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Orthopedic surgeon to chat about arthritis, joint replacement

July 18, 2011

This chat has already taken place. Read the transcript below.

Dr. Doug Stull

Dr. Doug Stull, of OrthoKansas in Lawrence, will answer questions about orthopedics, which involves the care of bones and joints.
Typical problems include fractures; dislocations; strains of muscles, ligaments and joints; tendonitis; bursitis; and arthritis.
OrthoKansas performs arthroscopic surgery; total joint replacement of hips, knees and shoulders; shoulder reconstruction; complex hand surgery; and other procedures.
Stull specializes in the treatment of the shoulder and elbow in all ages and aspects including sports, trauma and reconstruction.

Moderator:

I would like to welcome Dr. Stull to The News Center. Thanks for coming in to answer some questions about orthopedics on this hot afternoon. Let's start by telling people a little bit about what you do.

Dr. Doug Stull:

Thanks for having me. I am an orthopaedic surgeon, and specialize in the care of the bones, joints and muscles. I subspecialize in care of the shoulder and elbow and deal with all ages.

CarolineTrowbridge:

Are there some joints that can't be replaced? I'm thinking about someone I know who has rheumatoid arthritis whose feet, hands and ankles have been particularly hard-hit. Is it possible to replace all joints?

Dr. Doug Stull:

Nearly all can be... The ones with the most track record are hips, knees, and shoulders. In rheumatoid patients the possiblities expand dramatically because they are typically low demand on the joints.

mfagan:

Thanks for participating in the chat. I have three questions:
1. How long to joint replacements generally last? I read a story awhile back about a triathlete who competes at a high level after having received a new heart, and how he expects it to wear out faster because of all the exertion. Is that the same with replacement joints?
2. I see you do shoulder replacements. What would cause a need for such a thing? Bone-on-bone pain?
3. My shoulders are fine, but I've wondered: If someone had a shoulder replacement, could that person still throw a ball? A baseball? Could the person still pitch?
Thanks...

Dr. Doug Stull:

1. depends on the joint but if done correctly and post op instructions are followed 15-20 years is a good estimate.
2. Osteoarthritis, trauma, tumor, rheumatoid and anything that would cause the destruction of the joint with the exception of infection
3. Yes they can still throw a ball, but I would not want them to do it as a past time or profession. Throwing catch with a grandchild occasionally is probably ok.

abrewer:

Bad knees run in my family. I often find my legs just ache at the end of the day, not necessarily in the knee itself. It seems that the greater my activity during the day, the more they ache. I am in relatively good condition and not overweight. Is there a particular exercise or dietary supplement that I should check in to?

Dr. Doug Stull:

Exercises that strengthen the quads, hamstrings, and calves are all good. flexibility is just as important though so stretching is very important and should go hand in hand with strengthening. Dietary supplement..... a multi vitamin and adequate calcium are reasonable, but basic lab work would show deficiencies that your primary doc could address.

DennisAnderson:

What can younger people do today to prevent having to have a joint replacement later in life?

Dr. Doug Stull:

Stay active, avoid smoking, avoid excessive alcohol intake.......There are no known supplements or meds to prevent the most common reason to have a joint replacement....osteoarthritis. We used to joke.... pick your parents well, which really means there is probably a genetic component to this that we have yet to fully figure out. If we do, we may be able to tell those patients at risk to avoid certain types of activities, foods etc....

jnewell:

Tom Watson just tied for 22nd in the British Open over the weekend. He is 61 years old and had a hip replacement three years ago.

Watson also was just quoted as saying that he fears that if Tiger Woods — at 35 — elects for a knee replacement, he believes it could have a huge impact on his golf game.

I was just wondering about the differences between knee and hip replacements in sports and why a knee replacement could potentially be more detrimental than a hip replacement.

Dr. Doug Stull:

Great question and hard to answer briefly. It has to do with what the respective activity demands of the respective joint. So golf and hip replacement go together nicely. Mr. Watson likely knows that a golf swing demands more of the knee than a knee replacement can provide.....especially Tiger's swing.

jajacut:

Generally, what would you recommend for back and shoulder pain. People spend a lot of money on chiro, new beds, work out equipment, etc. What helps more than others.

Dr. Doug Stull:

For back pain I usually recommend hamstring flexibility and core strength (abs). Most shoulder pain responds to some very basic physical therapy that can be learned with one or two visits to a physical therapist. Beds should be supportive, work out equipment can be excessive in todays world. Keep it simple and smart. A mat, pull up bar and good shoes can get most people as fit as they would ever want to be if doing the correct exercises.

