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Osteoarthritis afflicts millions of Americans and can
be a very debilitating condition to otherwise healthy and mobile
people. This column
has focused previously on the newer, less invasive and more
innovative techniques of treating osteoarthritis.
However, for people who have severe degenerative joint
disease, the definitive treatment remains total joint
replacement.
First a little background. Osteoarthritis (OA) and degenerative joint disease (DJD) are
essentially used interchangeably.
Degenerative joint disease is an appropriate name because
it accurately describes the disease.
Through a process of degeneration which is related to
many factors including age, weight, biomechanics, lifestyle and
others, the joint simply wears out.
Although people use the term “arthritis” to mean
DJD or OA, it is important to realize that although
osteoarthritis is one form of arthritis, there are many.
People with rheumatoid arthritis or other forms are not
always treated similarly to people with DJD.
Since the lower extremity joints must bear the
body’s weight they are the most commonly effected by DJD.
The knees seem to be especially vulnerable due to their
unique biomechanical responsibility. But the hips are certainly susceptible to overuse conditions
as well.
It should also be mentioned that although OA affects
primarily elderly patients, it can very easily creep up on
people in their middle age.
Just because someone is 45 or 50 years old doesn’t mean
that they can’t be suffering from a degenerative joint
condition.
As mentioned before, there are many new and effective
treatments for DJD which are less invasive than joint
replacement. Most
people who present to their orthopaedist in the early or middle
stages of joint degeneration can potentially benefit from one of
these standard or new therapies.
The more conservative treatments which are often
tried prior to joint replacement include non-steroidal oral
anti-inflammatory medications, steroid injections into the
joint, synthetic joint fluid injections into the joint and
arthroscopic surgery. However, people with end stage OA are likely to be helped by
a replacement of their degenerated joint.
Total joint replacement surgery is exactly what it
sounds like. Whether
the knee or the hip, the ends of the bones are resurfaced at the
joint and a prosthetic device is used to replace the worn out
joint.
Since its inception, many advances have been made in
both the mechanics of the prosthetic joints and in the manner
which they are implanted. Today’s
artificial joints can be expected to last for many years and
provide patients with a remarkable improvement in pain and
function.
Depending on the patient’s overall health and other
medical problems prior to surgery, patients may only require a
brief hospitalization in order to have a prosthetic joint
implanted. Patients
who are more ill or have significant medical problems may
require a slightly longer hospitalization.
For people who have degenerative joint disease, the
improvement that they realize after having their joint replaced
is often remarkable. The
pain and stiffness and lack of mobility associated with severe
joint degeneration can often be quite debilitating.
After recovering from the surgery and going through the
rehabilitation process, virtually all patients report a dramatic
improvement in pain reduction and in function.
Some patients even report a complete resolution of
symptoms following recovery from the procedure.
The effectiveness of the surgery depends on many
factors. The
comorbid conditions that a patient has prior to undergoing joint
replacement can effect their mobility after the procedure.
Also, the effort put into the rehabilitation of the joint
is very important. Patients
who commit to a thorough rehab process and work well with the
physical therapist often see the best results.
But virtually all patients report dramatic improvements
post-operatively.
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