Bone, Joint, and Muscle Infections in Children

Bone, Joint, and Muscle Infections in Children

Article Featured on AAOS

Children can develop infections in their bones, joints, or muscles. Often referred to as “deep” infections, the technical names for these conditions are:

  • Osteomyelitis (bone infection)
  • Septic arthritis (joint infection)
  • Pyomyositis (muscle infection)

This article covers the most common types of deep infections in children and includes the ways doctors identify and treat them.

Cause

Infections are usually caused by bacteria that are present in our normal living environment. The most common bacteria causing bone, joint, or muscle infections in children is Staphylococcus aureus (often referred to as “Staph” infections).

Bacteria can get into the body in a variety of ways. They circulate through the bloodstream until they reach a bone, joint, or muscle. Bacteria then leave the bloodstream and multiply in the bone, joint, or muscle tissues.

Description

Deep infections most often occur in the joints and at the ends of long bones where they meet to form joints. These include the hip, knee, and ankle joints of the leg, and the shoulder, elbow, and wrist joints of the arm.

The large muscle groups of the thigh, groin, and pelvis are the most common locations for deep muscle infections.

The reason infections occur in these areas is due to the way blood flows to these locations. There is a strong blood flow to the ends of bone near growth centers (called growth plates), the lining of the joints, and the large muscle groups. This allows bacteria to easily find their way to these areas.

The blood supply to the spine, pelvis, and heel is similar to that of the long bones, and infections often develop in these areas, as well.

Infections pose special risks to young children for a number of reasons:

  • Children under the age of three are easily infected. Their immune systems are not fully developed and they tend to fall down a lot, opening the skin to infection.
  • Infections spread quickly through a young child’s circulation system and bone structure.
  • Damage to bones and joints caused by infection can harm a child’s growth and lead to physical dysfunction. Infection of child’s hip joint is a surgical emergency.

Symptoms and Signs

Children who have infections of their bones, joints, or muscles often have the following:

  • Fever
  • Pain
  • Limited movement of the infected area — your child may limp or refuse to walk if the infection involves the legs or back
  • Infants may be irritable and lethargic, refuse to eat, or vomit

Many children who have bone, joint, or muscle infections have had recent injuries. The symptoms of infection are often masked by those of the injury. Because parents assume the injury will get better over time, it may take them longer to notice the infection.

It is important to bring your child to a doctor immediately if symptoms are not quickly resolving at home.

Doctor Examination

Medical History and Physical Examination

Make sure to tell your child’s doctor the circumstances surrounding the symptoms, such as when the symptoms began, and whether there was a prior infection or injury.

After discussing your child’s symptoms and medical history, your doctor will examine the painful area. He or she may ask your child to move the affected area to see whether movement increases the pain.

Tests

Other tests that may help your doctor confirm a diagnosis and plan your child’s treatment include:

  • Blood tests and tissue cultures. Tests on your child’s blood, as well as fluid and/or tissue from the infected area, can help identify the bacteria or other organism causing the infection. This information about the infection helps your doctor determine the most effective ways to treat it.
  • Imaging tests. Tests, such as x-rays, magnetic resonance imaging (MRI) scans, and ultrasound, provide your child’s doctor with pictures of the bones, muscles, and soft tissues in the affected area. Your doctor will look for swelling around bones and muscles, or fluid within the joints that are infected. This information helps your doctor when making the decision whether to treat the infection with antibiotics alone or to perform surgery to help resolve it.

Treatment

Antibiotic Treatment

Prescribing antibiotics is the mainstay of treatment for infections.

  • Intravenous. At first, your child will need to stay at the hospital to receive antibiotics through the veins (intravenous or IV). How long your child will stay in the hospital will depend on how severe the infection is. Most children with bone, joint, or muscle infections are in the hospital for 1 to 2 weeks.
  • Oral. For many children, the antibiotic is eventually changed to a form that can be taken by mouth (oral) and given at home.
  • PICC line. Some children can continue to receive an antibiotic by vein at home through a special intravenous device called a PICC (pronounced “pick”) line. This is a peripherally introduced central catheter (PICC).

The amount of time on antibiotics that is needed to resolve an infection varies from child to child but, in general, is 4 to 6 weeks for a bone infection and 3 to 4 weeks for joint or muscle infections.

It is very important to have your child take all of the antibiotics he or she is given, in exactly the way they are prescribed.

Surgical Treatment

In mild infections, antibiotics alone may resolve the condition. Many children, however, will need surgery to remove infected material (pus) from the area of infection. This will reduce pressure and inflammation and improve blood flow, which will make it easier for the antibiotics to reach the infected area. For most children, one surgical procedure is enough, but more severe infections may require two or more surgeries to help resolve the infection.

Infected biceps muscle

An infection in the biceps muscle has caused pus to accumulate in this child’s upper arm. During surgery, the pus will be drained so that antibiotics can effectively reach and resolve the infection.
Courtesy of Children’s Medical Center of Dallas

Outcome

Most children will completely recover from deep infections after proper treatment. They are not likely to develop the same infection again. In most cases, children have no further problems and return to all of their activities.

In general, children do better when the infection is recognized early. There is a greater chance for full recovery when the infection is quickly recognized and treated. The later the diagnosis is made, the more likely it is that the infection will cause greater damage to the bones, muscles and other tissues that are involved.

Some problems can occur in children who have serious and prolonged infections. These include blood clots, growth arrests, deformed bones, fractures through bone that is weakened from infection, bone death (called necrosis), and joint stiffness. However, these problems are rare.

Methicillin Resistant Staphylococcus Aureus (MRSA)

In many communities, deep infections are more frequently being caused by a particular type of bacteria known as MRSA. This bacteria is more able to resist antibiotics that previously worked well to treat these infections.

