Evaluation and Management of Hip and Knee Arthritis in Women
- 1st Edition - March 28, 2025
- Imprint: Elsevier
- Editors: Claudette M. Lajam, Anna Cohen-Rosenblum
- Language: English
- Paperback ISBN:9 7 8 - 0 - 4 4 3 - 1 0 5 5 9 - 3
- eBook ISBN:9 7 8 - 0 - 4 4 3 - 1 0 5 6 6 - 1
Women often experience arthritis differently from men for many reasons, ranging from biological and joint anatomy differences to pain perception and psychosocial factors.… Read more
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Request a sales quoteWomen often experience arthritis differently from men for many reasons, ranging from biological and joint anatomy differences to pain perception and psychosocial factors. Evaluation and Management of Hip and Knee Arthritis in Women is the first reference to directly address the unique needs of women in this challenging area, helping you improve diagnosis and treatment outcomes for your female patients. Offering comprehensive, up-to-date coverage of medical, surgical, and sociological considerations, this title is an essential resource for orthopaedic surgeons and primary care physicians in training and practice, rheumatologists, adult reconstruction fellows, advanced practice practitioners, and other clinicians who provide care to women with hip and knee osteoarthritis.
- Covers all aspects of hip and knee osteoarthritis that are specifically relevant to women’s health: biological differences and hormonal changes, pain perception, joint anatomy, comorbid conditions that are more prevalent in women, psychosocial factors and expectations, response to treatment, and research gaps
- Features concise, detailed text accompanied by abundant, high-quality clinical and radiologic images to provide a practical tool for use in the office, in the clinic, and at point of care
- Discusses intraoperative considerations, including implant design, implant sizing, use of technology, bearing surfaces, and fixation
- Covers etiology of and gender differences in bone health, and development of hip and knee arthritis
- Addresses postoperative pain and unique social considerations for women with fibromyalgia, mental health disorders, and/or chronic opioid use
- Includes value-based care considerations such as impact on health disparities, the doctor-patient relationship, cost to patients, and access to care
- An eBook version is included with purchase. The eBook allows you to access all of the text, figures, and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud. Additional digital ancillary content may publish up to 6 weeks following the publication date
Practicing orthopaedic surgeons who treat hip and knee arthritis, Primary care physicians who treat women with arthritis, Rheumatologists, Adult reconstruction fellows, Orthopaedic surgery residents
- Evaluation and Management of Hip and Knee Arthritis in Women
- Cover image
- Title page
- Table of Contents
- Copyright
- Dedication
- Contributors
- Foreword
- Preface
- Acknowledgments
- Video contents
- List of Illustrations
- List of Tables
- Section 1. Osteoarthritis in Female Patients
- 1. Epidemiology of osteoarthritis in female patients
- Introduction
- Prevalence and incidence of osteoarthritis
- Sex
- Treatment
- Race
- Socioeconomic status
- Social determinants of health
- Risk factors for osteoarthritis
- Systemic risk factors
- Local biomechanical risk factors
- Types of osteoarthritis
- Conclusion and future directions
- References
- 2. Presentation of arthritis in female patients
- Osteoarthritis
- Risk factors for osteoarthritis of the hip and knee in females
- Estrogen and osteoarthritis: Menopause
- Gender as a social construct, social determinants of health, and health equity
- Sex and gender differences in perception of pain
- Moving forward for the future of treatment of females with osteoarthritis
- References
- 3. Nonsurgical options for management
- Introduction
- Lifestyle modification
- Weight loss
- Physical therapy
- Bracing
- Medications
- Injections
- Radiofrequency ablation
- Conclusion
- References
