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Examiner
  • St. Mary Medical Center's Dr. Robert Paul: Joint replacement has more options now

  • Do you find yourself “sitting this one out” more often than not, when it comes to walking the dog or other physical activities because the aftermath is just too painful?

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  • Do you find yourself “sitting this one out” more often than not, when it comes to walking the dog or other physical activities because the aftermath is just too painful?
    Do you find it hard to sleep through the night because of joint pain? Does your knee or hip have you relying on pain medication to get you through the day?
    These are some of the questions that need to be answered when considering joint replacement and the sooner the better. If painful joints such as knees and hips are ignored too long, what doctors may be able to do for the patient will be limited.
    There is a point of diminishing returns, but also a great deal of good that can be done if the timing is right.
    Also, popular assumptions about joint replacement being a matter of age must change. In its infancy, total joint replacement (replacement arthroplasty) tended to be recommended primarily for senior patients because of the limited longevity of replacements. This is no longer true. With more people continuing to pursue active lifestyles, joint issues are affecting the young as well as old.
    I'm not an advocate of jumping into total joint replacement, if more conservative measures can bring the patient relief and range of motion. Surgery should never be taken lightly, but there comes a time when quality of life is affected and surgery may be a good option. There are many new methods and prostheses that now work wonders for patients in easing pain and returning function to worn out or damaged joints.
    Most orthopedic surgeons have gotten away from metal on metal implants. Newer plastic and ceramic components have tighter molecular structure, some are even infused with vitamin E to minimize oxidation and improve the life of the replacement. Joint implants that used to last 10 to 20 years now can be good for up to 40 years under normal use.
    Techniques have also improved immensely in recent years. The newer anterior approach to total hip replacement has eliminated the need to cut or detach muscles from the pelvis or femur (the long bone in the upper thigh). And, with no severed muscles to heal, the new hip is immediately stable. There is less post-operative pain, a shorter hospital stay and most importantly, less risk of dislocating the new hip joint.
    I don't want to give the impression there is minimal pain. There is expected postoperative pain – however, it's much less with the anterior hip approach (and there are new methods of controlling pain after total knee replacement.)
    In the case of a total knee replacement, we can customize the implant to the patient. Based on the patient's physical properties, activity level and goals, we can use MRI and CT scan information to make precise implants for an accurate fit that will provide better function and last longer.
    Page 2 of 2 - With MRI assisted technology, a customized cutting guide can be prepared to tell us where to place the implant and how much bone to remove. These technologies allow for 20 or more steps of the surgical procedure to occur before the implant is placed. Surgery time is cut in half, resulting in less risk of infection, less blood loss, less risk of blood transfusions and a better fitting knee that potentially will last longer.
    Total shoulder replacements are also much improved. In the past, your options were extremely limited if you had a coexisting rotator cuff injury. The rotator cuff is the muscle group that allows you to raise and rotate your arm. Previously, a patient with a rotator cuff tear and arthritis could not have a total shoulder replacement, only a “partial” replacement, which usually continued to hurt. Now, that same patient can have a “reverse” total shoulder replacement that doesn't require your rotator cuff to be intact. It is great for pain relief and usually helps in returning function to the shoulder. Again, I recommend conservative measures as long as possible, such as strengthening exercises or resurfacing the joint if necessary.
    Finally, your decision about if and when to consider total joint replacement should be made in consultation with your doctor. If you find yourself saying “yes” to my questions, it may be time to visit your doctor. I always regret hearing patients tell me, “I should have done this years ago.”
    Dr. Paul is an orthopedic surgeon in the Joint and Spine Institute at St. Mary's Medical Center.
     
     
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