Watch: The Mayo Clinic Minute

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Dr. Sierra wants to set the record straight about aging and joint replacements.

"The perception out there is that everybody's going to need a hip replacement down the road, whether it's knee or hip, everybody's going to need some form of replacement. That's not necessarily true," he says.

He says it's not aging but anatomy that will predispose people to knee or hip replacements down the road.

"This is a perfect example. This a patient that had a slip when they were very young. See, there's an abnormal shape to the femur. And this abnormal shape will cause damage of this affected bone into the socket that would lead to hip arthritis," says Dr. Sierra.

Joint replacements today are more successful than ever — thanks to precision robotic surgery. 

"And today, with navigation systems, robotic systems, precision is what is now achievable in almost every patient," Dr. Sierra says.

Related stories:

• Mayo Clinic expert offers tips on how to keep joints healthy as you age
• Mayo Clinic Q and A: Proper posture and body alignment

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"I've always been intrigued with understanding how science and biology work and how we can use it to our benefit," says Dr. Saris. "I was drawn to orthopedics, because it is a surgical expertise that focuses on quality of life and the tangible improvements it can make in the lives of patients."

Dr. Saris works on joint preservation at Mayo Clinic. His research investigates cellular therapies that repair cartilage defects. Dr. Saris compares it to filling potholes to fix a road rather than replacing the entire street.

"If we can treat the 20- to 50-something-year-olds with a new biotherapeutic that repairs cartilage and enables them to use their own joints for years to come, that's a significant benefit to them," says Dr. Saris. "By enabling their active lifestyle and delaying their first joint replacement until they are older and a little bit less active, they are likely to have a better outcome."

Mayo Clinic's Center for Regenerative Biotherapeutics is leading biomanufacturing strategy to accelerate new cellular therapies to early-stage clinical trials and, eventually, to clinical care. The center supports Dr. Saris' research as part of its objective of delivering new cures to the practice, particularly for rare and complex conditions.

Seeking cellular solutions

Dr. Saris is the principal investigator of a clinical trial that is testing use of a regenerative cell therapy to repair damaged cartilage with just one surgery. In this research, healthy cartilage from a patient is recycled and mixed with donated mesenchymal stem cells from Mayo Clinic's stem cell bank. Mesenchymal stem cells are adult stem cells that have been well studied and have shown healing potential. Dr. Saris' team uses the cell mixture to plug holes in the cartilage and then documents the results.

"In our research, we are mixing the patient's cartilage cells with donor stem cells, a one-step procedure to study how that facilitates cartilage growth in the knee," says Dr. Saris. "Our research enables us to understand how cartilage cells talk to mesenchymal stem cells and the role that plays in repairing tissue."

Dr. Saris' team has studied this procedure in a phase one safety study of knee cartilage damage and now a phase one study of hip cartilage damage.

Tears in cartilage — the connective tissue that lines the joints — are a common problem from sports injuries, falls or daily wear and tear. A tear often affects the knee, but can happen in the hip, ankle, elbow or shoulder. Left untreated, cartilage damage typically gets worse and can lead to osteoarthritis and joint replacement.

"Cartilage does not have a blood supply or nerves. That means when it is damaged, it does not heal by itself," says Dr. Saris.

Cartilage injury can happen at any age but is particularly troublesome for active adults under the age of 55 who are not ready for joint replacements. Options for preserving joints among this age group have traditionally been limited.

Tears in cartilage — the connective tissue that lines the joints — are a common problem from sports injuries, falls or daily wear and tear. Left untreated, cartilage damage typically gets worse and can lead to osteoarthritis and joint replacement.

Dr. Saris believes that regenerative medicine holds the key to delivering new biotherapeutics for cartilage repair and many other unmet patient needs.

"As people live longer across the world, we will be confronted with more diseases," says Dr. Saris. "We have to come up with smarter solutions to make sure that we have a good quality of life as we grow older. One solution is regenerative medicine and using the body's own capacity to heal and correct disease."

