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Knee: 90% wait too long to be operated
TOO soon as a delay. 90% of those who suffer from osteoarthritis of the knee wait too long before undergoing surgery, while 25% do so with a advance excessive. To reveal the importance of timing for the knee arthroplasty is a study of the Feinberg School of Medicine Northwestern University Chicago published on the Journal of Bone and Joint Surgery . We ask the experts to help us understand why it is important to choose the right time to have surgery and even when it is necessary to sottoporvisi and when, instead, it may suffice infiltration.
the time of The arthroplasty, The researchers analyzed data from more than 8 thousand patients at risk of osteoarthritis by comparing the results of the operations of replacement of the knee joint based on the time in which they were performed. It is seen that is to do it too early and late has negative effects on the outcome of the intervention. In those who anticipate too much, for example, increase the likelihood of having to repeat the surgery after a few years, while the latecomers get the benefits below. What is the risk if you wait too long to Delay the most possible the operation is a classic because as long as the pain is bearable and autonomy is not strongly reduced, people tend to avoid the scalpel. But what happens if you wait too long? “First of all, it is necessary to clarify that, in general, the knee surgery always creates some dissatisfaction, even when it is perfectly executed, because in most of the cases, the patients have too high expectations,” says Francesco Falez , president of the Italian Society of Orthopaedics and Traumatology (Siot), which adds: “of Course, regardless of age, most of the osteoarthritis is advanced, the more likely it is that intervention, even if perfectly executed, is less decisive because you to lengthen the time of rehabilitation.” Patients who are operated on too late, it is hard to recover the full function of the knee. Mobility is very reduced as compared to those who carried out the operation at the right time. Why do you expect so much? “The reason for the delay - clarifies Falez - is the fear of work and then there is the conditioning of the negative experiences recounted that discourage”. What is the risk if it is anticipated In the last years and especially among athletes rose early interventions, that is, within 60 years because at the first sign of pain you prefer to run to the shelters before it is too late: “this haste is not positive,” warns Falez. “Often, the patient is ahead of its time passing from a situation of pain and mobility problems related to a feeling of total dissatisfaction and, moreover, increases the risk of having to repeat the surgery later in the years”. Also, anticipate too much of the time it means to submit in vain a person to the dangers of an invasive procedure was performed: the risk of complications outweighs the potential benefits. Often patients who have undergone the surgery too soon you are forced to go back under the knife a second time in the span of a life. The second operation can present major difficulties and lower possibilities of success.
osteoarthritis of The knee osteoarthritis causes a deterioration of the functionality of the limbs. Some people may not be able to stretch out the leg, impairing walking ability, and reduced mobility. The reduced mobility and brings with it other health problems such as the cardiovascular ones, but also the depression. According to the data of Siot, in Italy they make 40-50 thousand knee replacement each year.
How to understand when to undergo an operation, But then what is the right time? Researchers at Northwestern University in Chicago have identified an algorithm that allows to recognize the right moment for arthroplasty of the knee. The calculation is performed based on a number of factors, such as the pain of the functionality of the joints, the results of the x-ray and the age of the patient. “Must be your doctor to assess when it is better to operate by clarifying the good to the patient what to expect, and also that the implants give a lot of satisfaction but they are not a panacea for the aches and pains of osteoarthritis,” explains Falez. The robotic surgery is The latest frontier for this type of intervention is the robotic surgery which is spreading also in Italy. And’ the case of the Robot Navio, a system installed in the province of Varese and Milan, that allows to reach a level of accuracy that no hand and no human eye can have. And this can make all the difference. “Not only is the choice of the prosthesis is, in fact, taking into account the anatomical features of the patient, but the robotic system allows you to customize the surgical procedure, giving the maximum benefit to the patient: less pain and recovery of full functionality in the shortest possible time”, explains Flavio Terragnoli , director of the Department of Orthopaedics and Traumatology of Fondazione Poliambulanza. The surgery is performed through a minimal surgical incision. The leg and thigh are attached to sensors for navigation, robotics and one special tool-allows 3D reconstruction. The surgeon will make a study of the movement of flexion and extension of the knee to measure the tension of the ligaments. On the basis of the 3D reconstruction and to study the kinematic, the doctor is able to place the prosthetic components in the optimal position with a margin of error of less than 0.5 mm.
When to use and infiltration Before arriving at the implant surgery is now used to infiltration. Hyaluronic acid, growth factors, and stem cells give satisfactory results and in a few years they could replace up to 35% of surgical operations. According to the data of the Orthopaedic Hospital of Italy (OTODI), today, more than 40% of the subjects (50% males and 50% females) treated with Prp (platelet rich Plasma) viscosupplementazione, magnetic fields, rehabilitation has achieved significant improvements. with. “For all people with joint problems, even disabling, but that do not yet have the indication to the hearing aid – recommend Giuseppe Monteleone , director of the unit, orthopaedic hospital San Paolo of Naples - you can do the articular infiltration with a variety of substances that can slow the progression of arthritis and reduce the painful symptoms”.
The hyaluronic acid to stem cells
For many years, orthopedic surgeons have had access to only the hyaluronic acid and various scientific works have proven to be effective in clinical efficacy on the reduction of painful symptoms in more than 80% of the cases treated. “Today, " continues Monteleone - we have a wide range of acids ialuronici, molecular weight too high, or branched, which give us several options of treatment, depending on the type and degree of injury”. The last frontier of treatment, regenerative treatment with stem cells or mesenchymal cells are activated. The modern techniques of sampling from peripheral blood or from fat tissue have minimised the invasiveness of the sampling, making it applicable this technique to a large number of people in the field of day surgery or even outpatient.

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