduce their chronic pain.  He has a number of books where you can read about his method.

There are over 30 Egoscue Clinics in the United States so you may be able to find a trained specialist in your area if you think this method may be helpful for you.

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This is a common question many patients have - can I do too much?

It depends. It is rare to do so much that you harm yourself. On average you should see less pain, less swelling and better function.

If you are ahead of schedule and have more symptoms back off 10%. But if you are behind, even though you are having more pain, you may need to push harder.

This is where your therapist and care team come in handy. By working with you they can guide you on how to balance your symptoms and your recovery.

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So many patients are coming in with the same story. Due to covid they have gained weight and stopped exercising. We are now seeing patients with pain and it got worse when they tried to go back to the gym. Others are struggling with losing the weight they gained during the past two years.

Here I will share what I am seeing and the things I have discussed with my patients.

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I have been reading and learning more and more about CBD lately. I am excited for all of the research that is beginning to come out. The ACES (Advancing Cannabinoid Education & Science) Trial is scheduled to be released in a few months. I have talked with the founders at Corganics who produce CBD in three forms with a very stringent process with third party testing. A quarter of products on the market have no purity testing and almost a quarter contain THC. You need to be cautious and aware of what you use and what you buy to make sure that it is safe for you.

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Covid is once again ravaging the world and the healthcare systems that people depend on. The United States spends more per person than any other country in the world yet the US does not have the best health metrics.

Covid has not helped. Hospitals are overwhelmed. Doctors, nurses and other hospital workers are at the breaking point. PPE is still limited. Elective surgeries are cancelled. Wait times are longer than ever.

The future is bleak. Many have left the profession of healthcare. I doubt many people will look eagerly to enter medical school, nursing school or some other hospital based profession. Patients will still need care. The ability to access care will be compromised. Wait times will be longer. Patients will suffer. The future is coming but it will be different and the effects of covid will leave a stain on healthcare systems for a long time.

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I am happy to share with you my new book THE KNEE BOOK - A GUIDE TO THE AGING KNEE

In the book you will find answers to all of the questions you may have about your knee symptoms.

Chapters cover knee symptoms and imaging, exercise and weight loss, over the counter treatments and surgical treatments such as arthroscopy and knee replacement.

You can find the paperback book on Amazon or through this  link:
https://www.amazon.com/Knee-Book-Guide-Aging/dp/B09NKWMYFN/ref=sr_1_2?crid=3BSKDJRI44D9G&keywords=the+knee+book&qid=1639946441&sprefix=the+knee+book%2Caps%2C144&sr=8-2


And an ebook version is available here:
https://www.amazon.com/Knee-Book-Guide-Aging-ebook/dp/B09NLL58LG/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1639946441&sr=8-2

Available at Barnes & Noble as a Nook here:
https://www.barnesandnoble.com/w/the-knee-book-a-guide-to-the-aging-knee-adam-rosen/1140795276?ean=2940161052846

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Total knee rehab is a long journey for many. It can be scary if you do not know what to expect. Here I will share what is common at one month and three months on your road to recovery after a total knee replacement.

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Some people are born with a leg length discrepancy. Some have an injury, like a fracture, which can lead to the limb being short or long. Many patients with arthritis will have the leg shorten, even if they are not aware of it. At the time of surgery the goal is to fix the knee or hip and make it stable. Patients may feel long after surgery. For many this resolves in a number of weeks. Some may continue to feel long, especially if they have spine issues. Sometimes to make the hip or knee stable the leg may have to be lengthened on purpose otherwise the knee or hip would be unstable which could lead to problems such as a dislocation

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Antibiotics before the dentist is a debate that has gone back and forth for decades between the AAOS and the ADA. Listen in on my take on antibiotic prophylaxis for joint replacement patients.

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Here is my summary of the AAOS (American Academy of Orthopedic Surgeons) Clinical Practice Guidelines on Management of Osteoarthritis of the Knee (Non-Arthroplasty) 3rd

1. Not Recommended
a. narcotic medication
b. viscosupplements (hyaluronic acid)
c. arthroscopic washout
d. orthotics
e. interposistional devices

2. Should Help
a. oral or topical Nsaids
b. acetaminophen
c. patient education
d. self management / supervised exercise

3. May Help
a. cane
b. brace
c. oral supplements (tumeric, ginger, glucosamine, chondrotin, vit D)
d. weight loss
e. neuromuscular training, manual therapy, massage
f. cortisone injections
g. PRP injections
h. denervation
i. menisectomy if other conservative options have failed
j. osteotomy

you can read the full guidelines here:

https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-knee/

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The Female Athlete Triad
First described in 1992

1. Amenorrhea
2. Osteoporosis
3. Disordered Eating

It is really important to make athletes, parents, trainers and coaches aware of this triad. Usually a stress fracture may be the first presentation of these disease pattern.