About Dr. Saris

Dr. Saris graduated from the University of Amsterdam Medical School. Following that, he came to Mayo Clinic for a research fellowship in orthopedics, cartilage and biomechanics. Dr. Saris then completed his Ph.D. and a residency in orthopedics at the University of Utrecht in the Netherlands.

He came back to join the physician staff at Mayo Clinic in 2018, where he applies his love of science to continual improvements in the techniques of joint preservation.

"I wouldn't be satisfied doing the same thing for 30 years and not finding a way to improve it for the benefit of patients," says Dr. Saris.

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Research by Dr. Saris:

Five-Year Outcome of 1-Stage Cell-Based Cartilage Repair Using Recycled Autologous Chondrons and Allogenic Mesenchymal Stromal Cells: A First-in-Human Clinical Trial

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ROCHESTER, Minn. — For joints to work well, they need cartilage, a slippery tissue that covers the ends of bones, acts like a shock absorber, and helps joints move smoothly. Joaquin Sanchez-Sotelo, M.D., Ph.D., a Mayo Clinic orthopedic surgeon, says many people lose cartilage as they age, but it does not mean that joint replacement is inevitable. Here are some tips for keeping joints healthy.

Cartilage degenerates for various reasons, Dr. Sanchez-Sotelo says. People may be born with abnormally shaped bones or a tendency toward weaker cartilage. Obesity, overuse or injuries from accidents also can damage joints and cartilage.

"When cartilage degenerates, the body forms bone spurs," Dr. Sanchez-Sotelo says. "This is a reaction to the main underlying problem, cartilage degeneration. Bone spurs can hit each other and become painful. Many patients get obsessed with bone spurs, but just taking them out won’t cure the problem, except in very rare circumstances."

Loss of articular cartilage is the essence of what is called osteoarthritis, a common joint disorder. Dr. Sanchez-Sotelo says most of his osteoarthritis patients are in their 60s when they go to see a health care professional with symptoms — achy and painful joints, stiffness, and loss of movement — that developed over time.

Dr. Sanchez-Sotelo says you can take steps when you are younger to protect your joints as you age. Having strong muscles around the joints can help take the load off the joints. However, people who exercise at high levels in sports, like football and bodybuilding, have higher risks of developing arthritis.

"You have to exercise within reason," Dr. Sanchez-Sotelo says. "Find that point where your muscles are healthy, flexible, strong and will protect the joints, but don’t overdo it."

Maintaining a healthy weight is important, as obesity is hard on the joints. Glucosamine and chondroitin are popular supplements for joint pain, but lack convincing evidence that they work, Dr. Sanchez-Sotelo says.

He offers these suggestions for managing arthritic pain:

• Modify your activities. If you have an arthritic hip or knee, instead of running — which results in the pounding of the joints — maybe you can try bicycling.

• Take the load off the joints with gait aids. Using a cane can help lighten the load on your hip, knee and ankle joints, and decrease the pain. A knee brace — worn outside the clothes — shifts the load to the healthier side of the knee joint.

• If the pain persists, you may want to consider over-the-counter medications, like acetaminophen and ibuprofen. However, be aware of the side effects, such as ulcers, kidney or heart issues. In general, narcotics should not be used for osteoarthritis.

• If the pain continues, you also may consider injections with medications, such as cortisone or toradol, which, when injected into the joint, can help relieve pain. Again, these medications have side effects, so be sure to speak with your health care professional.

• Hyaluronic acid, which also is injected, uses components similar to those of the joint lubricating fluid to try to replenish it. It has been more successful with the knee joint than hip and shoulder joints.

• Some injections, marketed as regenerative medicine, include stem cells and platelet-rich plasma. At this point, many consider their use as experimental since there is no firm evidence about their efficacy.

"In the past, older people just accepted joint pain," Dr. Sanchez-Sotelo says. "Now people are living longer and want to remain active as they age. We are not all destined for joint replacement. There are some people in their 80s and 90s who have great joints."

