When Busy Hands Hurt: What Hand Pain May Be Telling You

**By Julie Roberts, MD**

Numb fingers? Aching wrists? Hand pain? With the pandemic, many of us who are lucky enough to work from home are dealing with new or worsened hand and arm pain related to strange workspaces and unhealthy postures. Not only that, but those of us who are finally getting to that long-overdue yard improvement project may find that these activities are triggering chronic and repetitive overuse injuries. For example, pruning shrubs, raking leaves, or painting can cause tendonitis to flare up or can aggravate pre-existing conditions, such as arthritis.

Here are two common hand issues that folks might be having as a result of working from home and other hands-on activities we’re attempting in the pandemic.

Carpal Tunnel Syndrome

Have numbness and tingling in your hands? It might be related to carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is caused by a compression of the median nerve at the wrist. Symptoms include numbness and tingling in the hand, particularly affecting the thumb, index, and middle fingers. People often describe a “pins and needles” sensation in the fingers. With early CTS, you might experience symptoms at night. You may wake up at night with your hands asleep and have to shake them to get sensation back. Most people sleep with their hands curled up and their wrists bent; this position puts a lot of pressure on the carpal tunnel.

Another symptom of CTS is hand fatigue with repetitive activities. Less commonly, people will have pain in their hands and forearms related to CTS. If you wake up at night several times a week, or have symptoms throughout the day, you should be evaluated for CTS. There are other, less common causes of numbness and tingling in the hands, and an exam and thorough evaluation is necessary to make the correct diagnosis and discuss treatment.

Treatment options for CTS start with activity modification and night splinting for mild symptoms. More moderate and severe symptoms may require surgical release of the carpal tunnel. There are two main ways to perform a carpal tunnel release including the traditional open approach and a minimally-invasive endoscopic release, which has been shown to allow a faster return to work.

Trigger Finger

Experiencing pain in your palm? It might be related to trigger finger, a type of tendonitis known as tenosynovitis.

Trigger finger symptoms may include clicking, catching, and locking of the fingers and is often associated with pain in one’s palm. The tendons that bend our fingers run through tight tunnels called “pulleys.” In trigger finger, both the tendon and the pulley become inflamed. Repetitive activity, such as weeding your garden or trimming hedges can exacerbate this inflammation. Many people experience symptoms with repetitive activity or in the mornings, because our hands naturally swell at night. There will not be associated numbness or tingling with trigger finger. Interestingly, folks who get trigger finger are predisposed to carpal tunnel, and vice versa. 

Trigger fingers are often treated with steroid injections. One or two injections are often all that is needed to decrease the swelling around the tendon to allow it to glide smoothly again. Steroid injections can cure trigger fingers and symptoms never return. If a trigger finger is persistent, then you might have a discussion with your doctor about surgical release.

It’s important to maintain an ergonomic work position to prevent CTS, trigger finger and other hand and arm conditions related to overuse and repetitive motions. One should sit square to the workstation with a 90-degree bend at the elbows, hips and knees and monitor placed at eye level. Any position can cause strain after long periods of time, so it’s also important to move! Take short breaks to get up, walk around and stretch. 

When symptoms are persistent, despite initial care, it can be advantageous to see a specialist to confirm diagnosis and discuss further treatment options. If you’re experiencing hand pain, numbness, or tingling, see a specialist when symptoms have persisted or worsened, despite trying rest and activity modification for a few weeks.

Julie Roberts MDJulie Roberts, MD, is an orthopedic hand surgeon who practices at Virginia Mason Medical Center in Federal Way and Seattle. She specializes in hand and wrist surgery and performs minimally invasive endoscopic carpal tunnel releases.

Bad Break, Good Outcome: Team Effort Restores Joint Function

“This is me leaving my apartment on my first day in Rome,” says Roberta Kelley, looking through her photo collection. “See how happy I was? And here I am having my first and only cup of espresso.”

Roberta’s dream vacation ended abruptly when after a long day of sightseeing, she stepped off a surprise curb and went down hard. Holding her tour map and phone, Roberta’s elbow took the brunt of the impact, crushing it. She remembers bystanders helping her into a cab and later, falling asleep in her rented apartment.

