Health Scan: Joint replacements

Electromagnetic guidance makes joint replacement more precise.

By JUDY SIEGEL-ITZKOVICH
knee joint 88 (photo credit: )
knee joint 88
(photo credit: )
Computer-guided surgery to replace joints has been a boon to people suffering from orthopedic and rheumatic disorders because it allows for more accurate placement of artificial implants. Now a new electromagnetic technique has made such surgery even more precise. Jerusalem's two Hadassah University Medical Centers in Jerusalem and on Mount Scopus are now using this technique, which is said to shorten hospitalization and recovery. The equipment was developed and is manufactured by Medtronics and the Zimmer companies, which selected Hadassah as one of the few world centers to use it. Most hospitals that perform computer-guided joint replacement use electro-optic equipment, which requires surgeons to establish a continuous direct link between the computer and the patient. This forces the operating team to move during surgery and causes it to take longer. But surgeons don't have to move during surgery with electromagnetic equipment, says orthopedics department chairman Prof. Meir Liebergall, who performs the surgery in Ein Kerem along with Dr. Yoav Matan, head of the unit for joint replacement on Mount Scopus. The unit performs about 600 joint replacements a year, including 230 knee joints. Five operations have already been performed using the electromagnetic technique. HRT SHOULD BE AVOIDED IF POSSIBLE Menopausal women have a greater risk of cancer and stroke if they undergo hormone replacement therapy (HRT), according to Prof. Nancy Woods, one of the world's leading women's health researchers, who was in Israel recently to receive an honorary doctorate from the University of Haifa. Studies of scores of thousands of women have shown that the damage caused by hormones taken to treat change-of-life problems is greater in many cases than the utility from taking them, Woods said. In the event that a women suffers from a problem associated with menopause, like hot flashes, Woods advised her to take a minimal dose of hormones and not to continue the treatment for more than five years. But it is best, she said, to avoid taking them at all. Woods, who is dean of the School of Nursing at the University of Washington in Seattle, told her audience: "Today there are many alternative treatments to reduce hot flashes that can be used in order to avoid hormones, such as breathing exercises or biofeedback and self-calming treatment." The nursing educator and researcher, who was visiting Israel for the first time, stressed that in every case a woman should consult with her physician in regard to taking hormones. The woman's family history should also be checked, she said. She also recommends that women adopt a low-fat diet with plenty of fiber and more than 1,200 mg of calcium a day, with a daily supplement of vitamin D. "Taking calcium and vitamin D," she said, "will help prevent bone breaks in older age, and is advised for all women." SEX DOESN'T SPEED DELIVERY A new study debunks the widely held belief that having sex during the final weeks of pregnancy can hasten labor and delivery. In fact, just the opposite was true in 93 women studied at Ohio State University Medical Center. Women who were sexually active in the final three weeks of their pregnancies carried their babies an average of 39.9 weeks, compared to average delivery at 39.3 weeks among women who abstained from sexual activity at term. "Patients may continue to hear the 'old wives' tale' that intercourse will hasten labor, but according to this data, they should not hear it from the medical community," concludes Dr. Jonathan Schaffir, an obstetrician at OSU Medical Center and author of the study published in the June issue of the journal Obstetrics & Gynecology. Schaffir also said the data don't support a recommendation to engage in sexual activity, either. Of the 93 women enrolled, 47, or 50.5 percent, reported they had sex during the final weeks of their pregnancies - more than any other similar study has indicated. The women were those with low-risk single pregnancies enrolled at their doctor's office visit after the 37th week of pregnancy. At this and subsequent routine visits, patients were asked whether they had engaged in sexual intercourse during the preceding week and if so, how many times. Cervical examinations were performed at each visit to gauge whether the activity had a "ripening" effect on the cervix. Schaffir found no correlation between the frequency of sexual intercourse and the score assigned to measure the cervix. That lack of change in the cervix among sexually active women, combined with the lack of difference in delivery dates among the two groups, suggests thatintercourse has no effect on inducing labor, Schaffir said. He acknowledged that women who are more comfortable late in pregnancy may be more likely to engage in sex, and that women who experience abdominal discomfort or pelvic pressure - possible signs of earlier delivery - won't be inclined to want sex. Schaffir also said that because of the highly personal nature of sexual behavior, the study doesn't address specific components of sexual behavior that might have varying effects on the onset of labor. ORTHOPEDIC SURGEONS at Hadassah University Medical Center enjoy freedom of movement while performing joint replacements because they don't have to worry about blocking the computer's line of vision to the patient. (Hadassah University Medical Center)