To interview Dr. Sanchez-Sotelo, please contact Rhoda Madson, Mayo Clinic Communications, newsbureau@mayo.edu.

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About Mayo Clinic   
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact:

• Rhoda Madson, Mayo Clinic Communications, newsbureau@mayo.edu

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What do you do after surviving an extraordinary health crisis? Steve Knutson celebrated his new lease on life with a bilateral hip replacement at Mayo Clinic Health System in Eau Claire, Wisconsin.

Steve's medical journey started on a typical workday in early March 2020. He and seven other colleagues came down with flu-like symptoms and felt ill enough that they headed home.

Halfway to his home in Andover, Minnesota, Steve began sweating profusely, and his vision went to black and white. Knowing something was seriously wrong, he headed to nearby Mercy Hospital. On the way, he called his sister, Kathy Sipple, clinic administrator at Chippewa Valley Eye Clinic in Eau Claire, to let her know something was wrong.

"I thought I could make it to the Emergency Department entrance, but all I could do was make it halfway across the parking lot before sitting down on the back of a pickup truck and hope someone would see me," Steve says. And someone did, rushing him by wheelchair into the Emergency Department.

His oxygen levels plummeted to low levels at first check, increasing slightly after being stabilized in the Emergency Department. The staff thought it might be COVID-19, since the virus was gaining a foothold in the state. But all tests came back negative. Eventually, the diagnosis would be Legionnaires' disease, although no trace of the Legionella bacterium was found in his workplace and none of his other colleagues became so ill.

From those first days, Steve's health became one crisis after another. His lungs, kidneys and other organs were failing. After being put on a ventilator and undergoing dialysis, the decision was made on March 17 to connect him to an extracorporeal membrane oxygenation machine, which would oxygenate his blood outside his body and give his heart and lungs a rest. Throughout his ordeal, he died five times and was brought back each time.

Kathy kept family and friends up to date with Steve's condition through regular CaringBridge posts. It was a roller coaster journey of steps forward and back. Eventually, good days began to outnumber the bad ones.

On April 10, 2020, ― Good Friday ― Steve was removed from the extracorporeal membrane oxygenation machine. On April 24, 2020, his kidneys were fully functioning and lungs that had been turning brown were regaining a healthy pink color.

With his health improving, Steve was transferred May 6, 2020, to Courage Kenny Rehabilitation Institute in Minneapolis.

On Aug. 22, 2020, Kathy wrote, "This will probably be my last entry because Steve has exceeded all our expectations and is doing fabulously. He has no physical limitations, and his mind is as sharp as ever. He's committed to doing whatever it takes to get back to his normal life and beyond. What an amazing recovery."

Steve eventually moved to his parents' home in Menomonie, Wisconsin, to continue his recovery with physical therapy at Mayo Clinic Health System – Red Cedar. He was walking 3 to 4 miles a day, but he realized that his illness and being bedridden for so long had exacerbated the arthritis in his hips.

Steve, who was an avid outdoorsperson and national long-range sharpshooting championship and coach, found that the pain was stalling his full recovery. Steve did not find this outcome to be acceptable.

"My hips were bothering me before my life-threatening illness, and they were worse afterward. The pain was limiting my mobility and keeping me from doing everything I wanted to do," he says. In May, Steve contacted and consulted with Jonathan Webb, M.D., an orthopedic surgeon at Mayo Clinic Health System in Eau Claire, Wisconsin.

"Dr. Webb said I was a good candidate for bilateral hip replacement, which meant I'd only have one surgery and one recovery cycle," Steve says. "I was really impressed with him, and I took his recommendation. The surgery went great, and I had very little discomfort during recovery. In the first week of recovery, I was getting around with the aid of a walker. By the second week, I transitioned to a cane. And by the third week, I was beginning to walk around on my own. I was walking every day with no medications. I did a lot of stretching and walked, walked, walked."