- Section 2. Systemic Conditions and Joint Pathology
- 4. Autoimmune disorders
- Prevalence of autoimmune disorder in females: Top 10 conditions
- Presentation of autoimmune arthritis in females
- When to refer patients for evaluation of autoimmune arthritis
- Management of autoimmune arthritis with antirheumatic drugs
- Medical treatment of RA, PsA, and IBD arthritis
- Sex differences in autoimmune arthritis medical treatment
- Perioperative management and outcomes of autoimmune arthritis
- Perioperative medication guidelines
- Postoperative complications
- Sex differences in perioperative outcomes
- Nonoperative and non-DMARD management of autoimmune arthritis symptoms
- Nonsteroidal antiinflammatory drugs
- Acetaminophen
- Corticosteroid injections
- Opioids, muscle relaxants, and benzodiazepines
- Nutritional supplements
- Physical therapy and occupational therapy
- Cognitive-behavioral therapy, mindfulness-based interventions, and antidepressants
- Alternative therapies: Acupuncture and balneotherapy
- Sex differences in non-dmard management of autoimmune arthritis
- Conclusions
- References
- 5. Arthroplasty in the hypermobile patient
- Introduction
- Patient evaluation
- Surgery in the hypermobile patient
- General considerations
- Ehlers-danlos syndrome and hypermobility spectrum disorders
- Osteogenesis imperfecta
- Down syndrome
- Marfan syndrome
- Conclusion
- References
- 6. Cancer and metastatic disease
- Cancer in females
- Chondrosarcoma
- Hematologic malignancies
- Metastatic bone disease
- Clinical presentation and evaluation of female patients
- Treatment options for patients with metastatic bone disease
- Surgical treatment of metastatic bone disease
- Lower extremity surgical considerations
- Postoperative recovery and rehabilitation
- Summary
- References
- Section 3. Bone Health in the Female Patient
- 7. Osteoporosis
- Basic science and mechanism of disease
- Epidemiology/female predominance
- Smoking, vaping, and bone health
- When to evaluate female patients for bone mineral disorders
- How to screen for osteoporosis
- Diagnosis of osteoporosis
- Treatment of osteoporosis
- When to treat
- Bisphosphonates
- Denosumab
- PTH and PTH-related protein analogs
- Selective estrogen receptor modulators
- Menopausal hormone therapy
- Calcitonin
- Calcium and vitamin D
- Choosing among therapies
- Vitamin D screening and preoperative optimization
- Conclusion
- References
- 8. Hormonal influences on joint health and osteoarthritis
- Effects of hormones in the development of osteoarthritis
- Thyroid hormones
- Parathyroid hormone
- Growth hormone
- Cortisol hormone
- Sex hormones
- Risk of osteoarthritis differs between males and females
- Reproductive factors and risk of osteoarthritis
- Age of menarche and risk of osteoarthritis
- Childbirth and risk of osteoarthritis
- Age of menopause and risk of osteoarthritis
- Surgical oophorectomy and risk of osteoarthritis
- Exogenous hormones and effect of knee and hip osteoarthritis
- Hormone replacement therapy
- Antihormones: Aromatase inhibitors and selective estrogen receptor modulators
- Obesity and osteoarthritis
- Metabolic effect of adipokines in developing osteoarthritis
- Conclusion
- References
- Section 4. Preoperative Optimization
- 9. Surgical risk assessment
- Introduction
- Perioperative surgical home
- Preoperative education and ambulatory assessment
- Preoperative physical therapy: “prehab”
- Modifiable and nonmodifiable risk factors
- Infection
- Glycemic control
- Anemia
- Smoking
- Obesity
- Malnutrition
- Vitamin D
- Social factors
- Sex-based perioperative risk
- Risk calculators
- Bone quality and bone health
- Venous thromboembolism risk
- Conclusion
- References
- 10. Obesity and malnutrition
- Introduction
- Obesity
- Total hip arthroplasty
- Technical elements and obesity
- Functional outcomes and satisfaction
- Postoperative complications, readmissions, and quality metrics
- Total knee arthroplasty
- Technical elements and obesity
- Functional outcomes and satisfaction
- Postoperative complications, readmissions, and quality metrics
