A National Joint Replacement Registry helps reduce the rate of failed procedures by keeping a database of information that keys in surgeons to problematic implants, and provides insight as to how to avoid mess ups. According to Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn,  “Every country that has developed a registry has been able to reduce failure rates significantly.”  Sweden is one case in point.

The newly formed American Joint Replacement Registry is still in its nascent stage and has started collecting data. Its goal is to improve the quality, outcomes, and cost-effectiveness of total joint replacement (TJR) surgeries through the achievement of four objectives:

1. Establish an infrastructure and a uniform system for the collecting device information and monitoring outcomes of TJR throughout the U.S.;

2. Identify patients who may need follow-up evaluation thereby increasing patient safety;

3. Create real-time survivorship curve in order to detect poorly performing implants;

4. Establish a uniform system that can be used to define the epidemiology of TJR for outcomes research to improve the quality and outcomes of patient care.

Until we have access to solid facts from the U.S. Registry, there are some proactive steps you can take if you are in the market for a new joint.

– Go with a highly experienced surgeon in a busy hospital; don’t look for the best deal. Ask for recommendations. A 2004 study published in The Journal of Bone and Joint Surgery found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

A similar trend was documented with hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

– A joint replacement is not for everyone. Some arthritic problems are better served with medication, and surgery may be too risky for those who have uncontrolled high blood pressure or another serious chronic condition.

– Research the joint implant that your surgeon recommends. Find out how well it has performed in others and if there are known complications. Some implants are somewhat controversial and may cause tissue and bone damage; newer doesn’t necessarily mean better. If the hospital has its own registry, ask to review the data.

– Educate yourself as to what the surgery entails. The American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org is very helpful.

– Prepare your recovery in advance. Arrange for the necessary support upon your return home, and make sure you have all the help you need. It is crucial not to overexert yourself during your initial healing period.

A New York Times review of the new book The Secret Life of the Grown-Up Brain caught my eye a week or so ago, and the author, Barbara Straunch, had some interesting insights to share relative to what middle-aged brains are actually good at, and how to keep our brains functioning well into the future.

• Our brains are still growing and developing far into adulthood.  Although we do have some compromises in short term memory (Where are my keys anyway? And what is your name?), the middle-aged brain is actually better in many ways than at any other point in our lives.

• Logic, creativity and social skills are all at a high point during those middle years.  Although you might not remember the name of the person to whom you are speaking, you will be an excellent judge of his character.

• We do not, as previously thought, actually lose brain cells as we age.

• Exercise and diet recommendations that benefit your heart are also likely to benefit the health of your brain.  Exercise in particular can actually help strengthen and grow your brain.  So get out there and start moving!

• Although there are benefits to making your brain work hard, crossword puzzles and learning a foreign language hold no particular magic powers in terms of maintaining the health of your brain.  Partaking in vigorous debates on subjects of interest can be just as helpful, so unless you just love the Sunday Times crossword puzzle, you can stop doing it!

• Meeting and engaging with people is healthy for your brain, and your mood!

It is so refreshing to hear that middle age is not necessarily the beginning of a slow slide into senility.  Staying engaged and active in life, both in terms of intellectual pursuits and social involvement, seems to be key to keeping your gray matter from graying.

I am hopeful that by maintaining an active life filled with fulfilling relationships, creative pursuits and lively conversation, I can remain one less consumer of Long Term Care services in New York!

The typical hospital fare such as jello, soggy sandwiches and tasteless chow that we’re all familiar with, seems to be a thing of the past. Think Machaca Steak with Sauce and Curried Banana Pierogi. Hospitals are now competing with the likes of five-star hotels and restaurants by installing sushi stations, organic salad bars and pizza ovens.

The National Society for Healthcare Foodservice Management recently launched an annual cooking competition. “We want to show the world that health-care food is so much different. It can be creative. It can dazzle,” said Betty Perez, a society board member and a hospital food administrator in New Jersey. “We have chefs that can compete with the best of them.”

However, hospital chefs must play by different rules than their glitzy restaurant counterparts. Their creative offerings must be in tune with doctors orders, as well as nutritionists and cost-sensitive food administrators.

600 calories, 20 grams of fat, and 1,000 milligrams of sodium were the max for each contest dish and the production cost per dish could not exceed $5.

So pass the Green Apple-Jicama Slaw and enjoy your stay.

The more aggressively you screen for and try to prevent osteoporosis, the lower your risk of a hip fracture is, studies show.
Hip fractures are common in the elderly, especially women, who lose essential calcium during pregnancy and menopause.
Kaiser Southern California has developed a three-step action plan that they say can reduce hip fractures by as much as 25%.
The three steps are as follows:
Bone scans: Kaiser recommends x-ray absotiometry, the best bone density test available. The tests should be taken by all women over 65, all men over 70, everyone on high dosages of medicines that leach calcium from the bones, and anyone over 50 with a history of fragility fractures. These are the high-risk populations, and a scan could catch a weakening bone before it becomes a fracture.
Education and treatment: Learning and teaching about osteoporosis helps people help themselves. The more you know about osteoporosis, the better you can protect yourself from fractures. Kaiser found that patients who understood their treatment opted for more than just drug treatment: they got home safety checks to help prevent falls. Slippery bathtubs, cords across the room, and loose rugs are all tripping hazards that can snap a fragile bone.
Fall Prevention: If you’re at risk for a fall, consider learning fall-reduction techniques, that will lower your risk for a fall. Physical therapy can improve balance and coordination, reducing the risk still further.
Kaiser ran a three-part program with 620,000 patients in Southwestern United States, and found an overall reduction of hip fractures by 35%. Why wait for them to test it in your neighborhood? Start your own three-part program today.