New Method of Joint Replacement for Seniors in Pain
At
age 65, Lynn moved to a new city and loves being within walking
distance of coffee shops, art galleries, and restaurants. The problem
for Lynn is that she has osteoarthritis in both knees and walking is
painful. She has put up with the pain for quite a while and tries to
avoid stairs, curbs, and sitting in chairs without armrests, which help
her get up.
Then
one day, an event happened that changed how Lynn decided to deal with
her joint pain. She works on the tenth floor of an office building, and
the fire alarm went off. Gripping the handrail and moving at a snail’s
pace, Lynn couldn’t get down the stairs. She heard people from the
stairs above her yelling, “What’s the hold-up down there? Why are we
stopped?” As is turns out, it was only a fire drill, and Lynn
was completely embarrassed as she attempted each step in severe pain.
“But what if there had been a real fire? I would have put everyone and
myself at risk. It was time for me to see a doctor,” recalls
Lynn.
Since
then, Lynn has had both knees replaced, worked hard at her physical
therapy, and has done exceptionally well in her recovery overall. She
now finds even more joy in her walks around the neighborhood. She can’t
believe that she let the pain go on for so long before looking into her
options.
Arthritis is the main reason for
joint replacement surgery, and today, over 32 million people are
affected by arthritis. Eighty percent of those have some limitation in
their movement and 25 percent are not able to perform major Activities
of Daily Living (ADLs). Factors that put someone at risk for getting
arthritis are genetics, activity level, prior joint injuries, and the
normal process of aging that involves the degradation of cartilage. No
wonder arthritis is the second most common chronic condition after
sinusitis (Bozic, 2010).
When someone has severe and chronic joint pain because of arthritis or
other reasons, they work with a doctor to determine the best approach
for dealing with it. Usually, these patients begin by
altering their lifestyles to relieve the pain; joint replacement
surgeries are a last resort.
Lifestyle
Changes to Try Before Surgery
Before considering surgery, the doctor may address your pain with
anti-inflammatory medications, or he or she may also suggest that you
make changes to your lifestyle, including:
- Activity modification – No
participation in impact sports. Instead, choose swimming, walking, or
the elliptical machine for exercise.
- Weight loss – Extra weight
can put an
extraordinary strain on joints.
- Bracing – A doctor-prescribed
or
over-the-counter brace from the drugstore offers support.
- Cane/walker – Helps take
weight off the
affected joint and decreases pressure on the distressed area.
- Physical therapy – Helps
strengthen the
joint.
If there is still no relief from
pain after a person has attempted
these lifestyle changes, the doctor will reassess the need for surgery
to replace the joint(s).
Common
Misconceptions About Joint Replacement
Joint replacement surgery patients often say how much better off they
are after the surgery, leading others to gravitate toward the same
option. However, orthopaedic surgeons are not quick to put you in their
surgery schedules. Patients may feel they are ready, but there is
enough misinformation circulating about joint replacements that should
be addressed first. Some common misconceptions about joint replacement
are:
Better
post-operative range of motion. This is just not true,
explains
Dr. Kevin Bozic, MD, MBA, Vice Chairman of UCSF’s
Department of
Orthopaedic Surgery. “While this is an option that will take
away the
pain for patients, increased range of motion is not a reality with
these surgeries. Whatever your range of motion is before the surgery,
it will remain the same after the surgery. You just won’t have the pain
associated with the movement anymore. The main goal of joint
replacement surgery is to relieve pain.”
Activity
level increase. This is a tricky one because it really
depends
on the patient. Some doctors don’t limit activity level, but most would
prescribe non-impact style activities after surgery. This could be
viewed as a decrease in activity level in some cases, but it prolongs
the durability of the new joint. However, without joint pain the
patient is now able to resume activity, which would increase their
activity level after surgery.
It
is for seniors only. Active adults of any age experience
pain in
their joints, so people aren’t waiting to become seniors to have their
joints replaced. Because the surgery options are becoming less
invasive, more people in their 30s and 40s are having joint replacement
surgeries. The younger the joint
replacement patient is, the shorter time the joint will last. This is
because that person is typically harder on the joint because they more
active, causing more wear and tear on the joint.
Diagnosing
with MRI. There is no need to go to the trouble or expense
of getting an MRI to determine if you have arthritis. A simple x-ray
shows a doctor very clearly if a joint is arthritic. However, even if
the x-ray confirms an arthritis diagnosis, a doctor will typically not
perform surgery unless lifestyle modifications and/or anti-inflammatory
drugs have been tried but have not reduced the pain.
