Five Causes of Loosened Total Knee Replacement Hardware
“Total Knee replacements can ‘fail’ by a number of mechanisms,” says orthopedic surgeon David Fisher, MD, Director of the Total Joint Center at the Indiana Orthopedic Hospital.
There are five chief reasons for a failed TKR. Unfortunately, the first one that Dr. Fisher mentions brings to mind the concept of surgeon error.
He states, “In some cases, they were not implanted in a way that creates a well-functioning knee, and the patients are never happy with them. This is one of the more common causes of revision knee replacement.”
It’s deeply troubling that surgeon error cannot be proven, as the defense will blame the manufacturer of the hardware and/or loosening of the cement over time.
Dr. Fisher continues, “Another common reason is an infection develops postoperatively and leads to a need for revision.
“This may occur in 0.1-2% of knees and may be related to the volume of the operating surgeon and the hospital in which the surgery was performed.”
Following knee (and other joint) replacement or revision surgery, patients will get their temperature taken as often as once every four hours, and this includes overnight, to check for signs of an infection.
“Late infections can develop occasionally many years after implantation,” says Dr. Fisher.
The first signs of an infection may be warmth and redness about the knee.
“Loosening of the prosthesis rarely occurs in the first few years but can be a cause of late failure and will usually be associated with pain and swelling.”
The final mechanism behind a failed TKR: “Polyethylene (bearing surface) wear can also occur many years after implantation and cause symptoms of pain and swelling.”
What if your knee replacement (or hip) has been doing great since surgery?
Dr. Fisher says, “In general, it is recommended that someone with an artificial hip or knee have a regular checkup and X-ray of the affected joint to pick up on any changes that might be occurring.
“That interval could be every 2-5 years if the joint is working well.”
Dr. Fisher has been involved in research and development of total hip and knee implants and has had numerous articles published in professional journals, and has participated in many research projects.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Miriam Doerr Martin Frommherz
General Anesthesia vs. Regional for Knee Replacement Surgery
Did you know that the use of regional anesthesia for total knee replacement surgery isn’t all that uncommon?
General anesthesia brings with it fear in many people that they’ll “never wake up.”
Don’t let the fear of general anesthesia stop you from pursuing total knee replacement surgery if your knee has reached a point of hopelessness with conservative treatment.
Yes, there are surgeons who use regional anesthesia to perform total knee replacements.
Now that you know that, it’s very logical to wonder why this approach isn’t utilized more often than general for knee replacement (or revision) surgery, since the risk of dangerous blood clots is less with the regional.
A blood clot that results from surgery is called a deep vein thrombosis (DVT).
A DVT can break loose and migrate to the lungs and kill a patient.
“In general, the risk of DVT is slightly higher with general anesthesia than with regional,” says orthopedic surgeon David Fisher, MD, Director of the Total Joint Center at the Indiana Orthopedic Hospital. “With prophylaxis of anticoagulation, the risk is between 1-2%.”
Anticoagulation refers to the use of blood thinning drugs. “The risk with regional (with or without general combined) tends to be on the lower side.”
Thus, there is no doubt that regional anesthesia wins over general for knee replacement surgery as far as yielding a lower risk of DVT development.
But regional anesthesia’s advantage over general doesn’t end there.
“Additional benefits from the regional include better postoperative pain control, and decreased anesthesia side effects (nausea, vomiting, hangover effect),” continues Dr. Fisher.
“Regional options include peripheral nerve blocks, spinal anesthetic, and epidural anesthesia.
“Depending on the hospital and anesthesiologist’s abilities or competency at administering regional anesthesia, local physicians may have preferences.
“If a patient wanted regional anesthesia, I would think the surgeon would be agreeable to having it provided.”
Dr. Fisher has been involved in research and development of total hip and knee implants and has had numerous articles published in professional journals, and has participated in many research projects.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
Beets, Red in Toilet, in Urine and Poops
Beets are one of the best foods you can put in your body.