- Weight reduction strategies
- Surgical weight loss
- Medical weight loss
- Malnutrition
- Conclusion
- References
- 11. Psychiatric optimization in patients undergoing total joint arthroplasty
- Introduction
- Assessment of psychiatric comorbidities
- Screening tools for psychiatric evaluation
- Depression
- Anxiety
- Substance use disorder
- Other psychiatric conditions
- Multidisciplinary approach
- Conclusion
- References
- 12. Anesthetic and pain considerations
- Introduction
- Chronic opioid use
- Multimodal analgesia
- Clinical pathways
- General versus neuraxial anesthesia
- Conclusion
- References
- 13. Infection risk
- Introduction
- Definition of periprosthetic joint infection
- Pathogenesis and microbiology
- Patient risk factors
- Modifiable patient risk factors
- Nonmodifiable patient risk factors
- Perioperative infection prevention
- Conclusion
- References
- Section 5. The Female Knee
- 14. Biomechanics of the female knee
- Introduction
- Knee anatomy
- Bony anatomy
- Cartilage
- Muscles and tendons
- Ligaments
- Nerves/vasculature
- Biomechanics
- Tibiofemoral articulation
- Patellofemoral articulation
- Alignment
- Knee stability
- Gait
- Conclusion
- References
- 15. Presentation of osteoarthritis of the knee in females
- The valgus knee
- The previously operated knee
- Preoperative imaging
- Factors contributing to delay in diagnosis and management
- References
- 16. Patellofemoral arthritis in the female patient
- Introduction
- Anatomy and mechanical considerations
- Pathology
- Physical exam
- Imaging
- Nonoperative management and outcomes
- Surgical management and outcomes
- On the horizon
- References
- 17. Surgical indications for total knee arthroplasty
- Surgical indications
- Shared decision making and expectation level-setting
- Psychosocial readiness and patient activation
- Physiologic readiness
- Recognizing disparities in surgical indication
- Unicompartmental arthroplasty VS total arthroplasty
- Preoperative technical considerations
- Planning ahead
- Use of technology assistance: Computer-assisted navigation and robotics
- Computer-assisted navigation
- Robotics
- Conclusion
- References
- 18. The female knee: Intraoperative considerations for the arthroplasty surgeon
- Introduction
- Implant considerations
- Polyethylene and wear
- Morphology of bearing surfaces
- Posterior stabilized versus cruciate retaining
- Mobile bearing versus fixed bearing
- Congruent implants
- Gender-specific implants
- Low-contact stress designs
- Cemented versus cementless TKA
- Prior surgery: Realignment procedures, ligament reconstruction, and fractures
- Intraoperative fractures
- The patella: Resurface always, sometimes, or never?
- Intraoperative alignment considerations
- Sex-based anatomical differences
- Alignment in total knee arthroplasty
- Technology-assisted total knee surgery
- Robotic-assisted and navigated TKA
- Management of bone loss
- Conclusion
- References
- 19. Postoperative considerations
- Postoperative outcomes
- Pain and function
- Why do these differences exist?
- Are these differences real?
- Urinary tract infection
- Conclusion
- References
- 20. Conversion total knee arthroplasty
- Introduction
- Preoperative planning
- TKA after ligamentous reconstruction and osteotomies
- TKA after fracture
- TKA after partial knee arthroplasty
- Conclusion
- References
- 21. Revision knee replacement
- Introduction
- Preoperative planning and imaging
- Patient history and presentation
- Physical examination
- Radiographic and laboratory studies
- Operative instrumentation
- Surgical approach
- Infection workup and diagnosis
- Static versus articulating spacers
- Static spacers
- Articulating spacers
- Comparison of static and articulating spacers
- Functional prosthetic spacers
- Implant removal
- Polyethylene insert
- Femoral component
- Tibial component
- Patellar component
- Management of bone loss
- Cement fixation
- Impaction grafting
- Bulk structural allografts
- Metaphyseal cones and sleeves
- To augment or not to augment?