Currently, there are several antibiotics that work very well against MRSA and are tolerated very well by the children who are treated.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Common Knee Injuries

What to do if you think your joint replacement is infected

Article Featured on AAOS

Knee and hip replacements are two of the most commonly performed elective operations. For the majority of patients, joint replacement surgery relieves pain and helps them to live fuller, more active lives.No surgical procedure is without risks, however. A small percentage of patients undergoing hip or knee replacement (roughly about 1 in 100) may develop an infection after the operation.Joint replacement infections may occur in the wound or deep around the artificial implants. An infection may develop during your hospital stay or after you go home. Joint replacement infections can even occur years after your surgery.

This article discusses why joint replacements may become infected, the signs and symptoms of infection, treatment for infections, and preventing infections.

Description

Any infection in your body can spread to your joint replacement.

Infections are caused by bacteria. Although bacteria are abundant in our gastrointestinal tract and on our skin, they are usually kept in check by our immune system. For example, if bacteria make it into our bloodstream, our immune system rapidly responds and kills the invading bacteria.

However, because joint replacements are made of metal and plastic, it is difficult for the immune system to attack bacteria that make it to these implants. If bacteria gain access to the implants, they may multiply and cause an infection.

Despite antibiotics and preventive treatments, patients with infected joint replacements often require surgery to cure the infection.

Total knee implants

Examples of total knee implants. Joint replacement implants are typically made of metal alloys and strong, durable plastic called polyethylene.

Cause

A total joint may become infected during the time of surgery, or anywhere from weeks to years after the surgery.

The most common ways bacteria enter the body include:

  • Through breaks or cuts in the skin
  • During major dental procedures (such as a tooth extraction or root canal)
  • Through wounds from other surgical procedures

Some people are at a higher risk for developing infections after a joint replacement procedure. Factors that increase the risk for infection include:

  • Immune deficiencies (such as HIV or lymphoma)
  • Diabetes mellitus
  • Peripheral vascular disease (poor circulation to the hands and feet)
  • Immunosuppressive treatments (such as chemotherapy or corticosteroids)
  • Obesity

Symptoms

Signs and symptoms of an infected joint replacement include:

  • Increased pain or stiffness in a previously well-functioning joint
  • Swelling
  • Warmth and redness around the wound
  • Wound drainage
  • Fevers, chills and night sweats
  • Fatigue

Doctor Examination

When total joint infection is suspected, early diagnosis and proper treatment increase the chances that the implants can be retained. Your doctor will discuss your medical history and conduct a detailed physical examination.

Tests

Imaging tests. X-rays and bone scans can help your doctor determine whether there is an infection in the implants.

Laboratory tests. Specific blood tests can help identify an infection. For example, in addition to routine blood tests like a complete blood count (CBC), your surgeon will likely order two blood tests that measure inflammation in your body. These are the C-reactive Protein (CRP) and the Erythrocyte Sedimentation Rate (ESR). Although neither test will confirm the presence of infection, if either or both of them are elevated, it raises the suspicion that an infection may be present. If the results of these tests are normal, it is unlikely that your joint is infected.

Additionally, your doctor will analyze fluid from your joint to help identify an infection. To do this, he or she uses a needle to draw fluid from your hip or knee. The fluid is examined under a microscope for the presence of bacteria and is sent to a laboratory. There, it is monitored to see if bacteria or fungus grow from the fluid.

The fluid is also analyzed for the presence of white blood cells. In normal hip or knee fluid, there are a low number of white blood cells. The presence of a large number of white blood cells (particularly cells called neutrophils) indicates that the joint may be infected. The fluid may also be tested for specific proteins that are known to be present in the setting of an infection.

Treatment

Nonsurgical Treatment

In some cases, just the skin and soft tissues around the joint are infected, and the infection has not spread deep into the artificial joint itself. This is called a “superficial infection.” If the infection is caught early, your doctor may prescribe intravenous (IV) or oral antibiotics.

This treatment has a good success rate for early superficial infections.

Surgical Treatment

Infections that go beyond the superficial tissues and gain deep access to the artificial joint almost always require surgical treatment.

Debridement. Deep infections that are caught early (within several days of their onset), and those that occur within weeks of the original surgery, may sometimes be cured with a surgical washout of the joint. During this procedure, called debridement, the surgeon removes all contaminated soft tissues. The implant is thoroughly cleaned, and plastic liners or spacers are replaced. After the procedure, intravenous (IV) antibiotics will be prescribed for approximately 6 weeks.

Staged surgery. In general, the longer the infection has been present, the harder it is to cure without removing the implant.

Late infections (those that occur months to years after the joint replacement surgery) and those infections that have been present for longer periods of time almost always require a staged surgery.

The first stage of this treatment includes:

  • Removal of the implant
  • Washout of the joint and soft tissues
  • Placement of an antibiotic spacer
  • Intravenous (IV) antibiotics

An antibiotic spacer is a device placed into the joint to maintain normal joint space and alignment. It also provides patient comfort and mobility while the infection is being treated.

Knee Implant Compressors

(Top) These x-rays show an original knee replacement from the front and from the side. (Bottom) An antibiotic spacer has been placed in the joint during the first stage of treatment for joint replacement infection.

Spacers are made with bone cement that is loaded with antibiotics. The antibiotics flow into the joint and surrounding tissues and, over time, help to eliminate the infection.

Patients who undergo staged surgery typically need at least 6 weeks of IV antibiotics, or possibly more, before a new joint replacement can be implanted. Orthopaedic surgeons work closely with other doctors who specialize in infectious disease. These infectious disease doctors help determine which antibiotic(s) you will be on, whether they will be intravenous (IV) or oral, and the duration of therapy. They will also obtain periodic blood work to evaluate the effectiveness of the antibiotic treatment.

Once your orthopaedic surgeon and the infectious disease doctor determine that the infection has been cured (this usually takes at least 6 weeks), you will be a candidate for a new total hip or knee implant (called a revision surgery). This second procedure is stage 2 of treatment for joint replacement infection.