The next morning Roberta’s shock gave way to the realization her swollen arm was broken. A local hospital took an agonizing X-ray, and Roberta learned she’d need surgery to repair her ruined elbow. She could have the surgery done in Rome, the doctor told her.

“But I said no, I’m flying back to Seattle,” remembers Roberta. “I need to go to Virginia Mason where I get all my care and my doctors know me.” Roberta shares another connection with Virginia Mason, retiring in 2018 as a speech-language pathologist and orofacial myofunctional therapist (treating muscle disorders of the mouth and face).

Fitted with a temporary cast from her shoulder to her wrist, Roberta made the long trip home and then to Virginia Mason’s Emergency Department. She relaxed for the first time in days, with the team making her comfortable and gently guiding her through X-rays. That same morning Roberta met orthopedic surgeon Laura Stoll, MD.

Roberta in chair

Roberta Kelley

“Dr. Stoll showed me the images and explained her plan for surgery,” says Roberta. “She wanted me to know it was a bad break and there were no guarantees about what function I’d get back. I was so worried and nervous, but she said ‘I will take good care of you’ and gave me a hug. That made a world of difference.”

Roberta’s severe elbow fracture and dislocation required a prosthetic replacement of the radial head, the knob-like end of the radius bone that helps form the joint. The radial head sits in a pocket of the ulna bone, allowing the forearm to both flex and rotate. In addition to the prosthetic, Dr. Stoll rebuilt and repositioned Roberta’s elbow with a stabilizing system of plates and screws.

“Because elbows are mechanically complex, they are tricky to repair and surgical outcomes can be unpredictable,” says Dr. Stoll. “Roberta’s dedication to recovery and her positive attitude were so important. Achieving a good outcome really becomes a team effort.”

“Team Roberta” included Dr. Stoll working side-by-side with an occupational therapist in joint visits, going over X-rays and creating a rehabilitation plan. Roberta began a rigorous therapy regimen, which included daily home exercises. Roberta set her smart phone to remind her when to do them. At first she felt discouraged, not able to bend her arm enough to wash her face, put on make-up or even earrings. But her occupational therapist stayed positive and encouraging, even as she challenged Roberta with those very tasks each week to help condition her new elbow.

“My range of motion is excellent now, but it came with a lot of effort and exercise,” says Roberta. “I told Dr. Stoll she did fabulous surgery. She said ‘yes, but you did all the hard work.’”

A version of this story originally appeared in the Virginia Mason 2019 Annual Report.

Knee Replacement: Targeted Pain Control is Key to Recovery

Of the more than 600,000 knee replacements done in the U.S. each year, the number of people in their 50s and even 40s having the procedure is growing. While carrying excess weight is one factor — one pound of excess weight is equal to five pounds of pressure on joints — middle-aged people are increasingly electing to have knee replacements to stay active and improve their quality of life.

MD PatientTo gain the full benefits of knee replacement, one of the most important aspects is rehabilitation. Specialized techniques using targeted pain relief help jump start rehabilitation, which can decrease time in the hospital and more quickly establish a new joint’s range of motion.

Reducing pain while sparing strength

In a study led by Virginia Mason anesthesiologist Neil Hanson, MD, physicians found that total knee replacement patients did better when local anesthetic medications were continuously infused into the adductor canal, a tunnel in the mid-thigh that contains the femoral artery, femoral vein and nerve branches. This continuous nerve block technique not only reduces pain, but allows patients to maintain muscle strength in the leg, which is critical to recovery.

“We found that by infusing the local anesthetic medication in a location that preferentially blocked sensation to the knee, we reduced muscle weakness, controlled pain more effectively and made a shorter hospital stay possible,” said anesthesiologist David Auyong, MD.

As participants in regular clinical research, the Anesthesiology and Orthopedics and Sports Medicine departments at Virginia Mason became early adopters of the adductor canal block approach, making it the gold standard for most total knee replacements performed at the medical center.

The benefits of continuous pain relief

Adductor canal block is an improvement over previous blocking techniques because it provides pain relief without causing weakness. Femoral blocks were used in the past, which provided good pain relief but reduced muscle strength. They also put patients at risk for falls.