- Options for instability
- Flexion instability
- Extension instability
- Hyperextension instability or genu recurvatum
- Management of the patellar component
- Conclusion
- References
- 22. Periprosthetic fractures about the knee
- Risk factors
- Patient related
- Surgical and implant related
- Diagnosis and classifications
- Diagnosis
- Classifications
- Treatment
- Periprosthetic fracture of distal femur
- Periprosthetic fracture of proximal tibia
- Periprosthetic fracture of patella
- Conclusions
- References
- Section 6. The Female Hip
- 23. Hip anatomy and biomechanics
- Bone anatomy and development
- Normal biomechanics
- Injury biomechanics
- References
- 24. Developmental dysplasia of the hip
- Introduction
- Evaluation
- Patient characteristics/presenting symptoms
- Radiographic measurements
- Grading/classification
- When to consider PAO
- Counseling patients with ddh
- Conclusions
- References
- 25. Osteonecrosis of the femoral head
- Etiologies of osteonecrosis of the femoral head
- Trauma
- Corticosteroids
- Alcohol use
- Blood dyscrasias
- Human immunodeficiency virus
- Caisson disease and other causes
- Diagnosis and classification of osteonecrosis of the femoral head
- Diagnosis
- Classification
- Nonarthroplasty management of osteonecrosis of the femoral head
- Total hip arthroplasty for osteonecrosis of the femoral head
- Preoperative optimization
- Intraoperative considerations for total hip arthroplasty in the setting of osteonecrosis of the femoral head
- Conclusion
- References
- 26. Surgical indications
- How to decide if a patient is ready for total hip arthroplasty
- Approaches
- Direct anterior approach
- Anterior based muscle sparing
- Direct lateral approach
- Posterior approach
- Other approaches
- Preoperative technical considerations
- Implants and sizing
- Use of technology in the operating room
- Evaluation of the spinopelvic relationship
- Conclusion
- References
- 27. The female hip: Intraoperative considerations
- Introduction
- Developmental dysplasia of the hip—technical considerations
- Proximal femoral anatomy
- Acetabular considerations
- Femoral shortening osteotomies
- Obesity
- Instruments
- Technical tips and tricks
- Stability in total hip arthroplasty
- Intraoperative evaluation
- Cup position
- Stem position
- Offset
- Leg length
- Impact of prior surgical procedures
- Hardware removal
- Prior periacetabular osteotomy
- Prior spinal fusion
- Intraoperative challenges
- Intraoperative fractures
- Preventing instability
- Limb lengthening
- Summary
- References
- 28. Postoperative considerations for females undergoing total hip arthroplasty
- Postanesthesia care unit
- Admission status
- Diet
- Activity level
- Vital signs
- Investigations
- Medications
- Inpatient floor
- Postoperative pain management
- Preexisting condition—depression
- Nursing care/hygiene products
- Postoperative medication management
- Discharge plan
- Other postoperative considerations
- Length of stay
- Driving
- Return to exercise, aquatic exercises
- Telehealth for total joint arthroplasty
- Conclusion
- References
- 29. Conversion total hip arthroplasty
- Introduction
- Indications
- Preoperative planning
- Recommended imaging modalities
- Preoperative laboratory evaluation
- Nutrition evaluation
- Bone health evaluation
- Infection workup
- Implant selection
- Acetabulum
- Femur
- Intraoperative technique and considerations
- Antibiotics and tranexamic acid
- Surgical approach
- Removal of hardware
- Tips for acetabular preparation
- Tips for femoral preparation
- Additional implants/equipment to request for conversion THA
- Postoperative protocol
- Complications
- Common clinical scenarios for conversion THA
- Case 1: Intramedullary nail hardware failure
- Case 2: Posttraumatic osteonecrosis of the femoral head
- Case 3: Femoral neck fracture nonunion
- Case 4: Dislocating hemiarthroplasty
- Case 5: Subacute acetabular fracture
- Case 6: Healed acetabular fracture with posttraumatic arthritis
- Case 7: Retained knowles pins and osteoarthritis
- Conclusion
- References
- 30. Revision total hip arthroplasty
- Introduction
- Preoperative planning
- History
- Physical exam
- Radiographic evaluation
- Instability
- Workup and diagnosis
- Implant considerations
- Femoral component malposition
- Appropriately positioned components
- Soft tissue management
- Infection
- Workup and diagnosis
- Spacer types
- Osteolysis and aseptic loosening
- Revision planning and techniques
- Evaluation of bone loss
- Prior implants
- Surgical preparation
- Approaches
- Tips for femoral component removal
- Techniques for acetabular component removal
- Acetabular reconstruction
- Femoral reconstruction
- Conclusion
- References
- 31. Periprosthetic fractures of the hip
- Risk factors
- Patient-related risk factors
- Implant-related risk factors
- Diagnosis and classifications
- Diagnosis
- Classifications
- Treatment
- Periprosthetic fracture of proximal femur
- Summary
- References
- 32. Cemented total hip arthroplasty
- Introduction
- Why cement?