During revision surgery, your surgeon will remove the antibiotic spacer, repeat the washout of the joint, and implant new total knee or hip components.

An antibiotic spacer in a hip joint.

This x-ray shows knee components used in a revision surgery (stage 2). Note that the stems of the implants are longer to help support bone that has been compromised due to infection and removal of the previous implants.

Single-stage surgery. In this procedure, the implants are removed, the joint is washed out (debrided), and new implants are placed all in one stage.  Single-stage surgery is not as popular as two-stage surgery, but is gaining wider acceptance as a method for treating infected total joints. Doctors continue to study the outcomes of single-stage surgery.

Prevention

At the time of original joint replacement surgery, there are several measures taken to minimize the risk of infection. Some of the steps have been proven to lower the risk of infection, and some are thought to help but have not been scientifically proven. The most important known measures to lower the risk of infection after total joint replacement include:

  • Antibiotics before and after surgery. Antibiotics are given within one hour of the start of surgery (usually once in the operating room) and continued at intervals for 24 hours following the procedure.
  • Short operating time and minimal operating room traffic. Efficiency in the operation by your surgeon helps to lower the risk of infection by limiting the time the joint is exposed. Limiting the number of operating room personnel entering and leaving the room is thought to the decrease risk of infection.
  • Use of strict sterile technique and sterilization instruments. Care is taken to ensure the operating site is sterile, the instruments have been autoclaved (sterilized) and not exposed to any contamination, and the implants are packaged to ensure their sterility.
  • Preoperative nasal screening for bacterial colonization. There is some evidence that testing for the presence of bacteria (particularly the Staphylococcus species) in the nasal passages several weeks prior to surgery may help prevent joint infection. In institutions where this is performed, those patients that are found to have Staphylococcus in their nasal passages are given an intranasal antibacterial ointment prior to surgery. The type of bacteria that is found in the nasal passages may help your doctors determine which antibiotic you are given at the time of your surgery.
  • Preoperative chlorhexidine wash. There is also evidence that home washing with a chlorhexidine solution (often in the form of soaked cloths) in the days leading up to surgery may help prevent infection. This may be particularly important if patients are known to have certain types of antibiotic-resistant bacteria on their skin or in their nasal passages (see above). Your surgeon will talk with you about this option.
  • Long-term prophylaxis. Surgeons sometimes prescribe antibiotics for patients who have had joint replacements before they undergo dental work. This is done to protect the implants from bacteria that might enter the bloodstream during the dental procedure and cause infection. The American Academy of Orthopaedic Surgeons has developed recommendations for when antibiotics should be given before dental work and for which patients would benefit.  In general, most people do not require antibiotics before dental procedures. There is little evidence that taking antibiotics before dental procedures is effective at preventing infection.

    Antibiotics may also be considered before major surgical procedures; however, most patients do not require this. Your orthopaedic surgeon will talk with you about the risks and benefits of prophylactic antibiotics in your specific situation.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Does Weight Loss Affect Knee Pain

Does Weight Loss Affect Knee Pain?

Why does my knee hurt?

Knee pain is one of the most common complications of being overweight or obese. If you’re among the millions of people who experience chronic knee pain, even a small weight loss can help reduce pain and lower the risk of osteoarthritis (OA).

According to a 2011 report from the Institute of Medicine (IOM), of the roughly 100 million American adults who experience common chronic pain, nearly 20 percent, or 20 million people, have knee pain. This is second only to the number of people with lower back pain.

More than two-thirds of people in the United StatesTrusted are either overweight (with a BMI between 25 and 29.9) or obese (with a BMI of 30 or higher).

Those extra pounds increase the stress on your knees. That stress can cause chronic pain and lead to other complications such as OA.

How weight loss affects knee pain

Maintaining a healthy weight has many health benefits, including reduced risk of a number of diseases that include:

  • heart disease
  • type 2 diabetes
  • high blood pressure
  • certain types of cancers

Losing weight benefits knee pain in two ways.

Decreases weight-bearing pressure on the knees

Each pound of weight loss can reduce the load on the knee joint by 4 pounds. Lose 10 pounds, and that’s 40 fewer pounds per step that your knees must support. And the results add up quickly. Less pressure means less wear and tear on the knees. This lowers the risk of OA.

Reduces inflammation in the body

For years, OA was considered a wear and tear disease caused by prolonged excess pressure on the joints, particularly the knees, which, in turn, caused inflammation. But recent research suggests that inflammation is a key OA risk factor, rather than a consequence of OA.

Being overweight may increase inflammation in the body that can lead to joint pain. Losing weight can reduce this inflammatory response. One study suggests that just a 10 percent reduction in weight can significantly lower inflammation in the body. Another study found that even simply overeating triggers the body’s immune response, which increases inflammation.

The link between weight gain and OA

Being overweight or obese significantly increases a person’s risk for developing OA. According to John Hopkins Medicine, women who are overweight are four times more likely to develop OA than women who are a healthy weight. And men who are overweight are five times more likely to develop OA than men who are a healthy weight.

But losing even a small amount of weight can be beneficial. For women who are overweight, every 11 pounds of weight loss can reduce the risk of knee OA by more than 50 percent. Men who drop into the overweight category (BMI below 30) and men who drop into the normal weight category (BMI below 26) can reduce their risk of knee OA by 21.5 percent.

Easy ways to lose weight

There are steps you can take to start shedding pounds, including:

  • reduce portion sizes
  • add one vegetable to your plate
  • go for a walk after a meal
  • take the stairs rather than the escalator or elevator
  • pack your own lunch instead of eating out
  • use a pedometer

Taking the necessary steps to manage your weight can help protect your knees from joint pain and reduce your risk of OA.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

More Than Just Joints: How Rheumatoid Arthritis Affects the Rest of Your Body

More Than Just Joints: How Rheumatoid Arthritis Affects the Rest of Your Body

Article by Mary Anne Dunkin | Featured on Arthritis.org

The inflammation that characterizes RA can impact organs and systems, too.