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When you have elective or scheduled surgery it is important to be as healthy as you can to reduce the chance of a complication. We call this process optimizing a patient for surgery. Here I will talk to you about what we look for and why it is important.

There is a great risk tool you can use to look at your risk at the time of total joint replacement from the National Joint Registry in the UK: https://jointcalc.shef.ac.uk/

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Carpal tunnel syndrome is a condition where the median nerve is compressed at the wrist. This can lead to pain, numbness and weakness.

Find more information at AAOS: https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome/

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Low back pain is the most common disability worldwide.
LBP is the leading cause of missed days of work.

AAOS home exercises - https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_spine.pdf

Egoscue - https://www.egoscue.com/

Spine Zone - https://www.spinezone.com/

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I am sure there are other families who have had disagreements about whether or not to get vaccinated. My little brother has yet to get vaccinated. 

If you listen to this episode little brother, these are my thoughts behind why I believe you should get vaccinated against Covid-19.

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Hip fractures occur about 300,000 times per year in the United States.
There is approximately a 5% risk of death in the hospital when you are admitted with a hip fracture.
Many patients may lose a function grade and require a cane or walker even after successful treatment.
You may prevent the risk of a fracture by being checked and treated for osteoporosis, checking your home for things which can increase the chance of a fall. Exercises which focus on balance can help reduce the risk of a fall. And, getting your eyes checked may help vision related issues which can lead to tripping and falling.

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This episode contains a lot. Physician burnout rates of 42% and a physician shortage of 100,000 by 2034 and the forth wave of covid. Sit back and listen in on my opinion of it all.

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Shoulder pain results in two million doctor visits per year in the United States. People can have should pain for many reasons. One common reason is a rotator cuff tear. Here I will go over what the rotator cuff is, what symptoms you may have and what treatment options are available.

Here is the link to the home exercises I spoke about in this episode: https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_shoulder.pdf

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A number of employers have travel programs. This is a program where if you need a spine surgery, bariatric surgery or joint replacement you may be sent to a center outside of your home area. I have been involved with a program like this for a few years. I hear a number of misconceptions when I talk to doctors and patients. Here I want to share what I have learned over the past few years caring for a number of patient through a travel program.

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Elbow pain can occur. It is common in tennis players and it typically occurs on the outside part of the elbow. It is called lateral epicondylitis. It can occur on the inside, commonly referred to as golfers elbow. Golfers get medial epicondylitis.

Most people can get better with non-surgical care. Rest, otc medications and stretching helps. Changing your grip can make a difference.

Occasionally your doctor may offer an injection of cortisone or PRP.

Some patients who fail 6 to 12 months of non-op care may benefit from surgery.

AAOS home exercises:

https://orthoinfo.aaos.org/globalassets/pdfs/a00790_therapeutic-exercise-program-for-epicondylitis_final.pdf

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A knee dislocation is a severe traumatic injury. It can tear multiple ligaments and injure blood vessels. It is an emergency.

More commonly people will have the knee cap dislocate. This is a patella dislocation. It can be painful and cause problems. Here I will review the anatomy and the injury to help answer some of the questions you may have about this injury.

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Tai Chi and Qi Gong are  ancient forms of exercise that can improve flexibility, strength, balance and stability.

From the NIH:
https://www.nccih.nih.gov/health/tai-chi-and-qi-gong-in-depth

Tai Chi Wellness Center in San Diego:
http://www.taichimasterhenry.com/

Qi Gong on YouTube:
https://www.youtube.com/watch?v=cwlvTcWR3Gs

Tai Chi on YouTube:
https://www.youtube.com/watch?v=cEOS2zoyQw4

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Insurance companies and health care institutions are commonly non-for-profit yet record earnings in the billions.

You doctor may, in their medical opinion, order or recommend a test, medication or surgery. This treatment may be held up or denied by the health care institution or insurance company.

Here I am going to walk you through the process and more importantly help you with what information I would recommend you put into an appeal letter to your insurance company if you have to fight their denial of care.

