Painful Knees and Hips
When a man walks, the impact on his hips reaches three times his body weight. Running and jumping can more than double the impact on these ball-and-socket joints that connect the trunk to the lower limbs. The knee, one joint below, connects the two longest bones in the body. The knee is a sliding, gliding hinge supported by three factors: its shape, the cord and strap-like ligaments that bind it, and the muscles that cause it to flex and extend. The knee is the single most injury-prone joint in the human body.
More than ever before, humans are living longer and remaining active, often despite being overweight or plagued by illnesses or debilitating conditions. Even if a person is free of injury, there is a certain amount of “wear and tear” on the hips and knees from exercise, work and simply living a long life. In some individuals, this wear and tear thins the glistening, pearly-white cartilage that coats our bone-ends and normally serves to glide and cushion. Instability or wobbliness from old sprains, and muscles that have weakened from lack of use can further accelerate the wearing out process, leading to swelling or inflammation. This may also be accompanied by the formation of bone spurs, which cause pain and reduce mobility for both bending and straightening.
Joints affected by injury, overuse, obesity, inactivity or heredity may eventually develop a condition called osteoarthritis. Medications and rest generally relieve the pain of arthritis at first, but when it becomes difficult to perform daily tasks, more advanced treatment is needed. The ultimate resolution for severe arthritis pain may be to replace the joint.
Joint replacement is not a one-answer-fits-all situation, however. Hip and knee replacements must be tailored to an individual’s specific needs, because each person is different. A customized plan takes a number of factors into account, including age, occupation, hobbies, recreational activities, weight, sex, health, the existence of other arthritic joints, concurrent illnesses and medical conditions. Numerous special technologies can be employed to maximize results and reduce the likelihood of complications. A thorough and comprehensive understanding of the patient is essential for this to occur, as well as a physician and hospital able and willing to make these treatments available.
Regarding Knees With Arthritis
The field of orthopedics has devised very good solutions for the most frequent and severe knee problems. Orthopedic surgeons focus on knees from the sub-disciplines of trauma, sports medicine and reconstruction via joint replacement. A fracture can be repaired even when it disturbs the actual joint surfaces. A sports medicine specialist can address instability or wobbliness by repairing or replacing torn ligaments immediately after an injury or years later. End-stage arthritic joints, the result of progressive erosion of surfaces, can be replaced, even when there is severe damage or when limbs have become crooked, deformed or stiffened.
Knee replacement has rightfully gained a reputation as a fairly difficult procedure for a patient to undergo, but several recent developments have helped to make the process far less difficult to withstand and more reliable in its outcome.
At the head of the list of recent improvements are implants that are easier to bend. This makes post-operative physical therapy much less difficult to endure for many patients. The knee bends more easily because the replacements come in multiple sizes, enabling a fit that is generally more exact and suited precisely to the shape of each individual’s knee bones. In addition, the bone ends are resurfaced with artificial caps of metal and a plastic-like substance, which are designed to roll more easily. One manufacturer has cleverly attracted over half of the potential market of recipients by wisely naming these multi-sized replacements as "the Woman’s (or) Gender specific knee.” Each hospital that offers this brand must stock an impressively large number of sizes on its shelves.
Also contributing to an easier recovery from knee replacement is a thin pain-blocking tube that can be inserted in the upper thigh before anesthesia wears off, just next to the nerve that leads to the entire front of the knee where the incision is. Although smaller than in the past, the incision is still the most painful point for the patient. By trickling a local anesthetic like novocaine around the nerve for the first two days, much of the pain is numbed, but the muscles can still function well enough for the patient to walk and move the knee relatively freely. When compared to what was available only a few years ago, the differences add up to an easier and safer recovery.
Another advance is geared toward the large category of patients who suffer greatly from early wear-and-tear osteoarthritic knees. These patients don’t have enough damage to warrant a knee replacement, yet many are very uncomfortable and unhappy. They are unable to walk, squat, stand from a sitting position or climb stairs without using their arms or favoring their bad leg. Gradually, they may lose mobility and muscle strength. They are often very upset at having suddenly deteriorated from formerly healthy, active lives.