Adductor canal block, along with different types of anesthesia, helps accelerate recovery with a quicker return to full motion and function. The approach uses an “indwelling” catheter, providing up to three days of continuous post-surgical pain relief. It can also  reduce the amount of pain medication that a knee replacement patient might need, which in turn lowers the risk of medication side effects.

Other benefits of early mobilization after knee replacement include a lower risk of blood clots, stiffness and other complications that can occur from long periods of inactivity.

Board-certified orthopedic surgeons at Virginia Mason perform nearly 1,000 joint surgeries annually. Please visit our joint replacement page and knee replacement page, or call
(206) 341-3000.   


Total Ankle Replacement Restores Function

Roger Dunn battled chronic ankle pain for decades, an unwelcome side effect of playing college football and repeat injuries over the years. Finally tired of “dragging it along,” Roger got an appointment close to home with foot and ankle surgeon Matthew Williams, DPM, at the Virginia Mason Kirkland Medical Center. Dr. Williams discussed a treatment option Roger never knew existed: total ankle replacement.


Roger Dunn

“For years the gold standard for ankle arthritis was permanently fusing the joint, which relieves pain but decreases motion, leading to arthritis in nearby joints over time,” says Dr. Williams. “While earlier ankle replacement devices had high failure rates, recent advances in design and materials have significantly improved longevity and decreased complications.”

Roger needed no convincing to undergo the surgery, with his bone-on-bone ankle joint — the worst kind of daily grind. He scheduled the procedure, bracing for a long recovery and some next-level pain, but he was in for a big surprise.

“It just amazed the heck out of me that I never experienced any pain in the joint or in the surrounding tendons,” says Roger, who had the procedure in November 2018. “Once out of a cast I was religious about wearing my boot and not taking any chances. I went back to work on a knee scooter in two weeks, where I could also ride my desk chair around a bit.”

Soon Dr. Williams eased Roger off the scooter and into walking with a brace. Physical therapy helped keep Roger’s mobility on track, steadily improving his strength and balance. X-rays confirmed successful realignment of Roger’s foot, ankle and leg, something Roger never imagined possible with such an old, gnarled body, as he put it. What he didn’t know is everything that made his case unique informed a treatment plan designed for the best possible outcome.

“Before performing an ankle replacement, we use advanced computer programs to plan the surgical approach, building in correction for any existing deformity,” says Dr. Williams. “Sometimes it’s necessary to make corrections in stages to achieve the best function for patients. I also take great care when selecting patients who are likely to benefit from ankle replacement. Things like recreational activity level, age, occupation and body mass are all critical considerations for success.”

Roger wrapped up physical therapy a few months after surgery, feeling balanced and confident on his new ankle. A recent X-ray showing everything healed as expected told Roger he’s good to go. Now when it’s time to get a knee replacement on the other leg – another troubled joint destined for a fix – he’ll have the stability on the right to take whatever comes.

Would Roger recommend total ankle replacement to other people who wonder if it’s worth the time, bulky boot, scooter-cruising and physical therapy visits? Absolutely, he says.

“I was careful to follow all the rules of the road and was lucky I didn’t have any falls,” says Roger. “The no-pain part is what really worked for me. It wasn’t something Dr. Williams guaranteed going in, it’s something that happened because he’s an excellent surgeon.”

A version of this story also appears in the Virginia Mason Health System 2018 Annual Report.  

Make Stretching Your Fitness Strategy: Tips from Tyler Lockett and David Belfie, MD

When is the best time to stretch, before or after exercise? What types of stretches have the most benefit? Why does stretching become more important as we age? These are just a few of the questions Tyler Lockett of the Seattle Seahawks and orthopedic surgeon David Belfie, MD, answered for viewers of King 5’s Take 5 show last week. Watch the video, then discover your own favorite stretch.

Peer Partners Offer Encouragement and Support to Joint Replacement Patients

When it comes to innovation and improvement, Virginia Mason recognizes that patients are a valuable resource. This is especially true in the Peer Partners program. When former joint replacement patients were asked what could be done to improve their experience, many said they wished they’d been able to talk with someone who had recently gone through a hip or knee replacement.