The article in the San Diego Union Tribune:
https://www.sandiegouniontribune.com/news/watchdog/story/2020-11-14/scripps-health-executive-compensation-use-of-hospice-donations-called-into-question

Information on Health Insurance Companies Profits:
https://www.nytimes.com/2020/08/05/health/covid-insurance-profits.html

https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports

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SIBO or small intestinal bacterial overgrowth is an abnormal amount of bacteria in the small intestine. It can occur after surgery or in patients with celiac disease, crohn's disease, diabetes, scleroderma or simple aging. Symptoms vary and may include a feeling of fullness, bloating, loss of appetite, weight loss and malnutrition. Testing may be needed and your doctor may prescribe an antibiotic to reduce the overgrowth of bacteria.

Please talk with your health care provider if you are having any of these problems.

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The EMR is unfortunately here to stay.
Your information is yours and you should have access to it.
A computer system is at risk of intrusion.
The EMR at one institution does not always talk, or share information, with other institutions.
Make hard copies of your records.
Keep a file of labs, studies and implants.
Regularly update a document with allergies, medication and surgeries.

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So many people I meet are worried about their meniscus tear. Meniscus tears are a normal process of aging and are normally seen in arthritic knees. Meniscus tears in older patients do not heal and can not be repaired. Here I will try to discuss meniscus tears, the treatments and workup. I will also discuss when surgery is performed and its chance of success.

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Neck pain is common. In 2013 1.8% of health care visits were for neck pain, that is over 21 million visits.

Neck pain can be caused by sleeping wrong, poor posture, stress, computer time, and after exercise.

Severe neck problems can be from arthritis or disc problems. Occasionally a heart attack can present as neck pain. Infections such as meningitis can present as neck pain.

If you have severe pain, numbness, weakness, balance issues, fevers you should seek out medical care immediately.

The common home options for your run of the mill stiff neck
1. ice and/or heat
2. OTC medications or ointments
3. Stretches
a. forward bending (flexion)/backward bending (extension)
b. side to side
c. rotation
d. forward and backward
e. hug stretch

Try using a heating pad for a few minutes before your stretches
Try to stretch every hour or two while you are awake.
Try a new pillow.
Adjust your desk or computer to improve your ergonomics
Improve your posture. Check out the UpRightGo.

Always talk to your health provider to make sure that any exercise or treatment is safe and appropriate for you.

Support the show at https://WWW.PATREON.COM/YOURKNEEYOURHEALTH

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I like knees and if I enjoy the complexity of performing total knee replacements.

But, I also do total hip replacements. That surgery has great outcomes. So many patients have questions about what approach is used. Here I will try to explain the similarities and differences between the approaches and briefly go over what a total hip replacement is.

As always, talk to your health provider for specific details on the surgery, your options and a discussion of the risks and benefits of any intervention.

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Dogs and cats. Many people have pet dogs and pet cats. Occasionally those animal bite.

Animal bites can be a big problem and many times people do not think they are a big deal until it is too late and there is a bad infection.

Here I will share the information on animal bites, seeing your healthcare provider or ER, and the importance of washing the wound, the use of antibiotics and the possible need for tetanus or rabies shots.

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Doctors and surgeons are not just created they are trained over time. Friends and family ask me if they should go to a teaching hospital. What is a medical student? An intern? A resident or fellow?

Do they do the surgery or are they just watching?

Here I will try to explain what their roles are and what questions you might want to ask your doctor about who will be involved in your care.

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Sciatica is a common complaint affected roughly 40% of people in their lifetime.

It can be caused by inflammation, irritation, disc problems, arthritis, tumors or more.

Mild symptoms like mild pain, tingling, aching can usually be treated at home.

Anything more severe should be evaluated by your doctor or healthcare provider.

Weakness or loss of bowel or bladder (incontinence) is an emergency and you should go to your local ER.

Ice, heat, OTC meds, stretching and strengthening can help.
Your doctor may send you to PT or orders tests such as an x-ray, MRI or EMG.
Rarely surgery is required.

Here is a link to the stretching book I recommend to many of my patients:
https://www.amazon.com/gp/product/0936070846/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0936070846&linkCode=as2&tag=dradamrosen20-20&linkId=76f92d2cbb506b533cc55cd09af8e2ec

And this is a great stretching strap for the hamstring:
https://www.amazon.com/gp/product/B00065X222/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=B00065X222&linkCode=as2&tag=dradamrosen20-20&linkId=ec63e2bafba991fdcbf2cf1378f9167e

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Sex is a normal human activity. It can improve your health, lower depression and anxiety, boost your immune system even decrease pain.

More than 50% of people have pain with sex due to hip arthritis.

Although the risk of dislocation after total hip replacement is about 2% it is a real fear for many patient after surgery. It is a concern for many as to when it is safe to resume sexual relations with their partner.

Here I will go over what I discuss with my patients to help you better understand returning to sexual relations after surgery.