Trimming or repairing arthritic tissues telescopically through tiny incisions often works well for individuals under 55. But for those who already have ongoing painful inflammation caused by generalized damage to the cartilage surfaces and shock-absorbing pads (menisci), the telescopic procedures sometimes do more harm than good.
Curiously, there are some people who remain active despite knee wear so severe that they’ve become knock-kneed or bow-legged. These individuals ski, play tennis and somehow continue to thrive. Age doesn’t seem to be a factor, nor does their gender. They use their knees and deny having enough pain to warrant surgery. How do they differ?
When examined, their knees still move well, have little swelling or inflammation and are surrounded by muscles that remain powerful from frequent use. By studying these fortunate individuals, a treatment plan has evolved over the last decade that helps people with early localized osteoarthritic wear. The treatment goals are to eliminate painful inflammation and maintain the knee’s cushioning strength and flexibility through the surrounding and supporting muscles and joints. Damaged areas are allowed to wear down naturally while pain is limited and function is preserved.
This treatment, called the Non-operative Arthritis Supression Program, services more than 500 patients annually under the supervision of Phelps orthopaedist, J. Robert Seebacher, MD. The treatment leads to improved function and confidence in many people, sometimes to a great degree. It is often the answer for individuals who had previously tried “cutting edge” surgical treatments that they thought were the latest and the greatest – such as telescopic trimming and smoothing, which is more suitable for younger patients who have no area of surface wear. A review of the history of arthritis treatments reveals many seemingly promising techniques that were abandoned because they didn’t work out. Before choosing arthroscopy or telescopic operations, patients are wise to seek a second opinion.
Regarding Hips with Arthritis
By and large, hip replacements have provided good service and relief to hundreds of thousands of Americans over the last half century. Some of the changes to the basic hip replacement have made the operation safer and more reliable for younger, heavier and more active individuals.
Still, patients must choose from a confusing list of treatment possibilities, with issues that are more complicated than those associated with knee arthritis. By seeking guidance from an experienced orthopedic surgeon, patients can ensure that the hip replacement procedure they decide upon is the safest and best for them.
There are certain generally accepted facts or principles that can be combined to form broad general rules about hip replacement. First, a modern basic hip replacement should last a moderately active, not terribly overweight individual 20 years or even longer in those who reach extreme old age. Longevity of the “new hip” is ensured by the use of a metal ball and stem that are allowed to move freely under normal muscle control inside a plastic-like liner.
For younger, heavier or more active patients, various possible substitutes for the metal-on-plastic moving surfaces have been tried. Ceramic against plastic seems to be the most promising, but it is not yet considered a perfected solution.
Since the inception of hip replacements in the 1960s, various surgical approaches have been utilized seeking the safest results, best functional outcome and fastest recovery for the patient. To date, there is no clear cut winner, and each technique has its benefits and drawbacks in the short and long term.
While not common, problems that are possible in the short term include fracture of the thigh bone, infection of the tissues, blood clots and extended hospitalization. Possible longer term issues include dislocation of the ball from the socket caused by sitting on low seats, permanent weakness of the hip and/or limb, and numbness of the outer thigh. There may be a delay in being able to return to driving and work.
An experienced and careful surgeon is the single most important factor in improving or maximizing the outcome of each technique.
Surprisingly, of the 2,000 - 3,000 hip replacements done in the USA each year, the vast majority are implanted by surgeons who replace fewer than 18 hips per year. Patients should ask prospective surgeons about their experience. Remember that no single technique or approach is suitable for every patient, nor is one clearly better than all others.
Today, new joints are possible for people of all ages, including active athletes, heavier individuals and those with health problems. They can all seek treatment for their damaged and worn joints and be helped with reliability, minimal down-time and implants that last longer than ever before.
J. Robert Seebacher, MD earned his Medical Degree at Georgetown University School of Medicine. He performed an internship in general surgery at Mount Sinai Medical Center, a residency in orthopedics at Hospital for Special Surgery and a fellowship in pediatric orthopedics at Hospital for Sick Children in Canada. Dr. Seebacher is board certified in orthopedic surgery and has performed more than three thousand hip and knee replacements at Phelps Memorial Hospital Center. Partnering with Phelps and his own partners and colleagues, Dr. Seebacher is committed to offering treatment that meets the unique needs of each of his patients. His office is located in Hawthorne (914-631-7777).