Patient peer partner volunteer speaks with orthopedics patient.

A Virginia Mason patient learns his Peer Partner, Kent Smith (right), also looked forward to playing tennis again after joint replacement.

Patient Relations Program Manager Ann Hagensen, RN, realized the value of that suggestion. She and her team worked with patients to design the Peer Partners program. Now in its third year, the program trains former patients to become volunteer peer partners. The volunteers round on the orthopedics unit, visiting patients. They also attend pre-surgical classes to reinforce the knee and hip surgery protocols. In an orientation session, peer partners are prepared to visit with patients by learning communication techniques that help them listen for topics that matter most to the patient. Often patients are excited to talk about activities they plan to get back to with a newly functional joint.

Following their training, peer partners move through the orthopedics unit, introducing themselves to patients who are scheduled for surgery or are in recovery. Volunteer Kent Smith, who has been a peer partner for two years, found the program to be very helpful to him when he underwent his own hip replacement. “I wanted to find a way to pay back for the great care I’ve received at Virginia Mason,” he says. “The caregivers here have wonderful hearts. They give the kind of care you always want to receive.”

Kent credits the Patient Relations training with transforming the way he communicates in all aspects of his life.

“It’s all about listening and letting people know you’re there for them,” Kent says. “The conversation may begin with a focus on their surgery, but often expands to include their personal lives. Patients want someone to listen to them. Our goal is to be a source of encouragement and motivation, to help them get the hard work of recovery done.”

Kent is not alone in his enthusiasm for the Peer Partners program. Ann says the one-on-one experience is so positive that many patients decide to volunteer before they leave the hospital, returning six months later for their training.

“This program is a win-win,” says Ann. “It’s a win for our patient partners who have this opportunity to help others and see their ideas become reality, and it’s a win for Virginia Mason, helping us create the perfect patient experience.”

A version of this story also appears in the Virginia Mason Health System 2017 Annual Report. 

Chronic Ankle Pain? You May be a Candidate for Replacement

**By Eric Heit, DPM**

More than 30 years ago, Michael Diorio fell from a palm tree while trimming fronds at a San Diego apartment. The three-story fall crushed his left heel and fractured his right ankle. Over the years he’s had seven surgeries on his feet and suffered pain on a regular basis.

Michael Diorio_Total ankle replacement patientv2

Michael Diorio

After moving to the Pacific Northwest three years ago, Diorio, 56, was referred to a podiatrist with Virginia Mason Orthopedics and Sports Medicine. Diorio soon learned he was a candidate for a relatively new procedure – total ankle arthroplasty, also known as total ankle replacement. 

Last December Diorio underwent the three-hour outpatient surgery on his right ankle at Virginia Mason Hospital and Seattle Medical Center. He was able to return to full-time work in March, where he spends several hours a day on his feet.

“I used to limp and regularly experience pain,” says Diorio.  “Now I walk almost as well as I did before my injury and without any discomfort. I’m glad I was a candidate for total ankle replacement and have been very satisfied with the experience and outcome.”

The procedure

Total ankle replacement is similar to hip and knee replacements – patients receive a new ankle joint made of precisely engineered metal and plastic parts that replace the old ankle joint.

The surgery is typically performed without the need for an overnight hospital stay and patients usually go home the same day. Patients should expect a period of limited weight-bearing, followed by a gradual return to daily activity as their ankle heals. Most patients will have physical therapy after the procedure to help regain mobility.

The benefits — and some risks

Total ankle replacement relieves discomfort in the joint that older adults sometimes experience during weight-bearing activities. It might also ease occasional ankle pain when not moving the joint.

However, like every surgery, there are risks such as infection and wound healing problems, although this risk is low, occurring in less than 2 to 3 percent of cases.

The American Orthopaedic Foot & Ankle Society recommends people try non-surgical options for pain relief before considering total ankle replacement. Some patients get relief through treatments such as bracing, cortisone or steroid injections and changing to non-weight bearing or low-impact activities.

sr.coupleIf non-surgical approaches do not provide relief, total ankle replacement might be appropriate.