At the same time, few foods have caused more anxiety and fear than beets–because in some individuals, they cause urine to turn red or pink, making people think it’s blood.
Or, they give poops a reddish tinge as well as stain toilet water red.
The brilliant color of this vegetable means that it’s loaded with potent antioxidants.
Most people who eat beets or drink them as a whole-juiced product or as part of a mixture will not experience the undigested pigment coming out their opposite end.
The pigment is called betain, sometimes also referred to as betanin.
Below are articles that will help you fully understand this phenomenon of undigested pigment and how to tell that the red you see in the toilet or on the tissue paper is actually from the pigment in beets.
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Poops red from beets or from blood? How to tell the difference
Reassurance is very important. You certainly don’t want to give up eating this health-giving vegetable out of fear of what you’ll see in the toilet bowl. There are key ways to detect the difference.
Guide to telling the difference between poops that are red from blood and those that are red from whole beets and beet juice.
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A gastroenterologist answers questions about beet juice in urine and stools.
You’ll feel even more confident after you read what a gastroenterologist has to say about this. When undigested beet juice appears in urine, this is called beeturia. Yes, it even has a name!
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Can you excrete an entire glass of beet juice?
Suppose you drink a glass of beet juice or even a mix that includes this nutrient dense vegetable.
The amount of beet pigment that a person may see in the toilet bowl can make them wonder if they just took in all those phytonutrients for nothing.
Can much of the juice come out in your urine?
Shutterstock/Oksana Mizina
After all, some people swig down beet juice or eat the vegetable in solid form more for the health benefits than for the taste.
As healthy as this popular vegetable is, it is highly unpalatable to many people.
Nevertheless, the health-conscious individual will eat beets anyways for their antioxidant power — and would hate to see it all go down the toilet.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Sea Wave
How NOT to Let Long Femurs Prevent a Perfect Back Squat
Don’t Let Long Femurs Stop You from a Perfect Back Squat
There’s a HUGE issue in the strength training world with femur length.
I’m a former personal trainer who has long femurs — great for karate kicking, running down hills, sprinting, pedaling … but not the best tools for the perfect back squat.
HOWEVER, I actually have a pretty decent back squat.
My back squat is below parallel WITH A LUMBAR ARCH and a moderate forward lean — nothing that I’d call a “fold” or “doubled over.” And there is no “GMing” up the weight.
I use a wider than conventional stance, though not true sumo.
I make sure that my knees track over my slightly turned out feet (I keep them out only slightly because I don’t want built-up adductors).
I have good hip flexibility to really sink down and sit in the squat.
Many women have this challenge, though it isn’t necessarily a long femur, in and of itself, but rather, a torso that’s shorter than their femurs — or, shins that are shorter than their thighs.
A woman with seemingly proportionate femurs still faces the same issue in the back squat if she has a short torso. All the time, I see women with “no torso.”
There’s nothing outstanding about their femurs until you put them up against the torso.
Torso seems to be on the short side. Shutterstock/Vladimir Sukhachev
Though Smith machine and dumbbell squats are easier than the back squat, many women (and men too) struggle with these; they often don’t even hit parallel.
Or, with the dumbbell version, if they DO hit parallel, they are folded over. Their torsos are shorter, sometimes a lot shorter, than their femurs.
I might add that at one of the gyms I go to, there’s a man who squats 365 pounds–and he’s folded over at parallel because he has a short torso; he’s “all legs,” though he’s of average overall height.
He needs to widen his stance so that there isn’t so much pressure on his lower spine.
Shutterstock/Photology1971
So it isn’t just a long femur thing with the back squat; it’s a short torso thing.
A wide stance (Sumo squat) goes a long way in making the back squat more doable for the long femur build.
Ever wonder why toddlers and preschoolers have the perfect back squat?
What are they doing differently than the adults who, even with decent proportions, still struggle with being upright?