"Steve wanted to get back to his life, so we figured out how we could let him live this new stage of his life with less pain and greater mobility," says Dr. Webb. "Because of the severity of the arthritis, I don't know if he would have recovered as well if we'd done one hip at a time."

Steve, 61, is now back at work, coaching junior sharpshooting teams and attending shooting competitions. "I've got a great life, and I hope I have 50 more years ahead of me thanks to Dr. Webb and his staff."

This story also appears on the Mayo Clinic Health System Hometown Health blog. You can find it there and share it with others https://www.mayoclinichealthsystem.org/hometown-health/patient-stories

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This weekend on Mayo Clinic Radio, Dr. Robert Trousdale, an orthopedic surgeon at Mayo Clinic, will discuss knee and hip replacement surgeries. Also on the program, Dr. Lonzetta Neal, an internal medicine specialist at Mayo Clinic, will discuss genetic testing for breast cancer risk. And Dr. Phillip Young, a radiologist at Mayo Clinic, will explain MRIs, including what they are and what they're used for.

Here's your Mayo Clinic Radio podcast.

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On the next Mayo Clinic Radio program (8/24), the studio will be full with three orthopedics experts. Mark Morrey, M.D., will join your host Tom Shives, M.D., and co-host Amy McIntosh, M.D., to discuss joint replacement and regenerative medicine specifically for the joints.  As joint replacement surgery becomes more common, more patients are considering if the procedure is right for them.  Is it that simple?  We’ll find out and discuss what may be on the horizon for fixing troublesome joints. 

Myth or Matter of Fact: You have to be over 60 to be considered for hip or knee replacement.

Note: You can listen to the program LIVE Saturdays at 9 am CT on I Heart Radio via KROC AM. The show is taped for rebroadcast by some affiliates. On Twitter follow #MayoClinicRadio and tweet your questions.

Listen to this week’s Medical News Headlines at  News Segment Aug 24, 2013  (right click MP3).

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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[Video and animation are available in the downloads. Reporter pkgs. can be edited into vo/sots and incorporated into your local reporting.]

Read script: 3D Printer Helps Hips

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The need for joint surgery is declining among rheumatoid arthritis patients, possibly because they can now more effectively manage the disease with medication, Mayo Clinic research has found. When people diagnosed with arthritis since the mid-1990s do need orthopedic surgery, it now is more often on the knees rather than the hips, the study shows. The findings are published online in The Journal of Rheumatology.

Dr. Sherine Gabriel, is a Mayo Clinic rheumatologist and co-author of the study.

Click here to view the news release.

The need for joint surgery is declining among rheumatoid arthritis patients, possibly because they can now more effectively manage the disease with medication, Mayo Clinic research has found. When people diagnosed with arthritis since the mid-1990s do need orthopedic surgery, it now is more often on the knees rather than the hips, the study shows. The findings are published online in The Journal of Rheumatology.

The post Less Surgery for Painful Joints appeared first on Mayo Clinic News Network.

Body Mass Index (BMI) is the measurement of choice for many physicians studying obesity. BMI uses a mathematical formula that takes into account a persons height and weight. In this Mayo study, patients diagnosed as superobese had a BMI greater than 50. Generally, a BMI of 30 indicates obesity. A person 6-feet tall with a BMI of 30 would weigh about 225 pounds. A person that same height with a BMI of 50 would weigh 369 pounds.

In the first study, 43 patients categorized as superobese underwent total hip arthroplasty from 1996 to 2006. This surgical procedure replaces a worn, fractured or damaged hip joint with a prosthetic implant. The patients had a BMI ranging from 50 to 77, and a mean age of 56. Mayo followed them an average of three years to determine outcomes.

Results showed:

More than half (56.5 percent) experienced either surgical or medical complications, including prolonged wound drainage.
Five of the 43 patients required a total of 15 re-operations to correct problems such as recurring dislocation of the implant, chronic infection, and new bone fractures around the device.

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