News June 2004 Issue

In The News: 06/04

‘Drive-Through’ Joint Replacement: The Jury Is Out
We reported in December 2003 on mini-incision total knee replacement (MI-TKR), a new procedure that is not only less invasive but reduces scarring, recovery time, and helps a patient regain range of motion faster.

Some surgeons have now taken the procedure a step further, claiming that minimally invasive total knee or hip replacement (using very small surgical instruments to create tiny incisions) can be performed on an outpatient basis, with the patient being discharged on the day of surgery. Dr. Richard Berger of Chicago’s Rush Medical Center told colleages at a recent meeting of the American Academy of Orthopaedic Surgeons that he has performed the procedure on 100 hip patients and 23 knee patients, and every one has gone home the same day. (Caveat: To be discharged the same day, patients had to pass a variety of strength tests.)

However, other surgeons have not been so quick to endorse Berger’s “drive-through” approach. As reported by the news service Rheumawire (jointandbone.org), Dr.Thomas Sculco of the Hospital for Special Surgery in New York, said, “It may have application to a small population. However, you can’t take 80-year-olds with no backup and send them home the same day.” Added Dr. David Hungerford of the Johns Hopkins School of Medicine, “You run the risk of having easily treated, early recognizable complications and, because the patient is not there, they are not recognized and can have catastrophic results.”

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Got Gout? Get Milk
Eat less red meat and seafood, drink more low-fat dairy products, and you’ll cut the risk of developing gout by nearly 50 percent.

In a 12-year study of 47,150 men age 45-70, researchers at Boston’s Massachusetts General Hospital found that among 730 new and confirmed cases of gout, each additional daily serving of meat was associated with a 21 percent increase in the risk of gout, while each additional serving of seafood was associated with a 7 percent increase in risk. There was also a strong inverse association between the consumption of low-fat dairy products (skimmed milk, low-fat yogurt) and the incidence of gout. The study also found that there was no significant risk in the consumption of vegetables rich in purine (peas, beans, lentils, spinach, mushrooms, cauliflower), traditionally thought to be a contributor to gout.

“This is the first evidence that dairy products can be strongly protective,” said rheumatologist and lead researcher Dr. Hon Choi. “Every single seafood type we looked at was associated with increased risk of gout.”

Gout affects approximately 3.4 million American men, causing sometimes-extreme pain in the feet and joints. It is less common among women, usually occuring only after menopause.

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Cosmetic Foot Surgery: Appearance At A Price
Unsightly toes? Feet too bony? Can’t fit into those fashionable shoes? Think twice about cosmetic foot surgery. In a recent poll of U.S. foot and ankle surgeons, a majority claimed they’ve treated patients for foot problems resulting from cosmetic foot surgery, and 82 percent felt the surgery was unwarranted.

Cosmetic foot surgery, a growing trend among women seeking what has become known in fashion circles as “feet cleavage,” can lead to a variety of problems—nerve damage, infection, recurrence of deformity, scar formation—and it does nothing to improve the function of the foot or relieve pain.

Says Dr. Sharon Dreeben, chairman of AOFAS’ public education committee, “Changing the shape of the foot to make it narrower, or the length of the foot by shortening toes, can cause serious problems, sometimes forcing patients into specially fitted shoes or to use orthotic devices that may be necessary to give relief from chronic foot pain.” An AOFAS medical advisory adds that “foot surgery should never be performed in the absence of pain or functional limitation.”

Smart alternative: Rather than changing the shape of your feet, change the shape of your shoes to fit your feet.