An effortless upright position
Really now, if you had the proportions of a very young child, your nickname would be “melon head.”
In very young children, much of their height is between their hips and head, and this creates excellent leverage to stay upright.
ATG, feet flat on ground, spine upright. Shutterstock/Rozochka
Imagine if an adult had these proportions! I don’t know about you, but I’M seeing one stubby short femur that gets dwarfed by the long torso.
Here is why you shouldn’t compare an adult’s squatting form with a child’s.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
Is Ejection Fraction a Predictor of Mortality?
A cardiologist addresses the question of ejection fraction being a predictor of mortality.
Ejection fraction is the amount of “squeeze” or force that a heart yields with each beat.
Can this actually be a predictor of mortality?
“If the ejection fraction (EF) is due to poor blood flow to the heart, due to coronary disease, it is a predictor of higher mortality especially if the EF is less than 35%,” explains Dr. Sameer Sayeed, a cardiologist at ColumbiaDoctors of Somers, NY.
Coronary artery disease (CAD) is characterized by plaque buildup inside the artery walls of the heart, which decrease blood flow through the cardiac muscle.
BruceBlaus, CreativeCommons
A diet full of trans fats significantly contributes to this or may even outright cause it.
“If the low EF is due to some unknown cause, perhaps a prior viral infection or just out of the blue, the heart itself is probably pretty normal, and usually the ejection fraction will recover, but until it does there is higher mortality than a normal person, but less than the first scenario I mentioned,” explains Dr. Sayeed.
“Regardless if the EF is less than 35% for more than three months on optimal medical treatment, these people all need defibrillators to prevent sudden cardiac death and decrease their mortality.”
Though ejection fraction then, indeed, plays a role in mortality prediction, it is not the greatest predictor of mortality. That goes to heart rate recovery (HRR).
“Slow heart rate recovery occurs in those people with coronary artery disease and blockages and with heart muscle damaged by this.”
Slow or low HRR also occurs in those who do not exercise sufficiently.
Dr. Sayeed performs echocardiograms and stress tests at the Midtown Manhattan and Westchester offices at Columbia Doctors. He is also trained in cardiac CT imaging.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Freepik
Can a Marathon Runner Have a Low Ejection Fraction?
Marathon runners usually have strong hearts, but believe it or not, they can actually have a low ejection fraction, says a cardiologist.
You may have heard that it’s possible for a marathon runner to have an ejection fraction as low as 35 percent.
This is information that’s not easily forgettable, since a low ejection fraction is associated with people who have congestive heart failure or some acute process going on with their heart.
What Is an Ejection Fraction?
Ejection fraction is a measure of the amount of blood that is pumped out of the heart with each beat.
A low EF means that the heart does not pump as much blood as it should with each beat or squeeze.
• The heart’s chambers fill with a normal amount of blood, but the pumping action of this muscle is weak.
Therefore, an inadequate amount of blood gets pumped out for circulation throughout the body.
• Or … the pumping action is actually normal. The problem is that the chambers fail to fill with a normal amount of blood.
The result is a sub-optimal amount of blood going throughout the body.
• It is difficult to fathom that a marathon runner would have either of these situations.
Can marathon runners have a low ejection fraction?
“Yes, they could have a low EF, but it would be very rare,” says Dr. Sameer Sayeed, a cardiologist at ColumbiaDoctors of Somers, NY.
“Only a rare person who was very well-trained or could handle the symptoms could actually have a low ejection fraction and complete a marathon, as they would likely have to stop running long before the end of the marathon due to shortness of breath and chest pain,” explains Dr. Sayeed.
If you have shortness of breath disproportionate to your physical activity; new-onset shortness of breath; chest pain or tightness; a faint feeling; or nausea, see a cardiologist/emergency room physician as soon as possible.