You know that arthritis affects your joints. Painful, swollen knees or fingers are impossible to ignore. But did you know that other parts of your body – your skin, eyes and lungs, to name a few – may also be affected?

Rheumatoid arthritis is a systemic disease, meaning it can affect many parts of the body. For that matter, so can some of the drugs used to treat RA. Following is a listing by body part of the ways RA (and sometimes the drugs used to treat it) can affect you.

Many of these problems – such as bone thinning or changes in kidney function – cause no immediate symptoms so your doctor may monitor you through lab tests or checkups. For other problems – such as skin rashes or dry mouth – it’s important to report any symptoms to your doctor, who can determine the cause or causes, and adjust your treatment plan accordingly.

Skin

Nodules. About half of people with RA develop rheumatoid nodules – lumps of tissue that form under the skin, often over bony areas exposed to pressure, such as fingers or elbows. Unless the nodule is located in a sensitive spot, such as where you hold a pen, treatment may not be necessary. Nodules sometimes disappear on their own or with treatment with disease-modifying antirheumatic drugs (DMARDs).

Rashes. When RA-related inflammation of the blood vessels (called vasculitis) affects the skin, a rash of small red dots is the result. In more severe cases, vasculitis can cause skin ulcers on the legs or under the nails. Controlling the rash or ulcers requires controlling the underlying inflammation.

Drug effects. Corticosteroids, prescribed to reduce inflammation, can cause thinning of the skin and susceptibility to bruising. Non-steroidal anti-inflammatory drugs (NSAIDs), which treat pain and inflammation, and methotrexate, a widely prescribed DMARD, can cause sun sensitivity. People taking biologics, a sub-category of DMARDs designed to stop inflammation at the cellular level, may develop a rash at the injection site.

Bones

Thinning. Chronic inflammation from RA leads to loss of bone density, not only around the joints, but throughout the body, leading to thin, brittle bones. Exercise, a high-calcium diet and vitamin D can all help bones, but in some cases your doctor may need to prescribe a drug to stimulate bone growth or prevent bone loss.

Drug effects. Corticosteroids can also cause bone thinning.

Eyes

Inflammation and scarring. Some people with RA develop inflammation of the whites of the eyes (scleritis) that can lead to scarring. Symptoms include pain, redness, blurred vision and light sensitivity. Scleritis is usually treatable with medications prescribed by your doctor, but in rare cases, the eye may be permanently damaged. RA can also cause uveitis, an inflammation of the area between the retina and the white of the eye, which, if not treated, could cause blindness.

Dryness. The inflammatory process that affects the joints can also damage the tear-producing glands, a condition known as Sjögren’s syndrome. The result is eyes that feel dry and gritty.  Artificial tears, which are available over the counter, as well as medications your doctor prescribes, can keep eyes more comfortable and help prevent damage related to dryness.

Drug effects. Corticosteroids may cause glaucoma and cataracts. Hydroxychloroquine, in rare cases, causes pigment changes in the retina that can lead to vision loss. As a rule, people with RA should get eye checkups at least once a year.

Mouth

Dryness. Inflammation can damage the moisture-producing glands of the mouth as well as the eyes, resulting in a dry mouth. Over-the-counter artificial saliva products and self-treatment often helps. If not, your doctor may prescribe a medication to increase the production of saliva. Good dental hygiene is a must, as bacteria tend to flourish in a dry mouth, leading to tooth decay and gum disease.

Drug effects. Methotrexate can cause mouth sores or oral ulcers. For treatment, try a topical pain reliever or ask your doctor or dentist for a prescription mouthwash.

Lungs

Inflammation and scarring.  Up to 80 percent of people with RA have some degree of lung involvement, which is usually not severe enough to cause symptoms. However, severe, prolonged inflammation of the lung tissue can lead to a form of lung disease called pulmonary fibrosis that interferes with breathing and can be difficult to treat.

Nodules. Rheumatoid nodules might form in the lungs, but are usually harmless.

Drug effects. Methotrexate can cause a complication known as methotrexate lung or methotrexate pneumonia, which generally goes away when the methotrexate is stopped. Less common drugs, including injectable gold and penicillamine, can cause similar pneumonias. The condition goes away when treatment ceases; patients can usually resume the drug in a few weeks.

By suppressing your immune system, corticosteroids, DMARDs and biologics may increase your risk of tuberculosis (TB), a bacterial infection of the lungs. Your doctor should test for TB before initiating treatment and periodically after.

Heart and Blood Vessels

Atherosclerosis. Chronic inflammation can damage endothelial cells that line the blood vessels, causing the vessels to absorb more cholesterol and form plaques.

Heart attack and stroke. When plaques from damaged blood vessels break lose they can block a vessel, leading to heart attack or stroke. In fact, a 2010 Swedish study found that the risk of heart attack for people with RA was 60 percent higher just one year after being diagnosed with RA.

Pericarditis. Inflammation of the heart lining, the pericardium, may manifest as chest pain. Treatment to control arthritis often controls pericarditis as well.

Drug effects. While many RA medications, including methotrexate, other DMARDS and biologics may reduce cardiovascular risk in people with RA, other medications – chiefly NSAIDs – may increase the risk of cardiovascular events including heart attack. Your doctor will need to evaluate your risk when prescribing treatment for your RA.

Liver

Drug effects. Although RA doesn’t directly harm the liver, some medications taken for RA can.  For example, long-term use of the pain reliever acetaminophen (Tylenol) is considered a leading cause of liver failure. Liver diseases may also occur with long-term methotrexate use. Working with your rheumatologist to monitor your blood is key to preventing problems.

Kidneys

Drug effects. As with the liver, drugs taken for arthritis can lead to kidney problems. The most common offenders include cyclosporine, methotrexate and NSAIDs.  If you are taking these drugs long term, you doctor will monitor your kidney function to watch for problems.

