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Joints are formed by the ends of two or
more bones connected by tissue called cartilage. Healthy
cartilage serves as a protective cushion, allowing smooth,
low-friction movement of the joint. If the
cartilage becomes
damaged by disease or injury, the tissues around the joint
become inflamed, causing pain. With time, the cartilage
wears away, allowing the rough edges of bone to rub against
each other, causing more pain.
When only some of the joint is damaged, a
surgeon may be able to repair or replace just the damaged
parts. When the entire joint is damaged, a
total joint
replacement is done. To replace a total hip or
knee joint, an
orthopedic surgeon at United Bone & Joint removes the diseased or damaged parts and inserts
artificial parts, called prostheses or
implants. These
prostheses are considered medical devices, which are
regulated by the Food and Drug Administration.
The American Academy of Orthopedic
Surgeons calls
total hip replacement an orthopedic
success story, enabling hundreds of thousands of people to
live fuller, more active lives. In 2009, it was reported by
the National Institute of Arthritis and Musculoskeletal and
Skin Diseases that 773,000 Americans have a total
knee or
hip replacement
per year. Total knee replacement is
highly successful in relieving pain and restoring joint
function, says the AAOS. And a hip or knee replacement
lasts at least 20 years in about 80 percent of those who get
them.
But despite their success, hip and knee
joint replacements still have drawbacks. There may be
complications. They don't always last a lifetime and
when
they fail, surgery may be needed.
As artificial joints and surgical
techniques to implant them continue to evolve, the medical
community and patients hold out
hope for joint replacements
that cause fewer problems, last longer, and move more like a
healthy natural joint.
Why Joint Replacement?
The most common reason for having a hip or
knee replaced is osteoarthritis, according to the National
Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS). This degenerative joint disease, marked by the
breakdown of the joint's cartilage, is not limited to older
people. Although it most commonly affects people over age
45, younger men and women also can get this disease.
Some people are born with a deformed joint
or defective cartilage, which leads to
osteoarthritis.
Excess weight,
joint fracture,
ligament tears, or other
injury can damage cartilage and cause osteoarthritis.
Rheumatoid arthritis is another condition
that may be alleviated by hip or knee joint replacement.
This chronic inflammation of the joint lining causes pain,
stiffness, and swelling. The inflamed lining can invade and
damage bone and cartilage. Rheumatoid arthritis generally
starts in middle age, but can also affect children and young
adults.
Loss of bone caused by
poor blood supply (avascular
necrosis), which led to Van Halen's hip replacement, and
bone tumors may be other reasons for joint replacement.
The Risks of Replacement
Like any surgery, hip and knee joint
replacement carries certain life-threatening risks, such as
infection,
blood clots and complications from anesthesia.
Other complications include
nerve damage,
dislocation or
breakage after surgery, and wearing out or loosening of the
joint over time. After hip replacement surgery, one leg may
be shorter than the other.
Infection is an ongoing risk for people
with joint replacements. Not only can it occur in the
hospital, but it can happen years later if bacteria travel
through the bloodstream to the replacement area.
In the rare case that an infection spreads
to the new joint and does not clear up with antibiotic
treatment, the joint must be replaced. This usually requires
two surgeries--one to remove the infected joint and another
surgery later to insert the new joint. Between surgeries,
the infection is treated with antibiotics.
In 2001, the FDA approved a temporary
artificial hip for people with hip joint infection. The
temporary hip, called Prostalac, can be inserted and left in
place for about three months after the infected hip is
removed. It consists of a metal stem and ball that fits into
the thighbone, a plastic cup that attaches to the hipbone,
and a bone cement that contains antibiotics. The antibiotics
in the cement, along with oral antibiotics taken by the
patient, help to treat the infection. The temporary hip
allows a person some movement while healing.
How Do You Know It's Time for Surgery?
The
specialists at
United Bone & Joint have a checklist of items -- if you
are experiencing any of these signs, you should speak to
your orthopedic surgeon about the
possibility of joint replacement:
- you are unable to sleep at night
because of the pain
- you've tried a series of different
medications that don't help alleviate the pain, or the
medication you have been on no longer works
- you feel that the pain from your
arthritis is keeping you from regular outings, such as
visiting friends, going shopping or taking a vacation
- your activity is restricted to the
point where you have trouble getting out of a chair,
going up stairs, getting off the toilet, or getting up
from the floor.
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