Here is the link from the American Association of Hip and Knee Surgeons on their 'Guide to returning to sexual activity following Hip or Knee replacement sugery'

https://hipknee.aahks.org/wp-content/uploads/2019/01/sex-after-joint-surgery-AAHKS.pdf

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Please, please, please, if you use these medications check with your health care provider to make sure that based on your health conditions or medications that these drugs are safe for you to take.

NSAIDs or Anti-inflammatories
1. ibuprofen (Motrin, Advil) - 200 mg
2. naproxsyn (Aleve) - 220 mg

These can cause GI upset, bleeding, cardiovascular disease and kidney disease.
AVOID if you are on a blood thinner such as coumadin, plavix, pradaxa, eliquis, xarelto, etc.

Pain Reliever
1. Acetaminophen (Tylenol)
a. regular strength - 325 mg
b. extra strength - 500 mg
c. arthritis strength - 650 mg

AVOID if you have liver disease
Caution if you are taking along with pain pills such as percocet, norco or vicoden as they also contain acetaminophen

Combo Pills
1. Advil 125 mg + acetaminophen 250 mg

Topical 
1. diclofenac gel (Voltaren)

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One of the most common questions people have: it is broken or fractured?

Here I will go into breaks and fractures (they are the same thing) and how we treat them. You will hear more about vitamin D and osteoporosis and ways to prevent falls.

Check out the AOA Own the Bone website:
https://www.ownthebone.org/

You can check out my YouTube channel here:
https://www.youtube.com/channel/UCKcQmqjLERWxmotqLpCh4Lg

https://WWW.DRADAMROSEN.COM

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I love the outdoors, the quiet, the smell and the peacefulness.

The Japanese have a word for this Shinrin-Yoku which roughly translates to forrest bathing. It has been shown to lower blood pressure, improve your immunity and decrease stress.

Use your senses to embrace everything around you - listen with your ears, look with your eyes, smell with your nose, use your mouth to taste the fresh air and feel with your hands and feet.

You can find more in the following books:

Forrest Bathing by Dr. Qing Li

https://www.amazon.com/Forest-Bathing-Trees-Health-Happiness/dp/052555985X

and

Connect with Nature the Norwegian Way by Oliver Delurie

https://www.amazon.com/Friluftsliv-Reconnect-Oliver-Luke-Delorie/dp/0711251428

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Every 3 minutes a person in the United States is diagnosed with a blood cancer.

Every 9 minutes a person in the United States dies from a blood cancer.

Maybe you have been diagnosed or know someone who has been diagnosed with a blood cancer.  I wanted to give a brief overview of lymphoma and leukemia.

The Leukemia and Lymphoma Society raises money to help research to find a cure for these diseases. Consider donating to help their cause.

The Leukemia and Lymphoma Society: https://www.lls.org/

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When I was growing up my family doc was a DO.
I graduated from DO school in 2000.
I still get questions from patients about what a DO is or how it is different from an MD. Here I will answer all of your questions about osteopathic medicine as well as a bit of history lesson on where osteopathic medicine came from.

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I received my second Pfizer Covid-19 vaccine on Friday.  Here I will update you on the statistics which show an exponential rise in cases, especially here in California.

Although my first shot was not bad at all my second shot did affect me for about a day. Listen in and hear more.

Stay safe

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We are in the middle of the worst viral pandemic we may ever see in our lifetime and two vaccines have been approved for use by the FDA.

I have had lots of questions from patients, friends and family members.

Here I am going to very briefly go over the long history of vaccines and then do my best to very simply describe the DNA to RNA to protein pathway and what mRNA is and does.

I will also review the similarities and differences between the two current vaccines available in the US.

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Patients commonly ask "What is the best Total Knee Implant?"

The honest truth is we don't have one. There are differences but no study has proven that one design is superior - otherwise one knee would be used worldwide for every surgery.

Here I go into detail about some of the differences in designs and the thought process a surgeon may have for what they choose to use.

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As a student in medical school I was taught very little about celiac disease. When I was diagnosed with celiac disease I learned a lot.

Here I will discuss celiac disease, non-celiac gluten sensitivity and a gluten free diet.

As I discussed in this episode here are some great resources:

Celiac Disease Foundation - http://WWW.CELIAC.ORG

Alice Bast and Beyond Celiac - https://www.beyondceliac.org/

Peter Bronski - http://nogluten-noproblem.com/

Gluten Dude - https://glutendude.com/

Artisan Bread in 5 - https://artisanbreadinfive.com/2015/03/03/gluten-free-bread-in-five-minutes-a-day-the-video/

My blog which is in need of a big time upgrade - http://ungluten.blogspot.com/

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This is a common question that I get "Am I too old?"