Dr. Sayeed performs echocardiograms and stress tests at the Midtown Manhattan and Westchester offices at Columbia Doctors. He is also trained in cardiac CT imaging.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
THORACIC AORTIC ANEURYSM: Weightlifting & Cardio Guidelines
Top surgeons answer questions about just how much you can and cannot lift with a thoracic aortic aneurysm.
After all, information on sites like Mayoclinic.com is conflicting, generic and vague — open to much subjective interpretation.
For instance, just what exactly does “Don’t lift more than half your body weight” mean?
Does this apply to biceps curls? Seems that a 200 lb. person would strain a LOT more with trying to curl a 100 lb. barbell versus deadlifting it.
And if body weight is a criterion for how much a person with a thoracic aortic aneurysm can lift or should avoid lifting, then wouldn’t body composition play into this equation?
Does it make ANY sense at all that, according to the “Don’t lift more than half your body weight rule,” a 300 lb. person with 200 pounds of excess fat gets to bench press 150 lbs. — while a 200 lb. person who has way more muscle mass and upper body strength gets limited to lifting only a 100 lb. barbell just because they found out they have a thoracic aortic aneurysm?
What Are Your Questions About Strength Training with a Thoracic Aortic Aneurysm?
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Find out the answers to these riveting questions and many more in the articles linked below.
Some are interviews with aortic repair surgeons. Trust me — I left NO stone unturned!
- Putting into context the fact that research into weightlifting with an aortic aneurysm is very scarce.
- Safe weightlifting practices.
- Are deadlifts really dangerous? Yeah, if we’re talking about one RMs, but what about for fitness?
- Are pull-ups potentially risky?
- Guidelines for barbell squats
- Safety guidelines for biceps curls
CARDIO
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Rotator Cuff Injury Pain vs. Biceps Tendonitis: Comparison
Symptoms of rotator cuff injury and biceps tendonitis overlap; a sports medicine doctor explains if there’s a way to tell difference.
Is there a way to tell the difference between the symptoms of a rotator cuff problem and that of biceps tendonitis?
“The reality of rotator cuff and biceps tendonitis injuries is that they go hand in hand,” says Dr. Mark Galland, orthopedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina.
“It is rare to have them occur separately because the rotator cuff is comprised of four muscles, and the long biceps tendon attaches in the shoulder in between the first and second rotator cuff muscles,” continues Dr. Galland.
“One of the functions of the biceps tendon is identical to that of the rotator cuff, so when the rotator cuff is not healthy, the biceps tendon, under extra pressure, follows suit and can easily become unhealthy as well.”
Biceps tendonitis. Shutterstock/ilusmedical
Certain weightlifting exercises are more likely than others to injure the rotator cuff, namely chest and shoulder work.
The biceps tendon can also be injured with these exercises, and that includes the bench press.
Shutterstock/Alila Medical Media
You may be wondering how the biceps can be injured doing chest work when the biceps isn’t even involved in pressing motions.
But actually, the short head of the biceps does indeed play a minor role in pressing motions because chest pressing involves shoulder flexion. The biceps attaches to the shoulder joint.
“It is difficult to distinguish whether you have a rotator cuff or biceps tendon injury, since many of the symptoms overlap,” continues Dr. Galland.
“The truth is that there is so much connection between the two, to try to distinguish them is really an exercise in futility.
“If you have biceps tendonitis, you likely also have rotator cuff dysfunction.
“Again, while it is difficult to tell for sure because of the similarity in the symptoms, you can do this exercise to test for biceps tendonitis:
“First, bring your arm straight ahead and then try to raise it while pushing down on the arm with your other arm.
“If pain is present, you likely have biceps tendonitis.” That pain will be in the shoulder.
“Biceps tendonitis and rotator cuff injuries can both be treated with injections and subsequent physical rehabilitation.
“This is not something to ignore – if you have pain that you believe to be your rotator cuff and/or your biceps tendon, see your orthopedic specialist immediately.”
