Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
What are the risks of undergoing a total
knee replacement?
Risks of total knee replacement include
blood clots in the legs that can travel to the lungs (pulmonary
embolism). Pulmonary embolism can cause shortness of breath, chest
pain, and even shock. Other risks include urinary tract infection,
nausea and vomiting (usually related to pain medication), chronic
knee pain and stiffness, bleeding into the knee joint, nerve damage,
blood vessel injury, and infection of the knee which can require
re-operation. Furthermore, the risks of anesthesia include potential
heart, lung, kidney, and liver damage.
What is involved with the preoperative evaluation for total
knee replacement?
Before surgery, joints adjacent to the diseased knee are carefully
evaluated. This is important to ensure optimal outcome from the
surgery. Replacing a knee joint which is adjacent to a severely
damaged joint may not yield significant improvement in function.
Furthermore, all medications which the patient is taking are
reviewed. Blood-thinning medications such as warfarin (Coumadin) and
antiinflammatory medications such as aspirin may have to be
adjusted or discontinued prior to surgery.
Routine blood tests of liver and kidney function and urine tests
are evaluated for signs of anemia, infection, or abnormal metabolism.
Chest X-ray and EKG are performed to exclude significant heart
and lung disease which may preclude surgery or anesthesia. Finally,
it is less likely to have good long-term outcome if the patient's
weight is greater than 200 pounds. Excess body weight simply puts
the replaced knee at an increased risk of loosening and/or
dislocation.
A similar risk is encountered in younger patients who may tend
to be more active, thereby adding trauma to the replaced joint.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of
cartilage in the joints. Also known as degenerative arthritis. Osteoarthritis
can be caused by aging, heredity, and injury from trauma or disease.
Aseptic necrosis (avascular necrosis or osteonecrosis) is a condition that develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when the degenerating bone is used. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
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