Questions & answers

Questions & answers

Q Nine months after a total knee replacement, my pain is no better than it was before surgery. I was told I may have developed arthrofibrosis. What is that?

A Arthrofibrosis is the excessive development of scar tissue and adhesions in a joint that has undergone surgery or has been injured. In the knee, it causes pain and limits both flexion and extension. Arthrofibrosis after a total knee replacement usually occurs when the knee has had poor range of motion before surgery. It is a particular problem in knee revision surgery and reimplantation after treatment of an infected knee replacement. The best treatment for a stiff knee caused by arthrofibrosis is prevention. Physical therapy should begin promptly after surgery and be continued during the postoperative period. If physical therapy fails to achieve a useful range of motion, manipulation may be necessary: the adhesions and scar tissue are gently stretched while the patient is anesthetized. This manipulation is usually performed three to six months after surgery. If manipulation fails, surgery is sometimes necessary. This can include arthroscopic surgery or an open incision to remove the adhesions. If the knee needs to be opened, the scar should be excised since the skin sometimes adheres to the capsule of the joint. It is occasionally necessary to lengthen the tendon in front of the knee in a procedure called a quadriceplasty.

Q A friend of mine has been losing her memory and suffering from confusion. She’s been diagnosed with a condition called Lewy body dementia. What exactly is this disorder and how does it affect people?

A Lewy body dementia (LBD) is the second most frequent cause of dementia in older people. this neurodegenerative disease is characterized by the presence of abnormal structures called Lewy bodies in certain areas of the brain. It is not preventable, and there is no cure. Research has found that Lewy bodies contain a protein called alpha-synuclein that also has been linked to Parkinson’s. Lewy body dementia causes both physical and mental problems. Physical symptoms resemble those of Parkinson’s disease. They include changes in gait, shuffling, rigidity, and tremor. Mental symptoms resemble those of Alzheimer’s disease, with confusion, depression, loss of memory and impaired cognition that can fluctuate from alertness to delusion. LBD sufferers may also experience visual hallucinations and sleep disorders. Although LBD is incurable, many patients respond to treatment and can do well for years. Therapy is complicated, however. Antiparkinsonian medications prescribed to lessen tremors and movement problems can worsen hallucinations and delusions, while certain drugs used in the treatment of the psychiatric symptoms associated with Alzheimer’s can make physical problems more severe. Yet, cholinesterase inhibitors used to delay the progression of Alzheimer’s can stabilize and sometimes improve this condition. A comprehensive approach to treatment that combines therapy for cognitive, neuropsychiatry, motor, sleep, and other medical issues seems to produce good results in many cases. Patients who show little signs of brain atrophy on magnetic resonance imaging do especially well on this type of regimen.

Q I just had a coronary angiogram and was told that I didn’t need any stents or bypass surgery, but that I nevertheless had coronary artery disease and still faced a risk of a future heart attack. How can that be?

A From your description, it appears that your coronary arteries have some degree of narrowing. Even moderate plaque build-up accounts for a significant number of heart attacks. Your doctors probably couldn’t just “clean it out” when you underwent angiography because more moderate degrees of narrowing are best treated with medications rather than by procedures, according to currently available data. Cardiologists are now beginning to investigate whether drug-coated stents could help in cases involving more moderate narrowing. We won’t have those findings for several years.

COPYRIGHT 2006 Belvoir Media Group, LLC

COPYRIGHT 2007 Gale Group