Dr. Galland has authored many book chapters and papers in sports medicine. His advice and consultation have been sought by world-class athletes in track and field and Major League Baseball.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/KlaraBstock
Can Sore Neck Muscles from Weightlifting Cause Headache?
Not only can sore neck muscles from working out with weights cause a headache, but don’t underestimate what bad sitting posture can do, either.
A headache can be an alarming symptom, but remember, the head is like any other part of the body, in that if it’s the site of aggravation, a headache can often result.
And that site doesn’t necessarily have to be on the head itself; it can be nearby.
And this includes from lifting weights; the neck muscles are located in close enough proximity to the head to cause a radiating pain or ache that travels upward.
Let’s first look at lifting weights.
“Weightlifting can certainly cause headaches, especially when neck muscles are overworked, causing hypertrophy and sometimes muscle spasms,” says Dr. Mark Galland, orthopedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina.
These muscle spasms can register over 5 on the 1 to 10 pain scale.
Strength training moves that involve the neck muscles include shoulder shrugs, the deadlift and other pulling exercises.
But now another question is triggered…
Just what is the mechanism for these headaches that are induced by lifting weights?
Dr. Galland puts it this way: “Overworked muscles = spasm = tightness—which causes direct pain of scalp muscles or indirectly by pinching occipital and other scalp nerves.”
Nerve pain can really hurt, even if it’s a spasming muscle and lactic acid encroaching upon the nerve.
What about poor sitting posture?
Dr. Galland says, “One of the most common causes of headaches are muscles that are made sore from tension and the constant hunching over computers.
“When we do not sit up straight, our heads have to extend backward, which causes spasm and strain.
“Occipital neuralgia, which is quite rare, can cause very sharp, intense pain, can occur when your neck muscles are in spasm and contracted.”
Dr. Galland has authored many book chapters and papers in sports medicine. His advice and consultation have been sought by world-class athletes in track and field and Major League Baseball.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/iambasic_Studio
Six Reasons You Have Joint Pain at Night
Are you plagued by joint pain at night?
Joint pain at night is no picnic, and it can be caused by one or more of several factors.
Nighttime Joint Pain vs. Muscle Aches
“The first thing to determine is whether what you are feeling is really joint pain, rather than a muscular ache,” says Dr. Mark Galland, orthopedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina.
A distinguishing factor between pain in a joint and pain in a muscle is that the former seems to be coming smack from the joint itself.
The ache of a muscle, on the other hand, seems to originate in the fleshy area of the muscle — between joints.
“If the discomfort you are feeling truly is joint pain, it will most commonly be caused by arthritis, carpal tunnel syndrome, rotator cuff dysfunction or joint degeneration,” says Dr. Galland.
“If you are experiencing joint pain – not just muscle soreness – this discomfort should warrant a visit to an orthopedic surgeon.”
Make sure that any joint pain that you’ve been experiencing at night is not related to premenstrual syndrome (PMS).
A woman can also get mid-cycle joint pain. However, this can occur during the day as well.
Surprising Causes of Joint Aches at Night
There are more causes of joint discomfort overnight that deserve some mentioning: microscopic colitis, as well as Crohn’s disease and ulcerative colitis.
Add lupus and Sjogren’s syndrome to this list. However, as with mid-cycle joint pain, this symptom can occur any time of the day.
I had a bout with microscopic colitis (confirmed via colonoscopy), and this benign condition can present with one or more of several symptoms, including joint aches and dehydration.
These two symptoms I definitely had, along with the hallmark diarrhea.
If you have microscopic colitis, you’ll know something’s up: It causes watery, painless diarrhea, though the diarrhea may also be more “formed.”
This condition causes release of prostaglandins, the same hormones that are released during PMS that cause aching joints!
Dr. Galland has authored many book chapters and papers in sports medicine. His advice and consultation have been sought by world-class athletes in track and field and Major League Baseball.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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