Blood

Anemia. Unchecked inflammation can lead to a reduction in red blood cells characterized by headache and fatigue. Treatment consists of drugs to control inflammation along with iron supplements.

Blood clots. Inflammation might lead to elevated blood platelet levels, and blood clots.

Felty syndrome. Though rare, people with longstanding RA can develop Felty syndrome, characterized by an enlarged spleen and low white blood cell count. This condition may lead to increased risk of infection and lymphoma (cancer of the lymph glands). Immunosuppressant drugs are the usual treatment.

Drug effects. Aggressively treating inflammation with corticosteroids may cause thrombocytopenia, an abnormally low number of blood platelets.

Nervous System

Pinched or compressed nerves. Although RA does not directly affect the nerves, inflammation of tissues may cause compression of the nerves resulting in numbness or tingling. One relatively common problem is carpal tunnel syndrome, a condition in which the nerve that runs from the forearm to the hand is compressed by inflamed tissue in the wrist area, resulting in tingling, numbness and decreased grip strength.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Types of Joint Surgery: Understanding Your Joint Procedure Options

Types of Joint Surgery: Understanding Your Joint Procedure Options

Article Featured on The Arthritis Foundation

If you maintain a healthy weight and exercise regularly, but joint pain from your osteoarthritis (OA) or other type of arthritis is still debilitating, surgery may be in your future.

This guide to common surgical options can help you have an informed discussion with your doctor about which type is best for you.

Arthroscopy

What is it? Surgeons use this technique — which involves small incisions, specialized instruments and a tiny camera — to fix tears in soft tissues around the knee, hip, shoulder and other joints; repair damaged cartilage; and remove broken, free-floating cartilage pieces.

Best candidates: Active people younger than 40 years.

Pros: Often immediately reduces pain and improves range of motion and other symptoms. May delay or eliminate the need for an artificial joint

Cons:. “The jury is still out as to whether [arthroscopy] can actually stop the further deterioration of the joint,” says Mathias P. Bostrom, MD, an orthopaedic surgeon at the Hospital for Special Surgery in New York. “Right now, there are no long-term studies to support that idea.”

Joint Resurfacing

What is it? In the knee, this may also be called unicompartmental or partial knee replacement. In this procedure, surgeons replace with an implant only one of the three compartments of the knee, the medial (inside), lateral (outside) or patellofemoral (front) compartment. In the hip, surgeons replace the hip socket with a metal cup, and the damaged hip ball is reshaped and capped with a metal, dome-shaped prosthesis.

Best candidates: For the knee, older, less active patients with arthritis in only one knee compartment. For hips, men younger than 60, especially athletes or those with physically demanding jobs.

Pros: In the knee, this procedure can relieve pain and improve function with daily activities. In the hip, it may increase the ability to participate in high-impact sports and activities that require flexibility, such as martial arts and yoga. Conserving the thighbone may make future hip surgery easier.

Cons: Higher complication rate than conventional implants, and the metal-on-metal hip system poses the same risks as other all-metal hip replacement systems. It’s not recommended for people with osteoporosis, kidney disease or diabetes.

Osteotomy

What is it? The procedure involves cutting and removing bone or adding a wedge of bone near a damaged joint. In the knee, for example, an osteotomy shifts weight from an area damaged by arthritis to an undamaged area. In the hip it is often used to correct misalignment (hip dysplasia) that occurs early in life.

Best candidates: Patients in their 30s and younger or who are too young for total joint replacement.

Pros: Can halt damage and delay the need for a joint replacement.

Cons: Osteotomies are not simple, warns Robert L. Barrack, MD, chief of staff for orthopaedic surgery at Barnes-Jewish Hospital in St. Louis. “Because the surgery is so complex and highly specialized, only a small percentage of surgeons are best suited to perform it.”

Synovectomy

What is it? In people with inflammatory arthritis, the lining of the joints – the synovium – can become inflamed or grow too much, damaging surrounding cartilage and joints.In this procedure surgeons remove most or all of the affected synovium, either in a traditional, open surgery or by using arthroscopy.

Best candidates: People with limited cartilage damage in the affected area who have tried anti-inflammatory medications, but who continue to have inflammation or overgrowth of the synovium around the knee, elbow, wrist, fingers or hips.

Pros: Relieves pain and improves function, and people who have had the procedure may be able to reduce their dosage of anti-inflammatory drugs.  

Cons: The procedure may limit range of motion and provide only temporary relief of symptoms.

Arthrodesis, or Fusion

What is it? In this procedure surgeons use pins, plates, rods or other hardware to join two or more bones in the ankles, wrists, thumbs, fingers or spine, making one continuous joint. Over time the bones grow together and lock the joint in place.  

Best candidates: People with severe joint damage from OA or inflammatory arthritis.

Pros: This procedure is very durable, and results should last a lifetime.People who have weight-bearing joints fused can often take part safely in high-impact physical activity.

Cons: Fusing joints eliminates their motion and reduces flexibility. It also changes the joint’s normal biomechanics, which can put stress on surrounding joints and lead to the development of arthritis in other areas.

Total Joint Replacement (TJR), or Total Joint Arthroplasty

What is it? The damaged joint is replaced with an implant that mimics the motion the natural joint and is made from combinations of metal, plastic and/or ceramic components.

Best candidates: People with severe joint pain who haven’t been helped by other treatments. Improvement in implant durability means that TJR is more common in younger people than in the past.

Pros: Strong, proven track record for safety and success; reduces pain and improves mobility, daily functioning and quality of life.

Cons: All artificial joints can wear out, which may require joint revision surgery. Implants made entirely of metal (called metal-on-metal) can release metal ions that may damage bone and cause other health problems. Ask before surgery about an implant’s track record. TJR is not usually recommended for people who have weak bones or who are obese.

