How to Lose Weight…Even Around the Holidays

The holidays are an amazing time to enjoy the company of family and friends.  Typically one of the key components to holiday celebrations is the food.  It becomes a time that we splurge on treats that we may not often consume during the rest of the year.  This can take a particular toll on the waist line.  So how do we keep the weight off, even during those tempting holiday feasts?

The most obvious choice for preventing weight gain is avoiding overeating.  Note that 1 lb is the equivalent of 3,500 calories.  If you plan on not only avoiding weight gain, but possibly losing some weight during this challenging winter timeframe, your caloric intake will need to be reduced by 500-1000 calories per day in order to lose 1-2 lbs per week.  “But the food is so tempting!” you may think.  I’m not disagreeing with you.  If at all possible, limiting caloric intake will help you avoid gaining weight; however, there is an alternative.  If you plan on consuming those extra calories over the holidays, then you have to expend more calories.  In other words, you’re going to need to burn off those calories with activity. 

Activity does not have to be a particular structured exercise program like lifting weights or running on the treadmill, but you have to expend enough energy to burn off the extra calories that you have consumed.  You may choose to play in the yard with your children or grandchildren, go on a brisk walk and look at Christmas decorations, or even shovel snow off the driveway (depending on the accumulation this year).  The important thing is to balance how many calories you bring in compared to the amount you expend.  Just because you have been active for the afternoon does not necessarily mean that you have been active enough to consume everything that you may desire.  Keep that in mind when you are loading your plate; and especially if you are not particularly fond of exercise or being active, you may want to rethink the extra helping of mashed potatoes.

If losing weight and keeping it off are your goal, then both diet and exercise/activity should become a more regular part of your daily routine.  30-60 minutes of moderately intense activity at least 5 days a week will make maintaining or losing weight more sustainable.  The dieting portion of the program can be more challenging during the holidays; but if you find yourself falling off of the bandwagon, then don’t be afraid to hop back on.  Weight loss is not an overnight venture.  It takes time and commitment.  You may falter, but that does NOT mean give up ENTIRELY.  Also note that GRADUAL changes in diet and reducing calories will be more effective and sustainable than trying to keep a very strict reduction in calories right away.  Reducing your caloric intake to TOO low of a level may actually result in your body losing muscle rather than fat, decrease the likelihood of you getting all of the proper nutrients that your body needs from food, and may leave you more prone to binging when you feel starved.

The health benefits to losing excess weight are definitely worth the struggle.  If your goal is to lose 20% of excess body weight, that’s great; but even a 5% loss will begin to demonstrate health benefits.  These benefits may include improvements in blood pressure, cholesterol levels, and blood sugar.  In addition to these health benefits, weight loss can also assist in your energy level, mobility, mood, and self-confidence.  For more blogs related to weight loss and exercise, check out the following links: exercise for health or weight loss, different forms of exercise, childhood obesity, and obesity continued.

If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.

 

Resources:

http://www.cdc.gov/HEALTHYWEIGHT/LOSING_WEIGHT/INDEX.HTML

http://my.clevelandclinic.org/health/healthy_living/getting_fit/hic_Maintaining_a_Healthy_Weight/hic_The_Very_Best_Way_To_Lose_Weight_and_Keep_It_Off

http://www.calculators.org/health/weight-loss.php

Minimally Invasive Total Hip Replacement

As technology and techniques have advanced, so have the approaches to performing total hip arthroplasties (THA).  Our last blog discussed the typical approaches to performing this surgery.  In more recent years, however, minimally invasive total hip replacements have started to become more popular.

Now, don’t let the name fool you.  A minimally invasive THA is still a very invasive surgery.  What sets a minimally invasive THA apart from a traditional THA is the size of the incision and the amount of muscles that are cut.  As discussed in our last blog, a posterior approach THA consists of a 10 to 12 inch incision along the back and side of the hip along with cutting through muscles that stabilize the hip in order to replace the joint surfaces.

Minimally invasive total hip replacements use the same prosthetic hip components, but the incision used is smaller; therefore, special tools are needed to perform the procedure.  The theory behind using smaller incisions is that less tissue is damaged in the course of the surgery, thus healing time is quicker.

Minimally invasive THAs can be performed with either one or two small incisions.  The single incision surgery is much like a posterior THA.  The difference is that the incision measures 3 to 6 inches in length.  Muscles and tendons must still be split or detached with this procedure, but to a lesser extent than with a traditional posterior THA.  The two incision surgery, also known as MIS-2, consists of a 2 to 3 inch incision over the groin for placement of the socket and a 1 to 2 inch incision over the buttocks for placement of the stem that creates the ball of the hip.  The surgeon uses special instruments and x-ray guidance to move around muscle layers without cutting them.  The two incision surgery takes longer than a traditional hip replacement and is much more technical, so a highly skilled surgeon is required.  Hospital recover time is approximately 1 to 4 days and rehabilitation with a physical therapist is a key component to proper function.

Unfortunately, the minimally invasive THA procedure is not for everyone.  The best candidates are those who are thin, young, healthy, and highly motivated to participate in rehab.  Individuals who are obese, have undergone other hip surgeries, have significant deformities of the hip, or are highly muscular are not ideal candidates.  Currently, minimally invasive THAs are not as readily performed likely due to the limited pool of appropriate candidates, higher skill level required to perform the procedure, and the procedures overall level of difficulty.  Some statistics suggest that the procedure has a higher chance of failure than a traditional THA due there being a higher chance of improper placement of the prosthetic components.  The decrease in visibility of the hip joint during the operation and use of a surgeon who is not experienced enough in the procedure could increase the chances of this complication occurring.  Other assessments suggest that the recovery time is much quicker following a minimally invasive THA and requires a shorter duration of rehab following surgery.  So far, the long term benefits do not appear any different from that of a traditional THA; but, more research is needed on the effectiveness and long term benefits of these procedures.

