Knee braces, the management of Prolia in the context of total shoulder arthroplasty and negative pressure dressings Panel Discussion Dr Nargis Shaheen, Dr Jonathan Negus, Dr Bernard Zicat - Primary Care Masterclass Podcast

Session 2 Panel Discussion Dr Nargis Shaheen, Dr Jonathan Negus, Dr Bernard Zicat

The discussion focuses on the management of Prolia, an injectable osteoporosis medication, particularly in the context of total shoulder arthroplasty and its timing relative to surgical procedures. The discussion begins by highlighting the importance of educating general practitioners (GPs) regarding the administration and timing of Prolia in relation to arthroplasty surgeries, emphasizing a one to three-month window post-injection for optimal outcomes. The panelists agree on the critical nature of timing, noting that delaying the next dose of Prolia could lead to adverse effects such as rebound bone loss and challenges in implant integration.

The conversation expands to include variations in management approaches between shoulder and lower limb surgeries. While one panelist suggests referring patients to osteoporosis specialists managing Prolia, others share their experiences with knee and hip arthroplasties, indicating that many patients do not typically present with complications related to Prolia. The informative dialogue delves into the mechanism of action of Prolia and its impact on bone remodeling, detailing the balance between osteoblasts and osteoclasts and the potential implications for healing post-surgery.

Questioning the literature, the panel addresses concerns around stress fractures linked to Prolia and contrasts it with previous misconceptions about initiating osteoporosis medications in the hospital setting. They assert that recent studies have alleviated prior worries, encouraging a more integrated approach to managing osteoporosis medications in surgical patients since 2019. The discussion is enriched by an audience member's inquiry regarding the common advice found online about stopping osteoporosis medications around the time of surgery, leading to further clarification of Prolia's unique pharmacokinetics and implications for patient care during the perioperative period.

Transitioning to the subject of knee braces, the panel offers practical advice on recommending braces for various conditions, noting the challenges posed by the wide variety of products available. The focus shifts to the effectiveness of specific braces, particularly medial unloader braces, and the importance of basing recommendations on the individual patient's condition and personal experience with existing braces. The discussion touches on the psychological effect that braces may have on patients and their role in providing stability.

The latter part of the lecture examines negative pressure dressings commonly used post-knee replacement surgery, discussing the necessary follow-up procedures for managing these dressings, especially if they become compromised. Panelists emphasize the importance of maintaining a proper seal on these dressings and highlight the protocol for addressing issues such as leakage or discomfort, recommending that patients should promptly return to their surgeons if problems arise.

Lastly, the panel explores the incidence of delirium in postoperative patients, particularly the elderly, addressing how to make discharge decisions considering individual symptoms and needs. They discuss the potential benefits of returning to familiar environments for recovery, linking follow-up care with geriatricians to ensure comprehensive support. The session concludes with lighthearted remarks about weight gain post-arthroplasty, showcasing the panel's camaraderie and shared insights into the multifaceted considerations of surgical patient management.

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