Minimally Invasive TJR

What is it? This technique replaces a damaged joint, but uses shorter incisions than in a traditional TJR. Less muscle is cut and reattached.

Best candidates: Active normal-weight people younger than 50 years.

Pros: Less pain, less time in the hospital and quicker recovery than with conventional joint replacement.

Cons: These procedures are difficult and have higher complication rates than traditional TJR, according to Dr. Barrack. Look for an orthopaedic surgeon who does a high volume of these procedures.

Joint Revision

What is it? Surgery to remove a failed, infected or worn-out implant and replace it with a new one.

Best candidates: People with a damaged artificial joint. Implants can last 20 years or longer, but those who get them as young adults may eventually need a revision.

Pros: Pain relief and improved mobility, strength and coordination.

Cons: Because of the alterations surgeons make to bones during an original joint replacement, revision procedures are more complex and less successful than initial replacement surgeries. Sometimes surgeons need to take a bone graft from another area to complete the operation. Possible complications include a higher fracture risk after surgery, and in the hip, twice the risk of dislocation and uneven leg lengths.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

16 Ways You May Be Hurting Your Joints

16 Ways You May Be Hurting Your Joints

Your joints link bones together so you can bend your knees, wiggle your hips, and move your body. Learn how you might be preventing your joints from working their best.

Carry Extra Weight

Your joints, which link your bones together, are sensitive to heavy loads. Every pound on your frame puts 4 pounds of stress on your knees. It also strains your back, hips, and feet. That causes wear and tear that can lead to damage, aches, and pain. Being overweight also triggers inflammation. That can make all your joints, including in your hands, stiff, painful, and swollen.

Text Too Much

‘Texting thumb’ is a real thing. Your tendons can get irritated and lock your thumb in a curled position. All that looking down at your phone is just as bad for your neck and shoulders, too. Every inch your head drops forward raises the load on your muscles. If you bend your neck so far that your chin touches your chest, it’s as if your neck has to support the weight of 5 heads instead of just one.

Steep Price of High Heels

They might look fab, but the higher they rise, the more your weight tips forward. Your thigh muscles have to work harder to keep your knee straight, which can cause pain. When heels go up, so does the twisting force in your knees. If you wear them every day, you boost your odds for osteoarthritis. That’s when the bones and the cushioning between the bones break down.

Wear the Wrong Shoes

Worn-out shoes don’t support your feet and ankles enough. That’ll throw your knees, hips, and back out of whack. Also, make sure your sneakers are right for your sport. High tops for basketball, for example, can protect your ankles from sprains. But don’t go overboard. Too much cushion or arch support means your foot can’t move naturally, which could keep you in a cycle of pain.

Crack Your Knuckles

That satisfying pop comes from tiny bubbles bursting in the fluid around your joints. Or from ligaments snapping against bone. Despite what annoyed adults might have warned you, it doesn’t cause arthritis. Still, it might be smart to stop. One study showed that this habit may cause your hands to swell and weaken your grip.

Lug a Big Bag

Whether it’s a purse, backpack, or messenger bag, packing too much can cause neck and shoulder pain. Heavy weight on one shoulder throws off your balance and your walk. If you tend to carry things only on one side, the constant pull overstretches your muscles and tires out your joints. If you do that every day, your body’s going to let you know loud and clear.

Use Wrong Muscles for the Job

When you put too much load on little muscles, your joints pay the price. If you need to open a heavy door, push with your shoulder instead of your fingers. When you lift something off the floor, bend at your knees and push up with your strong leg muscles. When you carry something, hold it close to you in the palms of your hands instead of stressing your fingers.

Sleep on Your Stomach

It might help with snoring, but not so much with the rest of your body. Lying on your tummy pushes your head back, which compresses your spine. Your head also will face in one direction for longer stretches than if you sleep on your back. All that puts pressure on other joints and muscles.

Skip Stretching

You don’t need to be a yogi, but regular stretching can help strengthen your muscles and tendons. It also can make them more flexible. That allows your joints to move more easily and helps the muscles around them work better. That’s key to healthy and stable joints.

Skimp on Strength Training

Once you turn 40, your bones start to get a little thinner and more likely to break. If you build muscle with strength training, it slows bone loss and triggers new growth. So you not only get stronger muscles, but denser bones, too. Together, they stabilize your joints so you’re less likely to get hurt.

Smoke and Chew Tobacco

Here’s another reason to quit: Your joints will thank you. Nicotine from cigarettes and chewing tobacco cuts down on blood flow to your bones and to the cushioning discs in your back. It limits how much bone-building calcium your body can take in. It also breaks down estrogen, a hormone you need for bone health. And it slows new growth that thickens bones. All that makes your joints weaker and your hips more likely to break.

Don’t Get Quality ZZZs

You may wonder how poor sleep can affect your joints. One study found that people with arthritis felt more pain after restless nights. That made them take a closer look. One theory is that when you don’t sleep well, it triggers inflammation in your body. That might lead to joint problems over time. More research is needed, but in the meantime, it sure won’t hurt to get good shut-eye.

Slouch and Slump

Your body’s at its best when you work with it, not against it. That’s why posture matters. When you slump in your chair, it puts more stress on your muscles and joints and tires them out. It’s like always jamming on your car brakes when you could just ease down on the pedal instead. So keep your back straight and those shoulders back and down.

Ignore Pain

When you work out, you might think you just need to power through it. After all, no pain, no gain, right? It’s true that some muscle soreness is OK. But not if it lasts for days or if your muscles are swollen or too sore to move or to touch. Joint pain isn’t normal, so pay attention to it. If you think you overdid it, ease up on your exercises. If the pain won’t go away, check with your doctor.

Too Much Computer Time

It can literally be a pain in your neck — and your elbows, wrists, back, and shoulders. The problem isn’t just bad posture, but that you hold it for too long. That overworks your muscles. It also puts pressure on the discs in your back. If you’re in a soft chair, prop up your arms with cushions to take the load off your shoulders and your neck. Be sure to get up and move every hour.