Moderator:

I didn't get to shoulders in my joint replacement series, but was wondering if you could answer some basic questions for shoulders:
1. What's the typical age of someone needing a shoulder replacement?
2. About how many do you perform a year?
3. How long is the typical surgery?
4. What's the recovery like?

Dr. Doug Stull:

Same age as hips and knees. Men 55-65 Women 60-70. I do around 30 - 40 per year, not nearly as common as hip or knee. We don't walk on our arms. Surgery is about 2 hours. Harder recovery than hip but easier than knee.

TuckerD25:

How does Glucosamine and Chondrotin supplements help ease the pain in joints?

Dr. Doug Stull:

We THINK, it may help nourish an otherwise uhealthy joint, but there has not been a really good study to validate that in my opinion. In my practice I mention it early in the stage of arthritis and tell patients if they appreciate no relief after one month they should stop wasting their money.

monicataylor:

Hi Dr. Stull,
A family member was recently diagnosed with a narrowing of the spine caused by arthritis and has begun physical therapy. I'm wondering, from an anatomical perspective, how physical therapy benefits a patient with this type of condition.

Dr. Doug Stull:

It can strengthen muscles around the spine, and help with low back pain related to arthritis Hamstring flexiblity will also help positioning of the pelvis and may also help the pain in the back.

engelee:

are meds or surgery better for moderate arthritis?

Dr. Doug Stull:

Surgery should always with very few exceptions be a last resort. So if the pain is tolerable or can be managed with meds that are not habit forming, like narcotics, then delay surgery.

AnnaUndercover:

There is a lot of information out there on handling sciatica that develops with pregnancy, but not the other way around.

Is childbirth (completely) safe for patients who already have sciatica?

I've been told that it is, but as an athlete who has it, I just can't believe it.

Dr. Doug Stull:

First, pregnancy is not a benign condition. But sciatica, pain from a compressed nerve in the back, often the sciatic nerve could be made more symptomatic by pregnancy but I don't believe it should stop a woman from becoming pregnant.

Jayne:

In the recent LJW article I felt like the implication was how great KUMed is. Should I go there for my needed hip replacement?

Dr. Doug Stull:

No. We have great surgeons here in Lawrence, that's my opinion that I feel strongly about, but ultimately you as the patient have to feel comfortable with your surgeon.

ChristyLittle:

What kind of therapy and exercise do you recommend for knee injury patients?

Dr. Doug Stull:

Very tough to generalize with so many conditions that effect the knee, but general quadricep (muscle in front of thigh) strengthening is a good place to start.

cindyjoyks:

As a dental professional, my patients who have had joint replacement surgeries have a lot of confusion about the need for premedication before a dental appointment. Specifically, the rules surrounding this seem to change frequently. Could you please address the need for a antibiotic premed in patients with total joint replacement?

Dr. Doug Stull:

What is confusing is the type of dental procedure, teeth cleaning, vs root canal. Basically if bleeding has a chance occur then I feel and our academy feels that pre medicating with antibiotics is appropriate. So, in my practice all joint replacement patients should have antibiotics before any dental procedure. The benefits far outweigh the risks. An infected joint is a catastrophe.

militarymachine:

Who in the area is the expert on FAI in hips? Thanks.

Dr. Doug Stull:

FAI stands for femoral acetabular impingement. It is a relatively new diagnosis and one that we as a profession are learning a lot about. There are very few "experts" You should try to find a relatively young surgeon who is fellowship trained in hip surgery and has an interest in sports medicine. We are actively recruiting that surgeon for Lawrence.

TomKat:

I recently was informed that at age 41 I have less than 1/4 of the cartlige left in my hip. How often do you see in other patients other joints losing their cartlige or are most problems in one area only? (Should I be worried about the rest of my joints?)

Dr. Doug Stull:

Usually osteoarthritis is fairly isolated, and if you have it at this young age there may be an underlying anatomic cause specific to that joint. Having said that, some rheumatologic problems start isolated. It would be a good idea to ask that question to your specific doctor.

mommatocharlie:

what do i do when the pain in my arthritic knee is not relieved by pain medication--prescription meds

Dr. Doug Stull:

Its time to talk to an orthopaedic surgeon if you know you have arthritis, injection therapy and ultimately surgery may be offered.

Moderator:

Thanks Dr. Stull for coming in today and doing your first live chat! Hope you will come back again!

Dr. Doug Stull:

My pleasure. If anyone has other questions not answered we are available at OrthoKansas 785-843-9125. Have a great, cool, day.

Moderator:

Also, I apologize for not introducing myself — health reporter Karrey Britt — at the beginning as the moderator. Jayne had a follow-up question as to why I went to KU Hospital for my surgery. I was referred from a doctor at OrthoKansas to KU Hospital's Dr. Hendricks.

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