The human body is a marvelous — almost magical — creation. It can survive a tremendous punishment over the years. Given time and attention, it can recover from injuries and illnesses that would have killed it just 50 years ago.
But as the body ages, the wear and tear accumulates.
Every 7.5 seconds a baby boomer turns 50, which means paying closer attention to the toll of that wear and tear — especially in the joints.
Dr. Patrick Harrison, D.O. an orthopedic surgeon with Payson Regional Bone & Joint, talked about joint repair and replacement at the March 5 Lunch & Learn program at the Payson Regional Medical Center Senior Circle.
He said knee work — either total replacement or revisions (repairs) — are both expected to increase six-fold by 2030. Surgeries to address hip issues could increase in excess of 125 percent.
Harrison said total joint replacement is one of the most commonly performed and successful operations in orthopedics and one of the most cost-effective procedures in all of medicine.
Joint issues most often arise when the cartilage — the slick, lubricant covering the bones in the joint — wears out. When it’s optimum, the cartilage cushions and protects the ends of the bones and creates a smooth gliding surface.
With the cartilage wearing out, arthritis develops, resulting in painful bone-on-bone contact. The arthritic inflammation of the joint comes in 100 varieties, but the two primary types are osteoarthritis and rheumatoid. Arthritis is the second most common chronic condition in the U.S. — the first is sinusitis.
The causes of the main forms of arthritis include:
• Osteoarthritis can result from a prior trauma, high activity levels, excess weight, age, misalignment from such things as bowlegs or knock-knees, or a genetic predisposition to weak cartilage
• Arthritis can also develop following a trauma to the body (car wreck, fall, etc.)
• Rheumatoid arthritis seems to stem from an abnormality of the immune system and may be genetically linked
The signs of arthritis are:
— Joints warm to the touch and swollen;
— Joint pain, immobility and stiffness;
— Decreased activity and impaired lifestyle;
— Joint deformities.
Symptoms of arthritis include:
— Stiffness in the hip or hips;
— Loss of motion in the hip;
— Pain limiting activities and lifestyle;
— The feeling that one leg is shorter than the other;
— Pain in the groin or front of the thigh.
Surgery is the treatment of last resort. The first step is getting a proper diagnosis, Harrison said.
A doctor will review a patient’s medical history, including symptoms, health and activity then examine the affected joint to look for range of motion, joint-line tenderness and joint deformities.
An X-ray can help determine the severity of joint damage, but can’t see damage to cartilage — although the space between the joint bones shows how much cartilage remains.
The first treatment could involve activity modification, weight loss and physical therapy, along with non-steroidal anti-inflammatory drugs and similar prescription medications and nutritional supplements. The doctor may recommend injections of Corticosteroid.
Other treatments include self-help/assistive devices, heat and cold treatments, over-the-counter medications and topical creams.
If none of that works, a patient can consider surgery, Harrison said. Surgery is an option when the pain and mobility issues diminish the quality of life, based on discussions with an orthopedic surgeon. In the right circumstances, surgery can relieve pain and restore function and mobility.
Risks of the surgery include dislocation, leg length discrepancy, infection, blood clots, fracture, loosening of components over time, and future surgery to revise components.
Harrison said the use of a specialized HANA table has made it possible to access the joint through the front, which cuts recovery time by not touching the muscles and tendons in the side and back. The front-entry surgery also minimizes the disruption of the tissue and muscles, which improves the stability of the hip. Additional risks to this method include hip dislocation, limited hip motion and positions, possible persistent limp, greater reliance on a walker or cane after the operation (possibly as long as six weeks), and greater need for pain medication.
Harrison said his approach preserves muscles and tissues with a shorter incision, which also minimizes blood loss and tissue damage. The HANA table keeps the patient secured during the procedure and makes it possible to use X-rays on the spot to confirm placement of components and leg length. All of that reduces limits on the hip’s range of motion, the risk of dislocation and reliance on assistive devices, said Harrison.