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Mon, June 24

Joint replacement can give patients with pain a new lease on life<BR>

Osteoarthritis can occur from years of normal use, and Lane said it happens when "the cartilage that covers the bone wears, and then it's bone rubbing on bone."

According to a pamphlet about joint replacement, "when one or more parts of the knee are damaged, joint movement suffers. Over time, cartilage starts to crack or wear away. Because cartilage cannot fully repair itself, the damage may keep increasing. At first, your knee may just be a little stiff. But as the bones of the joint begin rubbing together, you're likely to feel pain."

Mardy Taylor, chief nursing officer at Yavapai Regional Medical Center, said the surgery team's job is to make a patient's experience as easy as possible.

"The before, during and after are all important in their own entity. They need to fit together," Taylor said.

Before the surgery, according to operating room scrub technician Mardi Kellerman, the patient washes the area doctors will operate on with a special anti-microbial soap. The nurses wash the area again upon the patient's arrival at the hospital.

"We do a lot of washing that leg," Kellerman said.

Charge nurse Lynda Hunt said the nurses then apply an iodine-based sticky prep to the area, which creates a semi-permanent barrier against bacteria.

"It stays on the skin and prevents build-up of bacteria around the incision," she said.

During a knee replacement surgery, Lane said he "takes away the diseased joint surfaces (with saws and templates) and replaces them with a new joint surface."

Typically, the new knee is made of titanium, nylon and chrome.

Immediately after the surgery, nurses place the patient in recovery. Hunt explained that the patient takes part in "passive therapy," where machines move the knees before patients can do it themselves, in order to begin therapy right away.

Osteoarthritis represents one type of damaged joints, and others include injury and inflammatory arthritis, which Lane said is the least common cause of joint pain.

"Inflammatory arthritis is an auto-immune disease where the body creates antibodies that basically turn you against your own joints," he said.

One of the two most important ways to keep joints healthy include regular diet and exercise. Lane said that "being overweight adds force to the joint and can accelerate the degenerative process."

Also, eating healthy "is good for you if you have arthritis," and he suggests eating fruits and vegetables, such as cabbage, blueberries, soy products and whole grain foods.

"In America, 65 percent of Americans are obese," he added. "No wonder we have so many arthritic problems. We eat too much and too much of the wrong things. The American lifestyle is the biggest enemy to arthritic joints."

The more people exercise throughout their life, the less likely they will be to have arthritic joints, Lane said.

"Our joints were designed to move, and if we don't move they start falling apart. They're healthy when they move. We're not designed to sit on the couch and eat potato chips. People need to start thinking about their bodies."

While having a total knee or hip replacement surgery is a definite option to correct joint pain, Lane said there are many alternatives a patient should try before resorting to surgery.

"People shouldn't have a knee or hip replacement unless they're suffering so much pain," Lane said. But "if a person has pain at night, can't walk well anymore and has failed all other treatments," then they should consider surgery.

One alternative to total joint replacement surgery is a "natural building block of cartilage," called Hyaluronate, that is injected into the knee. "It relieves the symptoms for eight to 12 months."

Others include cortisone injections and non-steroidal anti-inflammatory drugs (NSAIDs). Still, the best prevention method for a person, Lane said, is to take care of themselves through eating healthy, watching their weight and exercising.

"You can't do anything (to stop deteriorating joints), but you can control the symptoms," Lane said. "You can do something to make the pain go away and prolong knee replacement surgery."

There are a few possible risk factors for total joint replacement surgery, including developing blood clots, developing pneumonia, getting fractures around the joints and the actual prosthesis wearing out.

"The prosthesis is like any other machined joint," he said. "The parts can become loose."

However, the new part will usually last between 15 and 20 years "with normal activity."

If a person "has tried everything you can and you're still having significant pain, the surgery is your best alternative because the results are so good in a person who needs it. It eliminates the pain."

One of Lane's patients was a 90-year-old woman who was in a wheelchair, and after having total knee replacement surgery, Lane said she could walk again.

"To me, that's almost a miracle," he added. The surgery gives people "a whole new lease on life. They have stable knees, they can exercise and concentrate better."

If a person has one joint replaced, Lane said surgery lasts about an hour and a half, and about four hours for a person who has two joints replaced. The patient, in either case, usually is able to get up and walk with a walker a day or two later.

After about three months, the patient can walk without a cane or walker, and they usually attend physical therapy after a surgery. Patients typically spend about three to five days in the hospital doing therapy exercises, and then receive either home health care or therapy from an outpatient facility.

Lane said some people choose to have joint replacement surgery in order to "take out a new lease on life. You can do things you couldn't do before. You're doing this to improve the quality of your life."

Taylor concurred.

"Usually patients say they feel so much better. They're in a lot less pain and they're able to go back to their activities and daily living, which they weren't able to do prior to surgery," she said.

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