- Anatomical restoration/dislocation risk/leg length discrepancy
- Survivorship
- Specific benefits in osteopenic, osteoporotic, and irradiated bone
- Reduced incidence of thigh pain
- Reduced risk of periprosthetic femoral fracture
- Reduced revision burden
- Ease of revision
- Antibiotic delivery
- Maintaining and restoring bone stock
- Costs
- Use in hemiarthroplasty
- Cementing technique
- Cementing technique—acetabulum
- Cementing technique—femur
- Femoral neck cut
- Canal preparation
- Cement insertion and pressurization
- Stem insertion
- After stem insertion
- A note on use of cement by pregnant or breastfeeding surgeons
- Conclusion
- References
- Section 7. Health Policy and Disparities
- 33. Health disparities and value-based care
- Health disparity
- The transition to value-based care models
- Outpatient total joint arthroplasty
- Patient selection in total joint arthroplasty
- Preauthorization
- Patient access to total joint arthroplasty
- Patient selection and access to care by sex
- Racial and ethnic disparities among females
- Insurance type
- Conclusion
- References
- 34. Conclusion and future directions
- Reference
- Index
- Edition: 1
- Published: March 28, 2025
- Imprint: Elsevier
- No. of pages: 350
- Language: English
- Paperback ISBN: 9780443105593
- eBook ISBN: 9780443105661
CL
Claudette M. Lajam
Dr. Lajam is an Adult Reconstructive surgeon, Chief Safety Officer, Chief of Adult Reconstruction Quality, at NYU Langone Orthopedics. A Professor of Orthopedics at NYU School of Medicine, she is a Fellowship-trained Orthopedic Surgeon. She specializes in total hip replacement, total knee replacement, revision and complex revision total hip and knee replacement, She is also an original host of "The Orthopedics Show" on SiriusXM Doctor Radio. She sits on the Board of Directors of the American Academy of Orthopedic Surgeons and is the Chair of the central program committee for the AAOS annual meeting. Her track record of leadership, excellence in orthopedic education, and research speaks for itself.
Claudette M. Lajam, MD, is an adult reconstructive surgeon specializing in primary and revision hip and knee replacement. She is Professor of Orthopedic Surgery, System Chief of Orthopedic Quality and Safety, Chief of Quality for the Division of Arthroplasty, and has served on the Executive Committee of the Medical Board at NYU Langone Health and the NYU Grossman School of Medicine.
Dr. Lajam completed her residency in Orthopedic Surgery at the Mayo Clinic Graduate School of Medicine. She is the first woman and first orthopedic surgeon to receive the Mayo Clinic Alumni Association Professional Achievement Award. She went on to Adult Reconstruction fellowship at the Insall Scott Kelly Institute in New York.
Claudette served on the Board of Directors of the American Academy of Orthopedic Surgeons (AAOS) through her role as 50th Chair of the AAOS Board of Councilors. She is the first Latino person to Chair the AAOS Board of Councilors. She is one of two practicing female surgeon members of the Knee Society. She served as Chair of the Central Program Committee for the 2021 AAOS Annual Meeting. Dr. Lajam remains the only woman to be named to the AAOS Advocacy Wall o' Fame. She is Past President of the Ruth Jackson Orthopedic Society. Claudette is a founding member of the American Association of Latino Orthopedic Surgeons. Claudette has served on the AAOS Communications Cabinet, the Education Council, Committee Appointment Program, Quality Council, and Executive Committee.
She has served on the Board of Directors of the NY State Society of Orthopedic Surgeons. She is actively involved in American Association of Hip and Knee Surgeons Women in Arthroplasty and Advocacy Committees. She served on the Annual Meeting Committee for the National Hispanic Medical Association in 2022.
Dr. Lajam has published widely in the field of orthopedics. She has spoken nationally and internationally about primary and revision hip and knee replacement, telehealth, value-based care, health disparities, medical ethics, resident education, and technology. She is an original host of Sirius XM Doctor Radio “The Orthopedics Show” on Sirius XM 110.
Claudette was born in Queens, NY. She is first-generation Dominican- American and is fluent in the Spanish language.
Affiliations and expertise
Professor, Department of Orthopedic Surgery, NYU Langone Grossman School of Medicine, New York, New York, USAAC
Anna Cohen-Rosenblum
Assistant Professor Anna Cohen-Rosenblum works in the Department of Orthopaedic Surgery, LSU Health Sciences Center, New Orleans, Louisiana.
Affiliations and expertise
Assistant Professor, Department of Orthopaedic Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA