My name is Dr. Travers.
I'm a joint surgeon
at University of Pennsylvania Hospital system,
specifically Pennsylvania Hospital.
So I specialize in orthopaedics,
with a focus on joint replacement,
specifically knee and hip replacement.
There's a lot of questions surrounding COVID.
Penn Medicine Orthopaedics is taking
a lot of precautions,
so everyone who enters the hospital must be wearing a mask.
We're limiting the volume of patients we're seeing,
both in the office and in the OR,
to make sure that people aren't accumulating
in waiting areas.
We're also screening everybody that has surgery
with a nasal swab test to make sure
that nobody is COVID-positive,
and this goes for our staff, as well.
Every staff member who enters the hospital
has their temperature recorded,
and a questionnaire completed to make sure
that they aren't experiencing any COVID symptoms.
As far as what patients can do to manage joint pain
and inflammation during the pandemic,
these are things that I recommend
to anyone who has an injury or joint pain.
Specifically, something called RICE,
which is an acronym for rest, ice, compression,
and elevation, so if you have, for example,
a painful knee joint, you could put ice on it
during the day, rest, put your feet up on the couch,
you could even put a compressive ACE wrap on,
and that can help a lot with joint pain.
A lot of patients have been asking questions
regarding NSAID use, which is things like Aleve,
Advil, and if it can cause a worse COVID infection.
There was a paper published in early March
in the Lancet, which is actually just an opinion piece,
which they theorized that things like ibuprofen,
could cause a worse COVID infection.
There has been no evidence to date that that's the case,
and that's very much up in the air,
so there's been many literature reviews,
and there's no significant evidence
that things like Advil or Aleve are putting people
at some increased risk.
So, as far as at this stage, I am still prescribing that
to my patients for joint pain.
Those who are very concerned, or are higher risk,
can also take Tylenol, which is a different type
of medication that can also help joint pain,
but at this point, I am not overly concerned
that that is a significant risk factor
for a severe COVID infection.
So a lot of patients ask, what can they do
to avoid joint pain flare-ups,
or worsening of their joint pain during this time?
And really what I recommend is modifying activities
that you do that do cause pain.
And that really is focused on minimizing stress
on the joints.
Specifically, for example, knee pain,
sitting in really low chairs where you have
to really bend your knees to get in
and out should be avoided because
that can cause worsening knee pain.
Long distance walks or runs, typically,
are more likely to cause pain
than shorter distance walks or runs.
Things like deep squats, or kneeling,
any time when you're really doing an extreme range
of motion with your hip or your knee joint are
at higher risk of causing pain,
so I tell people to try to modify the things they do.
They have a specific activity that really bothers them,
try to modify in such a way that it's less stressful
on your joints, that requires less severe range of motion.
You know, a lot of us are at home,
we're maybe not exercising as much as we have in the past,
and obviously eating habits have to be maintained.
So monitoring caloric intake, trying to maintain weight,
is very important, specifically for joints.
Small changes in weight, either up or down,
can have huge effects on the amount of force a joint sees.
So for example, with your knees,
every pound you gain is about six times that on the knees,
specifically going up and down stairs,
so even a pound lost can be something to be proud of,
and that will definitely help with your joint pain.
What kind of exercises can I do at home
to keep my knees and hips healthy?
And specifically there are some exercises
that target specific muscle groups in that area.
So one of the most important muscles
for hip and knee health is the quadricep muscle.
This is the muscle on the front of your thigh.
So things that exercise that are extending your knee,
or straightening your leg out.
So if you're sitting in a chair
and you straighten your leg out at the knee,
that is working your quadricep muscle.
Keeping that strong is important for posture,
gait, and strength.
Focusing on the hips, you can also strengthen
your hip flexors and your core muscles.
So hip flexors are the muscles in the front of your hip
that lift your leg up off the ground.
So if you're laying flat on a bed,
you can lift your leg, your heel, off the bed,
as straight up as far as you can,
and that'll be working on your hip flexors.
And that will give you a good exercise
and good strengthening around that area.
All of these exercises for the knee
and hip health can be done at home.
They're typically low weight, low resistance,
so you don't require any kind of weight system
or exercise machine, and it's really just using gravity
and using your own body weight
to try to gently strengthen those areas.
So I'm not recommending going out
and buying really heavy weights,
or doing anything really extreme.
This is more just laying down on the floor
and lifting your leg up off the ground,
or even sitting in a chair during commercials,
and straightening your knee out
and trying to do a little bit
of strengthening of that area.
For patients who do need care during the pandemic,
Penn Medicine Orthopaedics has multiple options.
So, specifically, most people are going to be seen,
initially, through a telemedicine visit.
What that means is either a phone call or a video visit
with a physician, or a physician assistant,
where we discuss your problems,
we decide what needs to be done next.
Whether or not we need to obtain x-rays,
start therapy, bracing, things like that.
So we do have services available that can help
during this time without any contact at all.
For those people who do have significant injuries,
or do require more in-person care,
we do have clinic slots available for emergency
and urgent issues.
Going forward, we will slowly re-open the clinics,
and make more spots available for less urgent problems.
And that is a day-to-day decision,
so we will keep our patients updated
as to what slots are available
and what the best option is for them.
Probably the best thing to do is to call Penn Orthopaedics
and schedule a telemedicine visit.
If it is something that you do need to be seen for,
we can always make a spot for you
and have you come into the office,
but most problems can be initially dealt with
via telemedicine, and it's probably the safest for everyone.
We're trying to go through
every single patient that we take care of
and look at those risk factors,
and determine how high risk they are for surgery,
and then by looking at them each individually,
we can decide when is the best time to proceed with surgery,
and who needs it the most,
and what the best way to proceed is.
We're gonna be taking multiple precautions
and the clinic and OR will not look the same
as it did before the pandemic.
Specifically, we're going to be focusing
on preventing large groups of people from gathering,
so that will mean less visits,
and no waiting in the waiting area.
So people will be roomed immediately,
and there will be limited contact with staff,
so as limited as possible.
As far as the OR, the same thing applies,
so we're gonna be limiting the number of cases we do
to prevent people from being admitted
to the hospital, utilizing resources
that may be needed for COVID patients,
and also just preventing our patients
from coming in contact with more people during this time.
This is obviously something that's never been seen before,
and I think everyone's been doing a great job
of social distancing, and maintaining safety,
and the patients I have spoken to are doing very well
and are taking care of themselves,
and I just want everyone to know
that Penn Medicine Orthopaedics is here for you
if you have any kind of problem.
Even if it's not orthopaedic, get in touch.
We can always put you in touch with the right physician
or provider, and we're here to help.