Repeat Poor Form

When you run, bike, or play tennis, you use the same motions over and over. But if your form is bad, you’ll stress your body in all the wrong places. If you overload your muscles, it puts more pressure on your joints, and you can end up with an injury like tennis elbow.

 


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Relieving Arthritis Pain With Heat or Cold Therapy

Relieving Arthritis Pain With Heat or Cold Therapy

By Heidi Godman, Contributor  | Featured on US News

ARTHRITIS PAIN CAN BE disabling. Stiff, swollen, aching joints may keep you from doing the activities you love or the ones required to get through each day, like walking or dressing. While prescription medication and physical therapy are the first line of defense for addressing arthritis causes, an age-old home remedy – heat or cold therapy – may help reduce pain and improve range of motion. “It doesn’t change or improve arthritis, but it can provide symptom relief,” says Dr. M. Elaine Husni, a rheumatologist and physician scientist at Cleveland Clinic.

Read more

Healthy Joints for a Lifetime

Healthy Joints for a Lifetime

Article Featured on MedlinePlus

Remarkable advances are being made every day in the world of orthopedic health and disease treatment—our bones, muscles, tendons, ligaments, and related connective tissues. From reducing the crippling pain of arthritis to the miracle of knee and hip replacements, “musculoskeletal” research is changing how well—and how long—we can live an active, healthy life.

Most people take their bones and joints for granted—until something goes wrong with one or more of them. The human body has more than 200 bones and more than 200 joints that connect the bones.

“Almost every household in America is affected in some way by diseases of bones, joints, muscles, and skin,” says Stephen I. Katz, M.D., Ph.D., director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). It is NIAMS that is the nation’s research arm on these challenging conditions.

“Joint damage can happen to anyone at any age,” says Dr. Katz. “In fact, many of the diseases related to joints and bone problems affect women and minorities more severely. But there are steps you can take to help prevent or lessen the effects of joint damage.”

One of the most amazing options now is surgery to replace damaged joints. Almost half a million such hip or knee replacements occur in the United States each year. Here is an overview of the most common challenges and treatments.

Fast Facts

  • The most common joint problems come from arthritis and injuries. Arthritis literally means joint inflammation. Although joint inflammation describes a symptom or sign rather than a specific diagnosis, the term “arthritis” often refers to any disorder affecting the joints. These disorders fall within the broader category known as rheumatic diseases, of which there are more than 100 kinds, and are characterized by inflammation as well as loss of function of one or more connecting or supporting structures of the body.
  • More than 46 million people in the United States have arthritis or other rheumatic conditions. By the year 2020, this number is expected to reach 60 million. These diseases more frequently limit activity than do heart disease, cancer, or diabetes.
  • The most common form of arthritis is osteoarthritis. It is seen especially among older people and is sometimes called degenerative joint disease. In osteoarthritis, the surface layer of cartilage (the hard but slippery tissue that covers the ends of bones) breaks down and wears away, causing pain, swelling, and loss of joint motion.
  • About 435,000 Americans have a hip or knee replaced each year. Because of its structure and weight-bearing capacity, the knee is the most commonly injured joint. In the case of hip joint damage, osteoarthritis is the most common cause.
  • Young adults who have had a previous joint injury are more likely to develop osteoarthritis. Researchers are looking for ways to prevent cartilage breakdown after injury.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Stem Cell Clinics Sell Bogus Cures for Knee Pain

Stem Cell Clinics Sell Bogus ‘Cures’ for Knee Pain

By Dennis Thompson | Featured on WebMD

Stem cell clinics are charging big money for knee arthritis “cures” and making extravagant claims about their therapies, a new study contends. A same-day injection for one knee costs thousands of dollars at these centers, according to a consumer survey taken of clinics across the United States.

People are paying that kind of cash because two-thirds of stem cell clinics promise that their treatments work 80 to 100 percent of the time, researchers report. But there’s no medical evidence suggesting that any stem cell therapy can provide a lasting cure for knee arthritis, said study lead researcher Dr. George Muschler, an orthopedic surgeon with the Cleveland Clinic.

“There are claims made about efficacy [effectiveness] that aren’t supported by the literature,” Muschler said. “There’s a risk of charlatanism, and patients should be aware.”Stem cells have gained a reputation as a miracle treatment and potential cure for many ailments. The cells have the potential to provide replacement cells for any part of the body — blood, brain, bones or organs. As a result, a wave of stem cell centers have opened up around the country, offering cures for a variety of diseases, Muschler said.

“It’s very sexy to market yourself as a stem cell center, so there’s been a boom of centers, probably close to 600 now in the United States offering this therapy,” Muschler said. “But the truth is that the medical literature hasn’t quite caught up to the enthusiasm in the marketplace.”

The U.S. Food and Drug Administration has expressed extreme skepticism over these centers, and in November the agency announced that it would crack down on clinics offering dangerous stem cell treatments. The “pie-in-the-sky” dream for knee arthritis patients is that a stem cell injection will produce fresh new protective cartilage in their joint, said Dr. Scott Rodeo, an orthopedic surgeon with the Hospital for Special Surgery in New York City.

“The reality is they don’t do that. There is zero data to suggest that,” said Rodeo, who wasn’t involved with the study. “The idea these cells are going to regenerate cartilage — there’s zero data.”

At best, these injections might temporarily reduce pain and inflammation by prompting the release of soothing chemicals in the knee, Rodeo and Muschler said. To get an idea what stem cell centers are promising customers, Muschler and his colleagues called 273 U.S. clinics posing as a 57-year-old man with knee arthritis.The clinics were asked about same-day stem cell injections, how well they work and how much they cost. Of the 65 centers that provided pricing information, the average cost for a knee injection was $5,156, with prices ranging from $1,150 to $12,000, the researchers found. Fourteen centers charged less than $3,000 for a single injection, while 10 centers charged more than $8,000.