Getting the green light
Your physician will consider a few things before recommending surgery, such as:

  • Age
  • Activity level
  • Other potential medical complications
  • Severity of arthritis in your ankle
  • The potential for arthritis in other foot joints

In general, surgeons recommend total ankle replacement for people 55 or older. The thinking is that older adults will likely not stress the ankle as much as a younger patient, extending the life of the implant. Runners, or people who do other high-impact activities, are not good candidates for the surgery.

A person’s overall wellness before total ankle replacement is important. People should see their primary care physician before surgery to help ensure they are in optimal health.

Even if someone doesn’t think they’re a candidate for total ankle replacement, they  should get a referral from their primary care provider to consult with a foot surgeon. This is important because even if someone isn’t a candidate for the procedure, the specialist can discuss other treatment options that might help.

If you have health issues

Certain conditions can increase the risks associated with surgery and recovery, such as:

  • No ankle movement
  • Poor ankle-bone quality
  • Unstable ankle ligaments
  • Significant ankle alignment problem
  • Infection, especially in an ankle

If you have diabetes, your doctor will want to make sure you have good circulation and healthy blood-sugar levels before surgery. If your condition is not well-controlled, it increases the chance of complications, including infection.


According to the American Orthopaedic Foot & Ankle Society, there is a 90 to 95 percent chance that total ankle replacement will be successful and without complications.

Based on our experience at Virginia Mason, most people are doing well within about three months after surgery, and full recovery usually takes six months to a year.

Dr. Eric Heit

Eric Heit, DPM, is a board-certified podiatrist with Virginia Mason Orthopedics and Sports Medicine. His specialties include podiatry, foot and ankle surgery, podiatric surgery and sports medicine. He practices at Virginia Mason Hospital and Seattle Medical Center

You Zigged But Your Knee Zagged: How to Treat Mild Sprains and Strains

Tyler Lockett of the Seattle Seahawks

Seattle Seahawks Player Tyler Lockett

If playing sports will be part of your spring – whether on a team, tennis court or tossing a Frisbee around the local park – sprains and strains can result. What’s the difference between a sprain and a strain? While both injuries have similar signs and symptoms, they affect different parts of the body.

Sprains involve the stretching or tearing of ligaments, the fibrous tissue that connects bones in your joints. Strains are injuries to muscles or tendons, the cords of tissue that connect muscle to bone. Both injuries can cause pain, swelling and limited ability to move the affected area. The good news is mild sprains and strains can be treated at home.

One of Tyler’s Tips for Virginia Mason, from Tyler Lockett of the Seattle Seahawks, breaks down what every athlete (or weekend warrior) should keep in mind for treating mild sprains and strains:

“As an NFL player, I know firsthand — and first tibia and fibula — that injuries can happen to anyone. When it comes to recovery, RICE is an easy way to remember how to treat minor injuries.

“R” stands for Rest. When you get injured, the first thing to do is stop the activity that is causing pain. Resting gives your body time to recover.

“I” is for Ice. Applying an ice or cold pack will prevent or reduce swelling. Apply for 10 to 20 minutes, three or more times a day.

“C” means Compression. Wrapping the injured or sore area with an elastic bandage is another way to reduce swelling. But remember, don’t wrap it too tight or you could cause swelling below the bandage.

“E” stands for Elevation. Elevate the injured area while applying ice or when you are sitting or lying down. Try to keep the injury at or above the level of your heart to reduce swelling.

Remember that RICE is only for minor injuries that you can treat yourself at home. For more serious injuries, talk with your doctor.”

How do you know when it’s time to get medical attention for a strain or sprain? Watch out for these symptoms, which could indicate a more serious injury:

  • Difficulty walking more than a few steps without significant pain
  • Inability to move the affected joint
  • Numbness in any part of the injured area

Virginia Mason Orthopedics and Sports Medicine Services has cared for thousands of sports enthusiasts, from world-class athletes to “weekend warriors.” Board-certified experts work together from diagnosis through rehabilitation to help patients return to their favorite activities, feeling stronger and safer than before their injury. Get inspired by reading orthopedics comeback stories or meet our providers.

