HSS researchers found that patients form these expectations from a variety of sources, often drawing on more than one. The most common influence was hearing about successful outcomes from friends, family members or others who had undergone knee replacement. Patients also cited their own positive experiences with past orthopedic procedures, conversations with their surgeon, information they found online and a general sense of optimism about their recovery.

The findings suggest that expectations before knee replacement are shaped not only by medical information, but also by personal experiences, social networks and mindset. By better understanding where patients’ expectations come from, clinicians may be able to have more meaningful conversations before surgery and help patients develop realistic expectations about recovery and outcomes.

This prospective preoperative cohort included 232 patients who completed a validated 19-item expectations survey, the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR), and the Positive and Negative Affect Schedule (PANAS). 

Read the full article at ovid.com. 

Dr. Kahlenberg noted, “The components we use in joint replacement surgery are now better than past materials. We use highly cross-linked polyethylene providing greater durability and less wear. These new materials help hip replacement patients recover faster, be active and gain greater longevity from their new hip. For many, joint replacement surgery lasts a lifetime.”

She continued, “We’re involved with many cutting-edge studies to improve patient outcomes. I am working with a team of HSS hip and knee surgeons and our biomechanics department to run computer simulations of hip and knee replacement. These models help us determine individualized patient targets for ligament tensioning and balancing precisely for knee replacement. Our robotic and computer navigation technologies allow us to execute surgical plans and target specific alignment and balance of the knee with great precision."

Dr. Kahlenberg added, We’ve made great strides in speeding up patient recovery from joint replacement surgery. Also, new surgical techniques and the use of regional anesthesia instead of general anesthesia lowers the risk of complications and side effects. We like to get patients up and moving right after surgery; most can go home the same day or after a one-night stay. Within six weeks, many patients can return to low-impact activities, then higher-impact pursuits soon after that." 

Read the full article at greenwichsentinel.com/.

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic,  a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote. 

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.

Dr. Kahlenberg said the results sound “potentially promising.”

She continued, “It's always exciting to see new studies coming out about controlling post-op pain after total knee replacement.”

She explained that despite strides made in pain control, “many patients experience more pain than we'd like after knee replacement surgery.”

Dr. Kahlenberg said larger studies are needed to see if the current findings can be replicated. She also said that many hospitals, including HSS, have begun using an additional regional nerve block during surgery — one that was not employed in this study.

She added, “I'm not sure how much of a difference this new technique would make if the (researchers) were incorporating both of the commonly used regional anesthesia blocks rather than just one.”

Read the full article at Healthday.com.