Traditional
and Total Hip and Knee Joint Replacements Explained
Hip – The hip is a
ball-and-socket joint: The rounded head of the leg's
femur bone fits into a pocket in the pelvis called the acetabulum. In a
total hip replacement, the surgeon removes the entire head and neck of
the femur and replaces it with a half-sphere-shaped metal or ceramic
ball on top of a long stem, which is anchored deeply into the femur.
The acetabulum is capped with metal and plastic. A total hip
replacement can last up to two decades, but it forbids high-impact
activities such as running, jumping, and singles tennis, to reduce the
risk of loosening. For traditional hip replacement, hospital stays
average four to five days. Many patients need extensive rehabilitation
afterward.
The surgeon has options as to where to make the incision. Conventional
hip replacements utilize a side (lateral) or back (posterior) approach.
A new and less invasive approach is from a smaller incision on the
front (anterior) of the hip. From this angle, the surgeon doesn’t have
to cut the major muscles that stabilize the hip in the buttocks and
thigh. Patients often recover faster and are able to bend at the hip
and bear weight on it sooner after surgery. With the lateral and
posterior methods, patients have to limit hip motion cautiously for
many weeks following surgery.
Knee – The knee is a hinge joint where the thigh bone
(femur) meets the
large bone of the lower leg (tibia). During a total knee replacement,
the diseased or injured knee joint is replaced with an artificial
implant. The surgeon will remove the end of the femur bone and replace
it with a metal shell. The end of the lower tibia is also removed and
replaced with a durable plastic piece with a metal stem. If the
underside of the kneecap is diseased or injured, a plastic "button" may
also be added under the kneecap surface so it rides smoothly on the
other implant components.
Different types of designs and materials are currently used in total
knee replacement surgery. Most all of them consist of three components:
the femoral component made of a highly polished strong metal, the
tibial component made of a durable plastic and held in a metal tray,
and the patellar component made of plastic.
Both surgeries are considered to be major surgeries. Each takes a toll
on the body, the patient, the family, caregivers, and the patient.
Recovery times last many months and include significant physical
therapy. The ultimate success of the surgery often depends on how
committed a patient is to the healing process.
New
Advancements in Joint Replacement Surgery
Since the first total joint replacement surgery was performed in 1960
in England, advancements have been significant. Currently,
there are two relatively new surgical techniques for both hips and
knees that offer the biggest opportunity for
improvement: 1) “partial replacement” surgery, also referred
to as “resurfacing” and 2) Minimally Invasive Surgery (MIS), which
takes into account a smaller incision size and can be used for total or
partial joint replacements.
Doctors are not completely sold on these new methods, though. Most
agree that while the size of the incision does have advantages, it does
not always allow for proper placement of the prosthesis, which then
causes more issues for the patient after surgery. When determining
which approach will offer the best long-term benefit for the patient,
doctors continue to lean toward choosing the approach that will let
them place the joint properly rather than reduce the size of the
incision.
See how the two new approaches
compare to each other.
Comparative
Chart of Advancements in Joint Replacement Options
| Source for images: The Chester
County Hospital and Health System, www.cchosp.com |
| HIP SURGERIES |
Ideal Patient |
Technique |
Advantages |
Disadvantages |
Hip
Resurfacing
 |
-
Younger person.
- First joint replacement surgery.
- Strong bones.
|
-
The femur is shaved into a rounded shape and covered with a metal cap
on a small spike, which is cemented into the bone.
- The socket of the pelvis is also resurfaced and lined with a metal
cap.
|
- More of the bone is
preserved.
- Patient can have total hip replacement later in life.
- High impact sports and activities are possible.
- Better range of motion possible.
- Lower risk of leg lengths being different. |
-
Not many doctors are trained yet in this technique.
- Fracture of the femoral head.
- Small risk of an adverse reaction to the tiny metal particles
released into the bloodstream by the metal-on-metal implant.
|
| Minimally
Invasive Hip Surgery |
-
Younger person.
- Thinner.
- Healthier.
- A person who is more motivated to have a quick recovery.
|
-
The surgical procedure is similar to traditional, but with less
soft-tissue dissection.
- Specially designed instruments are needed to prepare the socket and
femur and to place the implants properly.
- A single incision (can sometimes be a two-incision operation) of
about 3 to 6 inches.
- Muscles and tendons surrounding the joint are split or detached, but
to a lesser extent than in the traditional hip replacement operation.
They are repaired after the setting of the joint. |
-
Recovery process is streamlined.
- Less pain.
- Less muscle damage.
- Hospital stays are shorter (1 to 2 days).
- Rehabilitation is faster.
|
-
The risks and long-term benefits of less-invasive techniques have not
yet been documented.
- Implant placement may not be positioned as consistently yet as with
traditional surgery because of the smaller opening.
|
| KNEE SURGERIES |
Ideal
Patient |
Technique |
Advantages
|
Disadvantages |
Knee
Resurfacing
 |
-
Younger person.