The 36 centers that provided information on effectiveness claimed an average effectiveness of 82 percent, the researchers said. Of them, 10 claimed that the injection worked 9 out of 10 times, and another 15 claimed 80 to 90 percent effectiveness. The findings were presented Tuesday at the American Academy of Orthopaedic Surgeons’ annual meeting, in New Orleans. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

“Patients are being told there’s an 80 percent likelihood of improvement, which is only 10 to 20 percent better than you’d expect from a placebo effect,” Muschler said. In fact, he suspects that the placebo effect is responsible for much of the improvement patients feel following a knee injection.

“People always show up to the doctor when they hurt,” Muschler said. “If I see a patient who has arthritis in their knee and I do nothing, there’s a very good chance they’re going to get better over the coming months, anyway. There’s this natural cycle of increasing and decreasing pain that’s present in the life of someone who has arthritis.”

That’s compounded by the fact that people expect to feel better after shelling out a load of cash, Muschler added. These centers generally provide three different types of treatment, only one of which actually has live stem cells involved, Muschler said.

One treatment injects the knee with platelet-rich plasma drawn from the patient’s own blood, while another uses a slurry produced from fetal tissue and fluid gathered after birth. Neither of these contains stem cells, but they are marketed as stem cell therapies, Muschler said.

A third option involves bone marrow taken from the patient and injected into the knee. This does contain a mixture of three types of stem cells, but “the evidence that you’re doing [your knees] a favor is still pretty weak in the literature,” Muschler said.People aren’t likely to be harmed by these injections, Rodeo said, but there’s not a lot of evidence that they’ll be helped. “Patients should go into it eyes wide open,” Rodeo said. “They’re paying a lot of money out of pocket, because these are not covered by insurers.” Knee arthritis sufferers would be better off trying many of the established options for reducing knee pain, Muschler and Rodeo said.

Losing weight is a “key factor,” Muschler said. “There’s very good evidence that if you are at a 5 on the pain scale and you lose 10 percent of your body weight, your pain will drop 2 points,” Muschler said. Patients also can use NSAIDs like aspirin or ibuprofen to reduce pain and swelling, get a steroid injection, or perform weight training to strengthen the muscles that support the knee, Muschler and Rodeo said.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

5 Best Low Impact Cardio Exercises for People with Bad Knees

5 Best Low Impact Cardio Exercises for People with Bad Knees

Article By Francesca Menato | Featured on Women’s Health

Anyone with a knee injury, new or old, will know how easy it is to feel it flair up with extreme cardio. Running, in particular, is very tough on the knees – so what exercises can you do to get the heart rate up, without hurting already bad knees?

We caught up with Lorraine Furmedge, Fitness First PT Ambassador, to find out the best workouts and exercises for bad knees.

Before you lace up your running shoes and risk another niggle, try these.

1. Swimming

If you’re on the search for cardio exercises for bad knees, head to the pool. Swimming provides a great workout that is low impact, versatile and burns calories fast. Whether you’re doing the butterfly or backstroke you’ll work all major muscle groups in your body including your glutes, abdominals and chest muscles.

Wondering which is the best stroke?

Freestyle, which tends to be the fastest stroke, can burn 100 calories every 10 minutes – more than jogging – but all of them will work your whole body.

2. Elliptical

Opt for an elliptical over a treadmill for minimal risk of knee injury. Your feet never leave the pedals, which means there is less of a chance to injure your knees, back, neck or hips. You’ll also get your heart rate up, making you work up a sweat! Increase the resistant to really test your endurance.

There’s a lot of discussion around which cardio machines burn more calories, and generally, the treadmill does tend to come out on top given you are moving whilst also supporting the full weight of your body but elliptical trainers are fantastic for getting in a great cardio workout with a bit more support.

With any form of exercise, you get out what you put in so it all depends on how hard you push and challenge yourself.

3. Stationary rowing

Rowing is a great way to burn calories without placing stress on your knee joints. Not only will you get a total body workout, you’ll also maximise your core strength with every pull.

Amp up the intensity by increasing the resistance while maintaining speed for a real cardiovascular challenge.

The more you train on a certain machine, the more stamina and strength your body will gain in that particular area, meaning the harder you have to work each time to continue challenging yourself.

If calorie burning is your main aim, switch up your routine and use a mixture of machines and freestyle training – it will keep your body guessing and will test you in different ways.

4. Cycling

Whether you prefer hitting a stationary bike indoors or riding your bicycle outside, you’ll get a fantastic fat-burning workout that will gradually improve your knee flexibility and strength.

To ensure you don’t put pressure on your knees, avoid hills and stick to a flat terrain. Raise your seat level slightly to decrease any pressure on your kneecap.

Wondering what resistance you should use? When it comes to cycling with resistance, there is no right or wrong answer.

Low resistance is great for those people who are just getting into fitness as it allows you to start building up your stamina without over-exerting yourself. Likewise, those suffering with knee injuries may find this an effective and low impact way of getting their regular exercise sessions in without causing further damage.

Medium and high resistance is more suited to those with higher fitness levels and works really well when it comes to building strength in your legs and lower body. If you’ve recently recovered from a knee injury consider using resistance to increase your strength and safeguard against any further damage.

To combine cardio and strength try some interval training and switch between low resistance sprints and medium-high resistance climbs.

Wondering about spin classes? Don’t fret. All good spin instructors will check for injuries before the class begins so let them know and they’ll be able to advise on how to best tackle the session.

Plus, the beauty of spin is that you can carry out the class at your own pace. Remember, you are in control and can adjust your pace according to your ability.

5. Step ups

For a low-impact cardio workout, turn to an aerobic step bench.

Step up onto the step with your right foot. Tap your left foot on the top of the step and then lower.

As you step up, your knee should be directly over your ankle to ensure you’re protecting your knees.

Repeat 10 times for a great calorie burn.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.