Joint Replacement: The Right Procedure at the Right Time Can Improve Quality of Life

**By Kevin MacDonald, MD**

sr.coupleJoint replacement is a type of orthopedic surgery where parts of an arthritic or damaged joint are removed and replaced with a metal, plastic or ceramic device called a “prosthesis.” The prosthesis is designed to replicate the movement of a normal, healthy joint.

National statistics help explain why many orthopedic surgery practices around the country are busy. When you combine the number of baby boomers reaching “the golden years” with the pervasiveness of osteoarthritis – or degenerative joint disease – and the growing obesity epidemic, experts predict that by 2030 there will be almost 3.5 million total knee replacements and more than 570,000 hip replacements performed annually in the United States.

And while hip and knee replacements are the most commonly performed joint replacements, joint replacement surgery is also performed on the ankle, elbow, shoulder and wrist.

When to consider surgery

I remind all my patients that joint replacement surgery is elective and should come down to a quality-of-life decision. My advice almost always includes recommending that they try non-surgical treatments first – such as ice, heat, anti-inflammatory medication, swimming or physical therapy.

However, if nothing works, people should ask themselves if pain and disability are destroying their quality of life. If the answer is yes, I advise them that it’s the appropriate time to discuss surgical options.

Benefits, and some risks

The benefits of joint replacement surgery can be life changing – both physically and emotionally – when someone can walk and move without pain.

Studies have consistently shown that hip and knee replacement are some of the most successful procedures when it comes to improving patient satisfaction and quality of life. Most patients are able to resume activities that arthritis had made difficult, such as golfing, biking, caring for family members, or missing fewer work days due to pain.

As with any surgical procedure, there are potential risks associated with joint replacement surgery, including infection, nerve damage, loosening of the joint over time, or complications from the stress of surgery, such as a heart attack or blood clots.

Fortunately, long-term benefits of total joint replacement also include years of use. Other recent research has shown that 95 percent of hip replacements performed in the United States last 15 to 20 years, and 85 percent of knee replacements last two decades. In addition, improvements in surgical techniques, prosthetic designs, bearing surfaces, and fixation methods may allow implants to last even longer.

Types of joint replacement

Thanks to advancements in surgical techniques and rehabilitation, many orthopedic surgeons are able to offer patients in need of joint replacement a variety of surgical options – depending on individual factors like overall health, chronic disease and anatomy. Options include:

  • Posterior total hip replacement – This proven hip replacement method has a long-term track record of success. During this one- to two-hour surgery, a three- to six-inch incision is made over the damaged hip to expose deeper tissue. The damaged “ball” or head of the thigh bone (femur) is dislocated and removed. Damaged bone and cartilage in the “socket” are removed and the socket is smoothed and enlarged to receive the metal implant. A highly polished socket liner, which is usually made of polyethylene plastic, is secured inside the socket. The surgeon then creates a narrow, five-inch channel on top of the thigh bone to receive the new implant’s stem and ball. Materials in the new ball-and-socket joint press against one another easily to help restore hip motion.
  • Anterior total hip replacement – This procedure is very similar to a posterior total hip replacement, except the surgeon accesses the hip joint from the front, as opposed to the back side (posterior) of the hip. This method has gained a lot of interest over the past decade and patients can generally expect an excellent outcome, as they can from the posterior approach.
  • Revision hip replacement – After a period of normal wear and tear on an artificial hip joint, parts of the prosthesis may wear out or become loose. In these cases, hip revision surgery may be recommended. It is done to repair a prosthesis that has been damaged over time due to infection or normal wear and tear. Revision surgery helps correct the problem so the hip can function normally.
  • Partial knee replacement – Also known as unicompartmental knee arthroplasty, this procedure is appropriate for people who are in good health and have exhausted conservative measures for managing knee pain. These patients may have had a torn meniscus (cartilage) or avascular necrosis (dead bone tissue) in the past that later led to arthritis in one part of the knee. For younger adults, a partial knee implant may help prevent further degeneration in the joint and the need for total knee replacement. Older adults may also be candidates, which is then expected to last the remainder of their lives.
  • Total knee replacement – The implant usually consists of two parts made of chrome cobalt, titanium alloy and polyethylene plastic. The cobalt-chrome part is attached to the end of the thigh bone (femur) and a titanium alloy base plate is attached to the end of the leg bone (tibia). A polyethylene plastic “articulating” surface is then positioned between them. A polyethylene plastic “button” is attached to the undersurface of the knee cap (patella). Knee implants come in various sizes to fit every knee.
  • Revision knee replacement – A knee replacement may fail over time for various reasons. If this occurs, a knee can become painful, swollen, stiff or unstable, making it difficult to perform everyday activities. If a knee replacement fails, your doctor may recommend a second surgery, called a revision total knee replacement. In this procedure, an orthopedic surgeon removes some or all of the original prosthesis and replaces it with a new one. Revision surgery is a longer, more complex procedure than total knee replacement. It requires extensive planning, as well as specialized implants and tools.

