Managing a patient with degenerative disease in both the hip and the lumber spine – the hip-spine syndrome – presents a challenge: Which procedure should be done first? Should the surgeon start with a total hip arthroplasty (THA), or should the patient be referred to a spine surgeon for spinal fusion before THA?
With surgeons offering total knee arthroplasty (TKA) to increasingly younger patients with osteoarthritis and other degenerative conditions, the idea that both knees could be replaced during the same operation is appealing. Many of these patients still work, and by undergoing surgery only once, they minimize time off from work and, theoretically, minimize the risk of complications from a second anesthesia and hospitalization.
Total knee arthroplasty (TKA) is increasing among patients age 65 and younger, with 1 study projecting a potential increase of 183% in the number of TKA and revision TKA surgeries in that age group by the year 2030. Concerns have been raised about poorer clinical outcomes, lower patient satisfaction, and diminished joint survival in a younger compared with an older patient population.
In a study from the John D. Dingell VA Medical Center in Detroit, veterans who received acupuncture treatment before undergoing total hip arthroplasty (THA) reported less postoperative pain and need far fewer opioids than veterans in the control group who did not receive acupuncture. Veterans in the acupuncture group also reported that they were more satisfied with their pain control.