Turn on the TV and there is golf legend Jack Nicklaus extolling the virtues of his hip replacement. Still competing on the links, Nicklaus is among the growing number of people in the United States each year who have a hip joint replaced. So is rock star Eddie Van Halen, who was 43 when he had his hip replaced in 1999, the same year as Nicklaus.
Cases like these are laying to rest the stereotype that only the aged and the inactive receive hip replacements. The same holds true for those who have knee joints replaced.
The American Academy of Orthopedic Surgeons (AAOS) calls total joint replacement an orthopaedic success story, “enabling hundreds of thousands of people to live fuller, more active lives.” In the year 2001 reportedly 165,000 hip and 326,000 knee joint replacements were performed, and in its 73rd annual conference in Chicago AAOS predicted the figures would leap by a staggering 673% by 2030 reaching 3.48 million cases annually in the USA alone.
What is joint replacement?
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 and low-friction movement of the joint. If the cartilage becomes damaged by excess weight, disease, injury, fracture or ligament tears, 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. This is called arthritis, which commonly affects people over 45, although younger men and women can get this disease as well.
When the entire joint is damaged, a total joint replacement is done. To replace a total hip or knee joint, a surgeon removes the damaged parts and inserts artificial implants called prostheses. Joints that can be replaced include the shoulders, fingers, ankles, and elbows. Hips and knees are replaced most often.
Do I need to have my joint replaced?
Only a bone specialist can tell if you need a joint replaced. He will look at your joint with an x-ray machine. The doctor may put a small, lighted tubular camera (arthroscope) into your joint to look for damage. A small sample of your tissue could also be tested.
After looking at your joint, the doctor may say that you should consider exercise, walking aids like braces or canes, physical therapy, or medicines and supplements. Medicines for arthritis include drugs that reduce inflammation. However, all drugs may cause side effects, including bone loss.
Joint replacement is often the answer if you have constant disabling pain and can’t move the joint well; for example, if you have trouble with things like walking, climbing stairs, and taking a bath.
What happens during surgery?
First, the surgical team will give you medicine so you won’t feel pain (anaesthesia). The medicine may block the pain only in one part of the body (regional), or it may put your whole body to sleep (general). The team will then replace the damaged joint with a prosthesis.
Each surgery is different. How long it takes depends on how badly the joint is damaged and how the surgery is done. To replace a knee or a hip takes about 2 hours or less, unless there are complicating factors. After surgery, you will be moved to a recovery room for 1 to 2 hours until you are fully awake or the numbness goes away.
What happens after surgery?
With knee or hip surgery, you may be able to go home in 3 days. If you are elderly or have additional handicaps, you may then need to spend additional 2-3 days before going home.
After hip or knee replacement, you will often stand and begin walking sometimes even on the day of surgery. At first, you will walk with a walker or crutches. You may have some temporary pain in the new joint because your muscles are weak from not being used. Also, your body is healing. The pain can be helped with medicines and should end in a few days.
Physical therapy can begin the day after surgery to help strengthen the muscles around the new joint and help you regain motion in the joint. A physical therapist will help you with gentle, range-of-motion exercises before you leave the hospital and also simple exercises which you can perform in the comfort of your home.
As you move your new joint and let your muscles grow strong again, pain will lessen, flexibility will increase, and movement will improve.
The risks?
Joint replacement is usually a success in more than 95 per cent of people who have it. When problems do occur, most are treatable. Possible problems include:
* Infection – Minor infections in the wound are usually treated with drugs. Deep infections may need a procedure.
* Blood clots – If your blood moves too slowly, it may begin to clot causing pain and swelling for which the doctor may suggest drugs to make your blood thin, or special stockings, exercises to help your blood move better.
* Loosening – The new joint may loosen, causing pain. This is seen when the lifespan of the joint, which is approximately 20 years, is complete.
* Dislocation – Sometimes the prosthesis can come out of its socket, although most cases can be corrected without surgery.
* Nerve injury – In rare instances nerves near the replaced joint may be damaged during surgery. Over time, the damage often improves and may disappear.
Anything artificial has a lifespan of its own; similarly, a joint replacement is likely to last 20 years based on global reports. The average patient takes a million steps a year and it will be quite a challenge to find an appliance in your home that you use a million times a year and have it last for 20 years with no maintenance.
Future of joint replacement surgery
On a concluding note, joint replacement surgery has 4 advantages:
* Pain reduction up to 100% relief
* Correction of all limb deformities eg bow-legs
* Restoration of almost complete range of joint movement
* Immediate mobility after surgery
With researchers constantly working on newer material and metallurgy for longer-lasting implants, and surgeons developing their surgical skills by reducing the sizes of their incisions and surgical time, we feel only the surface has been scratched so far. Astronomical numbers predicted for the coming decades underline the benefits of this extremely gratifying surgery, which is now reaching the third world.