- First joint replacement surgery.
- Localized pain in one part of the knee.
|
-
Only the damaged surface of the knee joint is resurfaced and then
replaced with a fitted implant. |
-
More of the bone is preserved.
- Patient can have total knee replacement later in life.
- Smaller incision.
- Less trauma to healthy bone and tissue.
- Faster recovery. |
-
Relatively new so not many doctors are proficient with this method. |
| Minimally
Invasive Knee Surgery |
-Non-obese.
- Reasonable motion.
- No significant deformity.
|
-
Relatively new technique and is more challenging than standard knee
replacements because of the smaller incision size.
- Incision is 4 to 6 inches, compared with an 8- to 10-inch incision
for traditional.
|
- Less blood loss.
- Shorter hospital stay.
- Shorter recovery.
- Better looking scar.
- Better motion. |
-
Doctors still unsure whether it can be done as well as with the
traditional approach.
- Some studies have shown a higher rate of complications, including
poorer positioning of the knee implants because of smaller incision.
|
The
Future of Joint Replacement
Joint replacement is a huge business in the United States. Currently,
about three million joint replacements are performed annually at 5,000
hospitals by 17,000 surgeons (Bozic, 2010). By the year 2030, the
number of surgeries is expected to increase three-fold. In addition to
the new partial replacement and MIS surgical techniques, other
developments are helping doctors and patients achieve success in joint
replacement surgery.
Joint replacement registry
– New to the US. Implants are registered in a computer system that
allows doctors and researchers to compare and monitor how implant
products and surgery methods perform over the long-term. This provides
performance feedback and a true look at how certain types of implants
respond to different types of surgeries.
Computer-assisted
surgical navigation – Not common and is yet to be a proven
method of surgery. Advantages appear to be more reproducible alignment,
fewer complications, and improved implant longevity.
Improving
implants – Technology is always improving, and therefore
so are the materials that the implants and surgical tools are made of.
One such technological advancement for knee surgeries is called
PROPHECY® Pre-Operative Navigation Alignment Guides by Wright.
Incredibly, this creates a customized knee replacement blueprint for
your surgeon to follow without the use of an alignment rod that would
normally be stuck through your shin bone to help align the
implants. The surgeon prescribes a CT or MRI scan of your
leg. The scan is sent to Wright whose engineers turn the scans into a
computerized 3-D visualization of the knee bones. The engineers then
perform a virtual knee replacement on the computer according to the
surgeon’s specifications. From this, Wright generates a PROPHECY
Alignment Guide surgical plan specific to your surgery that follows the
geometry of your knee. The guide assists the surgeon in aligning and
positioning the replacement components without the need of an alignment
rod.
Research
studies – As time goes on, scientists have more
information to use to compare traditional methods and materials with
new methods and materials. This helps doctors refine their offering and
improve patient outcomes.
The senior population is more active now than it ever has been. This
trend will only be increasing as the Baby Boomer generation ages into
senior citizen status at a rate of 10,000 every day. This means that
more seniors will likely develop arthritis pain and perhaps ultimately
need joint replacement surgery if lifestyle changes and pain relieving
medications aren’t effective. Joint replacement surgery is not to be
taken lightly, as recovery is a heavy burden placed on the patient. The
level of commitment to a physical therapy regime is crucial in
regaining mobility. The more a patient is active in their rehab, the
more likely they are to experience a positive outcome for themselves
and feel that the trouble of the surgery was well worth the risk and
hardships.
Caregivers’
survival guide for joint replacement recovery
Caregivers need help too. Here are tips for making the recovery period
of a loved one a smooth one.
Fill your loved one's
prescriptions
This
includes regular medications as well as pain medications. Consult
the doctor to find out which ones you should buy.
Get any special equipment the
doctor recommends
Your
loved one may need a special toilet seat, a bathtub bench, or a
cane.
Prepare the house for recovery
Put
regularly used items in easy-to-reach places and make sure there's
nothing that would cause your loved one to slip or fall.
Find out how long you’ll need to
provide care
The
doctor can estimate how long it will take your loved one to recover.
Keep the wound clean
You
may be required to help change the bandage on the incision.
Communicate effectively with each
other.
Both
the patient and the caregiver need to be able to express feelings
about the situation. Try to be clear and don’t assume that the other
person will guess what you need. Try to be a good listener.
Take
care of yourself
It
is not selfish for a caregiver to focus on their own needs too. Eat
a healthy diet, get enough sleep, exercise, maintain outside interests,
and try to manage the stress that will naturally build up from
caregiving. Recognize when you too may need some help and ask for it.
Adapted from
www.zimmer.com |
|