Age is a factor.  There are some healthy 90 year olds and some really sick 60 year olds.  There are risks that we worry about so a screening by your medical doctor is important to make sure that you are optimized for surgery.

Total knee replacement in older individuals can improve pain and quality of life.

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Another common question I am asked is how much pain will someone feel after total knee replacement surgery.  Here I will review some of the common things that I go over with my patients who have this very same question.

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I have talked previously about the use of a cane and the use of stairs.

But still one of the most frequent questions I get in the office is regarding the use or the fear of using the stairs after surgery.

Here I will go over the things I explain to many of my patients in the office when it comes to using the stairs after surgery.

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It is normal to feel anxious and it is normal to feel depressed.  Those emotions are felt by everyone from time to time.

I will go over some of the differences between feeling anxious and having an anxiety disorder.  Similarly, I will review the differences between feeling depressed and having clinical depression.

At times some people may feel suicidal.

Please get help if you are feeling this way.  People are available and want to help.
Reach out to friends or family members.

Call the suicide hotline to speak with someone 1-800-273-8255

https://suicidepreventionlifeline.org/

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Diabetes  is the 7th leading cause of death in the US.  Diabetes is the most common cause of non-traumatic amputation.  Diabetes affects 34 million Americans and costs around $325 Billion dollars a year.
Yes, Billion with a B.
Here I will go over the two common types of diabetes and what things to look out for if you have diabetes.
You should always know if your diabetes is under good control.  A lab test, HgbA1c, can help you understand if your diabetes is under control.
It is important to always care for your feet and see an eye doctor for regular checkups.

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I was taught to never talk about politics, abortion or religion.

Well, the only thing people are talking about now is coronavirus and politics.

With the upcoming election it made me think about the running of a candidate, the characther of a candidate and the platform that he or she runs on.

Here is just my two cents on the process.

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America makes up 4% of the world population, yet Americans consume 80% of the worlds narcotics.

Orthopedic surgeons only prescribe 8% of those narcotics when it comes to arthritis.  Other providers, PCP's and ER docs, prescribe 92% of the narcotics given out for arthritis pain.

Most studies show that for fractures and minor surgery you should not use narcotics for more than 72 hours.  And for major surgery the narcotics should not be used for more than 2 weeks.

This is not to say that you should suffer and take nothing.  There are alternatives to narcotics when it comes to treating pain.

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Many patients think we cut out a huge portion of the knee and drop in a hinge.  Although we have tools to do that, that procedure is typically reserved for tumors.  Here I will try to explain to you what the actual steps are during a total knee so that you understand what occurs during a typical surgery.  Your surgeon may do things differently so it is important to have good informed consent prior to undergoing surgery.

Here is a YouTube Video with photos of what I have described:
https://www.youtube.com/watch?v=wlbfsZUKYMw
https://www.youtube.com/watch?v=wlbfsZUKYMw

People also wonder how much a total knee replacement weighs.  We studied that and here is the answer:
https://www.youtube.com/watch?v=S8L9BWaRDEc
https://www.youtube.com/watch?v=S8L9BWaRDEc

This is a video on what happens specifically to the kneecap during surgery:
https://www.youtube.com/watch?v=_bWxkq6M-uU
https://www.youtube.com/watch?v=_bWxkq6M-uU

WWW.DRADAMROSEN.COM

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The achilles tendon is an important part of your leg.  Here I will discuss the common problems that people face - tendinitis, tendinosis and ruptures.

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I have heard a number of people tell me that they were never shown their x-rays or that their doctor did not go over their x-rays with them.  Here I want to go over the common things I look for and explain to you what I commonly see with arthritis.  I hope that this may give you a better understanding of what someone explained to you about your knee or it may give you a bit of information before you go to see your doctor and go over your x-rays with them

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Leg pain can be due to many causes.  Here I will try to explain to you what claudication is and what the difference is between vascular claudication and neurogenic claudication.

If you have symptoms like this contact your health provider so they can better evaluate and treat you.

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In my first episode I shared a few analogies that I use to help explain to people what they may feel in their knee.  In this second part I review those first analogies briefly and offer you a few more to help explain what you may feel or hear coming from your knee from time to time.

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I find a number of people that are resistant to see physician extenders such as PA's or nurse practitioners.  These health care providers may not have gone to medical school but they are knowledgeable.  At times you may be surprised at the great care you can receive from, sometimes with less of a wait time than it takes to see a surgeon.  Although they can not perform surgery on you a physician extender can evaluate, diagnose and treat your problem.

