Not quite 50, but aching joints…

Login to Health January 29, 2018 Bone Health 519 Views

There was a time when arthritis afflicted grey-hailed grandparents, but osteoarthritis has begun to occur among younger people too. Check-ups reveal worn out cartilage, which necessitate hip replacement surgery, freeing patients of pain and giving them mobility like before. So here’s to living a fuller life with painless swimming, golfing etc although with loads of help from your orthopedic surgeon!  

It was like any other busy day for Sangeeta, as she hurriedly ran down the railway bridge to catch the overcrowded train pirouetting into the station. But just as she was about to descend the stairs, a sharp pain in her knee joint shot through her leg, almost like a current and so sudden that the usually unfazed graphic designer could have screamed. By the time this 36 year old had reached the second or third step the pain seemed to have dulled a wee bit but was still very much there.

Getting into the train she again felt a jerk-like sensation. After a few stations Sangeeta managed to find a seat. Just as she was about to sit, she felt another sting. Bewildered, she tried to keep calm and had a swig of water from the small bottle that she was carrying and rested her palm underneath her knee for some comfort. She could move her leg, thankfully it had not gone limp; and after the crowd had thinned, when she got more room to herself, she tried rotating her foot. After a good 45 mins, when it was time to disembark, she got down slowly, taking care that she did not put too much pressure on her leg. She didn’t feel the pain while walking, but Sangeeta wasted no time in contacting her GP.

What Sangeeta did not know was that arthritis is not a precursor to pain in the joints which need surgery. Nor did she have any idea about osteoarthritis, a condition that precedes osteoporosis in senior citizens. Naturally, she wouldn’t be a candidate for hip replacement, but wait a minute – why was her GP referring her to an orthopedist? Sangeeta made a mental checklist of calcium intake, when the doctor’s query startled her, “Do you smoke?” “Huh,” spluttered Sangeeta, snapping out of her reverie. The doctor repeated the question. “No,” said Sangeeta rather empathetically, wondering what the connection was.

In a study of those who underwent total knee replacement surgery, it was found that smokers had ten times more probability of having to undergo a revision surgery. There would be similar evidence for total hip replacement surgery too, as patients are urged to quit smoking or reduce tobacco consumption, which in any case is an unhealthy practice. Among the volley of questions, Sangeeta was also asked whether she had diabetes as those with Type 2 diabetes are predisposed to post-surgery complications.

What could possibly go wrong in hip replacement surgery?

Here are a few contraindications:  

  • Weight is another factor to consider as it affects the lifespan of the implant, greatly reducing it. Not just this, being obese means higher the risk of post-surgical infection and complications.
  • Severe osteoporosis is another factor to consider before going in for hip replacement surgery, as brittle bones may not be able to adequately support the new joint implants. Bone density has to be improved and this treatment may also need to be continued after surgery.
  • In case of mild or moderate osteoporosis, bone cementing may be a more feasible option.
  • Infection may also be another reason to rule out surgery as intravenous antibiotics may lead to having the replacement removed.

But what exactly is hip replacement and why is it done?

A fracture or arthritis are two of the most common causes for hip replacement surgery, in which the hip joint also known in medical parlance as the-ball-and-socket joint is replaced. The tip or the ball, the femoral head is just one part of the entire joint. What is also important are cartilages and lubrication for painless, friction-free movement. Among the 300,000 hip replacements done annually in the United States, the everyday ‘wear-and-tear’ which escalates with age, (osteoarthritis) is the primary cause especially among those above fifty years of age. An important factor, here that also needs to be looked into is if there were irregularities in hip development during childhood.

Typically, in a hip replacement, the damaged part or parts are replaced – whether it is the femoral head or cartilage – with either a metal stem, a metal or ceramic ball and additional use of screws or cement.

When walking, bending and other regular daily activities such as getting into a chair, climbing stairs get restricted due to stiffness or pain or may become difficult to perform, then a total hip replacement surgery is recommended. Medication in the form of non steroidal anti-inflammatory drugs (NSAIDs) or steroid injections; and physical therapy such as using a cane or walker do not yield painless results then the surgery would be a better alternative. Pain experienced even while resting, is yet another symptom which indicates that hip replacement surgery is needed.

Evaluation before hip replacement surgery

It’s not just older patients who benefit, although it is usually among them that cartilage is worn out. While age is not a qualifying factor, what has to be considered on a case to case basis is:

  • Hip mobility, strength and alignment through a physical examination or an X-ray to detect hip deformities.
  • Family history of arthritis
  • Bone condition, which is usually determined through magnetic resonance imaging (MRI)

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