Improving your odds of success

No matter which joint replacement surgery may be most appropriate for any one patient, there are things people can do to help improve their odds of realizing the benefits of surgery, including:

  • Losing weight, if necessary
  • Quitting smoking
  • Limiting alcohol use
  • Muscle-strengthening exercises
  • Making sure other medical conditions, such as diabetes, are under optimal control

Making a personal decision


Like every surgery, deciding whether to have joint replacement is – and should be – a very personal choice. Knowing that, my final recommendation is straightforward: Work with your doctor to fully understand the plan for managing your individual risk factors before and after joint replacement.

If that’s done well, there is a good chance that the long-term advantages of joint replacement surgery will outweigh the short-term risks.

Dr Kevin MacDonaldKevin MacDonald, MD, is a board-certified orthopedic surgeon who specializes in orthopedic oncology, adult reconstructive surgery and anterior hip replacement. He has a special interest in benign and malignant bone and soft tissue tumors, surgical treatment of sarcoma, limb reconstruction, total hip replacement, total knee replacement, revision hip and knee replacement, and partial knee replacement. Dr. MacDonald practices at Virginia Mason Hospital and Seattle Medical Center.


New ‘Therapy Car’ Helps Orthopedic Patients Avoid Injury

Getting in and out of a vehicle is something most of us take for granted. But if you’ve just had a hip or knee replaced, suddenly ordinary maneuvers seem daunting or even dangerous. Discharge from the hospital usually means approaching a vehicle for the first time, with limited ability for routine movements like bending at the waist, or rotating and bending a leg. Motivated by the very real risk of patients falling or injuring themselves after surgery, a small team of Virginia Mason health care workers hatched an idea to help prepare patients for entering and exiting a car.

The team, consisting of occupational and physical therapists, a patient transporter, patient care technician and a kaizen (continuous improvement) specialist collaborated to build a prototype “therapy car.” This process included building 3D tabletop mockups – out of things like pipe cleaners and tongue depressors – to create the team’s vision. A Virginia Mason volunteer with an engineering background helped with design based on the staff’s list of functional requirements: it must be adjustable, lightweight and portable.

Therapy CarWhile the result wasn’t shiny or aerodynamic, the therapy car has a cushioned seat and adjustable height to simulate different sized vehicles. Wheels make it easy to move, though usually it stays “parked” in Virginia Mason’s Orthopedics Unit therapy gym. Before the creation of the therapy car, patients had no realistic way to practice getting in and out of a vehicle.

“When recovering patients are told they can’t bend or lift their leg in a certain way they are left wondering how they can possibly navigate the car safely,” says physical therapist Jennifer McClure. “Using the therapy car they practice with a therapist, usually someone who has been working with them and has insight into how well they are moving with other activities.”

While the therapy car is ideally suited for joint-replacement patients, it can also help patients who’ve suffered a stroke or other neurological problems to “re-learn” the mechanics of getting in a car. Therapy patients are encouraged to share ideas for improvement with the care team as the design is continually refined.

And what do patients think of the therapy car so far? “Patients often look at it with trepidation initially, but after some instruction and practicing the techniques for a safe transfer they consistently report more confidence for managing the car to go home,” says Jennifer. She points out that patients’ family members benefit too, by learning the techniques at discharge to help transport their loved ones safely.