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Pain on the bottom of your foot can be disabling.  People with plantar fasciitis describe that painful first step.  Here I will review plantar fasciitis and some simple things you can do to improve your symptoms.

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There are a number of people with knee pain that suffer from weak hip muscles.  The gluteus muscles, the minimus, medius and maximus, have important functions for the hip, knee and gait.  A weak gluteus can cause knee pain and even increase the risk of an ACL rupture.  Many times strengthening the hip muscles can improve knee pain and knee function.

Always check with your healthcare provider prior to beginning any exercise program.

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I commonly get asked by friends or family members around the country who they should see.  I encourage my patients to ask me if I am the right surgeon for them.

It is very important to find a surgeon that performs a high volume of total knee replacements each year.  Although there may be some excellent highly skilled surgeons that perform every procedure well, studies do show that those that perform more have better outcomes and lower complications rates.

You want a good technician but you also want to feel comfortable with the doctor and his staff.  There will be a lot of information and data and questions that may come up around the time of your surgery.  You need to be sure that beyond the actual procedure that the doctor and his staff is accessible and that they can care for you appropriately.

In this episode I will go into a few other items such as online statistics which need to taken with a grain of salt unless you can verify the statistical accuracy of the data.  I will also let you in on who I think is one of the best people to ask in your town when it comes to finding out who they would recommend you have perform your total knee.

The American Association of Hip and Knee Surgeons is a great resource for information and a doctor finder for surgeons who are members. - http://www.aahks.org/

You can jump right to their doctor finder here - https://findadoctor.aahks.net/



https://www.DrAdamRosen.com

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In episode 1 I talked about some basic introductory exercises.  In this episode I go over how to start a regular exercise program.

CAUTION: Check with your health provider before beginning any exercise program.

I believe starting slowly decreases the chance of injury and creating a habitual time to exercise prevents you from missing a day.  Once you can do a good amount of exercise start cross training to keep it fun but to work different muscle groups.

Many people find after regular exercise they stand taller, walk better, sleep better and more.  Find a work out partner and start a healthy program.

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As we age we are at risk of health conditions that can affect our balance.  Poor balance can lead to falls.  It is important to be sure that your home is free of hazards which could increase the risk of a fall.  A balance class or working with a therapist is a great way to start improving your balance and potentially preventing a fall in the future.

As with any program check with your health provider before starting a new exercise program.

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Stretching is so important for the health of our muscles.  You may have one or more muscle groups that are extremely tight.  Daily stretching helps improve the elasticity of your muscles.

The most common book I recommend to my patients is "Stretching" by Bob Anderson.

Here is a link to the book on Amazon :

https://www.amazon.com/dp/0936070463/ref=as_sl_pc_qf_sp_asin_til?tag=dradamrosen20-20&linkCode=w00&linkId=cd978fa288de370279a6c55f739f7770&creativeASIN=0936070463

As with any activity check with your health provider to make sure that it is safe for you to participate.

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Constipation is a common problem after surgery but it is also a common problem with many people on a daily basis.  One of the biggest reasons is that we do not eat enough fiber.  Here I will discuss some common things that may help you prevent constipation.

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People commonly mix up gout and pseduogout.  Here I will talk about the two problems and what happens when the attacks occur.

I'll review how your healthcare provider will diagnose and treat the two conditions.

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I believe that we should all have access to universal health care.  Insurance tied to your employer is a problem when millions of people lose their job.  No one should go bankrupt simply because you were sick.  Here I will share my beliefs and offer my two cents on how we can keep people covered.

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The knee may look swollen or actually be full of fluid.  The fluid can be an excess amount of the normal knee fluid or occasionally blood.  After surgery the knee may look full or look swollen due to scar tissue.  Here I will review some of the common causes of knee swelling and things that you may be able to do to help your symptoms.

Always check with your health provider before starting any treatment or taking any medication.

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People commonly complain of having a knee that is unstable or one that gives out.  There can be subjective instability where the knee joint is stable but feels like it will give way or it actually does buckle. There is subjective instability where ligaments are actually torn or stretched.  The causes and treatments depend on the cause of instability.  Here I will try to answer the common questions surrounding knee instability.

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There are some patients who will have knee pain without a knee problem.  They may present to the doctor, have x-rays of their knee, and maybe even receive some treatment directed at their knee.
In some people the pain can be referred pain from the hip.
Hip arthritis commonly occurs in the groin but occasionally people will feel the pain radiate down their leg to their knee.
Here I will discuss some the symptoms or things to look out for if your knee pain is actually due to hip arthritis.