If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions.

 

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00404

http://www.emedicinehealth.com/minimally_invasive_hip_replacement/article_em.htm

http://www.webmd.com/arthritis/features/is-less-invasive-hip-replacement-best-for-you

http://www.jointimplant.com/patient-education/hip/minimally-invasive-total-hip-replacement/

https://www.hss.edu/conditions_minimally-invasive-surgery-joint-replacement.asp

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257425/

Total Hip Replacements: Posterior versus Anterior Approach

Total hip replacements or arthroplasties (THA) are one of the most commonly performed joint replacement surgeries.  With wear and tear, broken bones, and various problems with blood supply that can occur at the hip, there will always be a need for some type of procedure like this.  The components involved and surgical approach for the replacement may vary, though, based on an individual’s age, past history, and desired activity level.

There is more than one way to perform a THA, but the overarching mechanics are the same.  Just like the shoulder, the hip joint is a ball-and-socket joint; thus, the prosthetic (artificial) portion of the hip joint consists of two parts: a cup-like component that is attached to the acetabulum (a portion of the pelvic bone) to make a socket, and a shaft with a round top that attaches to the femur (long bone of the leg) to make up the ball.  The damaged parts of the hip bone are removed and replaced with the prosthetic components.  There are several different types of materials that can be used for the hip prosthetic.  These material combinations can include metal-on-polyethylene, metal-on-metal, and ceramic-on-ceramic.  Each material combination has both pros and cons so it is important to discuss the best type of replacement for your intended level of activity.  The same is true for the attachment of the prosthetic.  There is an option of cementing the replacement parts to the bone or doing what is called a press fit which allows bone to grow into the prosthetic to hold it securely in place.  Determining which technique to use will depend on several factors including bone quality and strength.

In addition to the different types of material and attachment techniques that can be used for the hip joint prosthetic, the type of surgical approach used is also important to understand.  The most popular approach is known as the posterior approachDuring this surgery a curved incision is made along the posterior (back) hip which wraps down and to the side of the hip. The incision used is approximately 10 to 12 inches long.  Muscles and soft tissue that typically keep the hip stable are then cut, including the fascia lata, gluteus maximus, and several external rotator muscles of the hip.  The hip is dislocated, the arthritic surfaces of the bone are removed, the prosthetic pieces are attached, the hip is relocated in the socket, muscle and soft tissue that were previously cut are reattached, and the incision is closed.

The anterior approach is a different method of hip replacement which is not used as frequently as the posterior approach.  During this procedure an incision is made on the anterior (front) side of the hip instead of the posterior side.  The surgeon works between the muscles without detaching them from the bone when they replace the arthritic surfaces, thus less muscle damage occurs.  Along with the increased difficulty in performing this approach for a THA, the anterior approach requires a special table to be used in order to perform the procedure.  This may account for some of why the procedure is not used as often as the posterior approach.

So what are the pros and cons for having a posterior or anterior hip replacement?  Posterior hip replacements:

  • Pros
    • Provide the best view of the hip
    • Less likely to cause nerve damage
    • Cons
      • Must maintain strict hip precautions to prevent dislocation
      • Greater risk of dislocation (due to stabilization muscles being cut and then reattached)
      • Cutting of major muscles which require reattachment

Anterior hip replacement

  • Pros
    • Less damage to muscles
    • Less post-operative pain (due to less muscle damage)
    • Faster recovery than traditional posterior approach
    • Decreased risk of dislocation (due to muscles that stabilize hip not being cut)
    • Better range of motion (due to lack of strict hip precautions limiting motion)
    • Shorter hospital stay (but can vary based on patient and frequency of therapy in the hospital)
    • Cons
      • Obese or very muscular patient’s may not be good candidates
      • More challenging and technical surgery than posterior approach
        • Less visibility
        • Have to work between muscles without cutting or damaging nerves
  • Potential risk for nerve damage
  • Wound healing issues with patients with a larger amount of abdominal fat

Do your research in order to help determine which method and surgeon are the best for you.  As the THA procedure has been refined over the years, its longevity has improved thus allowing it to be performed at a much younger age than in previous decades.  There is over an 80% chance for a hip replacement lasting 20 years.  Various factors can increase the chances of failure, however, including an individual’s weight being over 165 lbs as well as level of activity.  Performing strengthening exercises is good for stabilizing the hip, but excessive high impact exercises can cause too much force and can increase the likelihood of replacement failure.  Despite the recent trends, rehab is very important in order to regain your full potential and recovery.  We have treated several patients who were told that they did not need outpatient physical therapy and ended up with other complications afterward.  For more information on the importance of rehabilitation following a total joint replacement surgery, check out our past blog on the topic here.

Resources:

http://orthoinfo.aaos.org/topic.cfm?topic=a00377

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1022709/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257425/

http://www.dartmouth-hitchcock.org/ortho/total_hip_replacement.html

http://www.arthritis-health.com/surgery/hip-surgery/anterior-vs-posterior-hip-replacement-surgeries

http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-replacement/total-hip-replacement/

 

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