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I get this question a lot.  Am I a candidate for a partial?  There are a number of very specific factors that a surgeon has to look at when deciding if you are a candidate for a partial total knee or if you would be treated better with a total knee.  Each has its pros and cons.  Here I will discuss some of the things relevant to the question - Partial versus Total?

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Anterior knee pain is a common problem.  This has also been referred to as chondromalcia patella or patello-femoral arthritis.  Here I will discuss some common things that you can do to help improve your symptoms.

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Many patients have questions about why their knee may be bow-legged or knock-knee'd.  Here I will explain what that is and why it happens.

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Ever get sudden knee pain.  Occasionally you can have a pain which is sharp, painful and scary.  Here I will talk about some of the causes and when to seek out care from your healthcare provider.

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Do you smoke?  Know someone that smokes?  Quitting is hard.  There are support groups and your healthcare provider can help.  Here I share my tips that I have used with my patients over the years in helping them quit the habit.

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Pain in the front of the knee is common.  One of the causes may be tendinitis.  Here I review quadriceps tendinitis and patellar tendinitis and options you can use to treat your symptoms.  Occasionally when symptoms are severe or persistent your health care provider may need to immobilize your knee or refer you to physical therapy.

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Once of the most common questions I get it what exercises are good for someone with knee pain.  My most common reply is "get on your bike."  A bike is a great low-impact way to improve range of motion, strength and your general health.

You can use a stationary bike or a regular bike.  E-bikes are a great option if you have a lot of intimidating hills where you live.

As with any exercise program, check with your health care provider to make sure that it is safe for you to participate.

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Educating patients on what occurs after a total knee replacement is extremely important.  I believe that you should be aware of what is common after a total knee and that you have realistic expectations going into the surgery.  Here I will go over some common things that you may have after a routine total knee surgery: a scar, warmth, clicking, numbness and difficulty kneeling.

https:www.rosenhipandknee.com

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I do not believe in "diets" because they tend to be a short term fix.  People finish their "diet" and go back to their old habits.  I prefer that people make slow changes and substitutions in what they eat.  This allows a better choice of food and the ability to make long term changes.  Eating whole foods is a good start as opposed to processed foods.  Eating a plant based diet or at least less meat if you are a regular meat eater.  This is better for your health and the health of the planet. And eat locally.  Support your local farmers, the food is fresher and it rotates with the seasons.

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The swelling you get behind your knee has been coined the Baker's Cyst after Sir Morton Baker who first described it in 1877, over 100 years ago.  Treatment recommendations for typical cysts are compression, ice, elevation and anti-inflammatories.  Occasionally they are drained or injected with cortisone.  Most commonly the knee is swollen due to underlying arthritis.  Here I will try to give some information on the popliteal cyst and treatment options that you can use.

Always check with your health care provider before instituting any treatment.

Here you can find a link to my website with a printable information sheet:

https://www.rosenhipandknee.com/pdf/bakers-cyst-6Nov17.pdf

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We are what we eat.  What we consume can directly affect our health.  There are a number of questions surrounding certain foods and their reported health benefits.  Here I will discuss what I have discovered about three common food type products and what effects they may have on your health.

Always discuss with your health care provider before using supplements or food products which could affect your health or interact with medications that you may be taking.

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Bursae are sacs located around the body to reduce friction.  Occasionally, inflammation can develop and you then have bursitis.  Knee bursitis can be painful and problematic.  Typical treatments such as ice, compression and anti-inflammatories can help.  Occasionally your health care provider may need to aspirate or drain the fluid.  In certain cases, such as infection, surgery may be required.

https://WWW.ROSENHIPANDKNEE.COM

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You skeleton is an important part of your body and good health can help prevent bone loss, known as osteoporosis.  Here I will touch on osteoporosis, vitamin D and ways to improve your bone health.  It is also important to avoid poor eating habits, excessive alcohol and smoking as they have been linked to poor bone health.

Discuss with your health care provider to determine what tests you may need to assess your bone health such as vitamin D levels or a bone density test.

Below are some links to where you can obtain more information about osteoporosis:

1. National Osteoporosis Foundation - https://www.nof.org/

2. National Institute of Health - https://www.bones.nih.gov/health-info/bone/osteoporosis/overview

3. AAOS - https://orthoinfo.aaos.org/en/diseases--conditions/osteoporosis/

4. Own the Bone - https://www.ownthebone.org/

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The MRI is one of the most over-utilized tests.  Yes, an MRI is a great test to look at certain structures such as the ACL and meniscus.  It is an excellent test if you suspect a fracture that is not seen on x-ray.  In an arthritic knee the meniscus is commonly torn as a process of the degeneration associated with arthritis.  For that reason the MRI rarely adds any additional information.  When patients read the report they do commonly get concerned about all of the things that are wrong, torn or degenerative.

The best, first line, radiological test for evaluating a painful knee is a plain x-ray.  If trauma and a fracture are not suspected it should be weight bearing or standing.

If you see your healthcare provider don't demand an MRI.  If an MRI is justified based on your exam, history or diagnosis they will most likely order it.  When evaluating the painful arthritic knee the best first line radiological test is a weight bearing x-ray of the knee to evaluate your arthritic knee.

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I want to review how to use a cane correctly when you have knee pain.  Many people have issues with using the stairs.  I will review some tips on navigating the stairs when you suffer from knee problems as well as review an exercise you can do to improve your stair climbing ability.

As with any exercise program check with your health care provider before making any changes in your activity or treatment plan.

https://www.ROSENHIPANDKNEE.COM

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Breathing in and out is something many people take for granted.  Practicing breathing and breathing well can help lower your heart rate, regulate your autonomic nervous system and improve your well being.  I review two breathing techniques here by Dr. Weil (4-7-8) and Mark Divine (Box breathing).

I will also discuss the idea of mindfulness and offer some tips on where to find information and how to incorporate mindfulness to help lower stress and anxiety.

For more information about Dr. Weil and the 4-7-8 technique visit https://www.drweil.com/

For more information about Mark Divine and box breathing visit https://sealfit.com/

Mindfulness Apps
1. https://www.calm.com/
2. https://www.tenpercent.com/
3. https://apps.apple.com/us/app/breethe-meditation-sleep/id920161006
4. https://buddhify.com/
5. https://www.headspace.com/

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You can walk into any store and pick up a number of medications that can treat knee pain.  Many patients that I meet do not have a good understanding of which medications can help, what dose to take, and when to avoid certain medications.  Here I would like to explain some of the common medications that you can purchase over the counter to treat knee pain and what are some of the risks with these pills.

As always talk to your healthcare provider before using any medication to make sure that they are safe for you.

https://WWW.ROSENHIPANDKNEE.COM

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Braces.  There are a ton of options out there for knee pain.  I will review some of the common reasons that people use braces and when they can help with your knee pain.  For some people who have tried a dozen different braces without any improvements - not wearing a brace for general arthritis will not make the knee worse.  Some individuals will benefit from special braces called off-loader braces.

Be sure to check with your healthcare professional to find out what treatments are best for you.

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I would like to offer you tips to the four things I recommend to people when they travel if they suffer from knee pain.
1. collapsible hiking pole
2. zip lock freezer bag
3. bottle of acetaminophen
4. bottle of anti-inflammatory

Alway check with your health care provider before beginning an exercise program or taking medications.  Some medication may not be safe for some individuals.

HTTP://WWW.ROSENHIPANDKNEE.COM

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Many people suffer from obesity and in addition to knee pain, the added weight can lead to diabetes, sleep apnea and other health problems.  In this episode I will review some ideas on how making good food choices and how the role exercise may have a positive impact on your health.  I discuss my 52/25 rule of trying to lose one pound a week and working to obtain a healthy weight.

What is the plateau?  That period when you are exercising and eating well but stop losing weight.  I will explain why this happens.

I hope that you take away one or two points that may help your health and well being.

Always discuss with your health provider before making any changes to your medicine, activity or other health concerns.

HTTPS://WWW.DRADAMROSEN.COM

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I will briefly review my current opinion on the use of stem cells for knee pain due to arthritis.  Data is changing very rapidly on this topic.

You can find the AAHKS position statement here:  http://www.aahks.org/position-statements/biologics-for-advanced-hip-and-knee-arthritis/

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Exercise is good for your health and exercise is good for your knee.  Many patient go from no exercise to an aggressive exercise program or trainer or therapist and have their symptoms get worse.  Starting slow is the plan.  Being consistent is important.  Creating the habit of healthy exercise is the goal.  Here I discuss two simple things that you can do at home to start an exercise program for your knee and your health.

Always check with your doctor prior to beginning any exercise program.

http://WWW.ROSENHIPANDKNEE.COM

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Knee pain is common.  Many people are afraid that if they exercise they will wear it out.  Others complain that their knee is unstable and will buckle.  Symptoms can vary based on your activity and the weather.  Here I will try to use some analogies to explain why those things occur and explain what you may be feeling.

https://WWW.DRADAMROSEN.COM

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