Friday Health Focus: Joint Replacement May Ease Pain, Improve Mobility

By Susan Bush
12:00AM / Friday, May 19, 2006

Dr. James Whittum described a replacement hip joint during a May 12 interview.

Some folks are made of flesh, bone, and muscle, others may add metals such as titanium to the mix.

In fact, a variety of man-made materials may be part of a person's physical make-up, thanks to the growing popularity of joint replacement surgery.

Out With The Old, In With The New

Hips, knees, ankles and shoulders may be replaced, with knee and hip replacement the most common procedures. Since the late 1960s, millions of people have had the surgeries. According to information available at w www.jointreplacement.com Internet web site, between 180,000 and 220,000 will seek knee replacement surgery this year while about the same number will undergo hip replacement intervention.

Replacement joints may be recommended when conditions such as osteoarthritis, rheumatoid arthritis, and trauma-related arthritis, which is caused by injury to a joint, create problems.

Osteoarthritis, for instance, can erode joint cartilage to the point that bone rubs bone and causes much pain. Rheumatoid arthritis leads the immune system to launch a chemical assault on joints and cartilage. Painful swelling, joint damage, and loss of mobility may result. In many situations, normal body motions such as walking, putting on shoes and socks, entering and exiting vehicles or bathtubs, and navigating stairs becomes extremely challenging. For many people who deal with these conditions, simple, everyday activities are restricted by pain and mobility limits.

Good Success Rate

One type of replacement knee joint

Northern Berkshire residents are among those looking for the pain relief new joints can bring. Orthopaedic Associates of Northern Berkshire surgeon Dr. James Whittum tackled 50 knee replacements and 20 hip replacements in 2005 and medical practice associate associate Dr. Suk Namkoong handled 10 knee replacement and 20 hip replacement surgeries during the same time period, Whittum said during a May 12 interview. Dr. Eric White is an orthopaedic surgeon with the practice; all three physicians handle hip, knee and shoulder replacement surgeries.

The success rate of knee and hip replacement, defined by a complete recovery and most normal activities resumed, is impressive. Those who undergo hip replacement seem to fare a bit better than those who acquire new knee joints, Whittum said.

"Hips have a 95 to 97 percent success, with people saying 'I'd have the other hip done,'" Whittum said. "And with knees, it's a little less than that."

One reason for the slight difference could be that adjusting to a new hip may be easier than "working" a new knee joint; the hip joint moves almost exclusively in a back and forth motion when walking, while knees are expected to function with a broader motion range.

Sometimes, Older Is Better

In most cases, hips and knees are replaced in people who are in their 60s or 70s, but the age of interest in the surgeries is shifting to younger populations, said White.

"[The age] is creeping down," he said.

But joint replacement may not be the best first line of action for younger folks, White and Whittum agreed.

For example, a 45-year-old male with joint pain who works in a physically demanding occupation and isn't expected to retire or change careers may not be a good candidate for joint replacement, White said. While new joints are quite sturdy and may be expected to last up to 20 years, the physical "pounding" generated by forceful repeated motions, such as hammering, climbing, and similar tasks can prove detrimental to new joints. For those who enjoy high-impact sports, such as running or skiing, joint replacement probably means giving up those activities.

"Running too much does not wreck your [natural] knees," White said. "If you do have an injury and need some [joint replacement] surgery, then high impact isn't for you."

Swimming or walking could replace high impact activities, he said, but noted that there are people who tell their doctors that they do not want to alter a high-impact lifestyle.

"It happens all the time," he said.

Dr. Eric White

There are alternative, non-surgical treatments that may better suit those people, Whittum and White said. Those options should be discussed with a physician.

And Sometimes, Younger Is OK

But in some cases, younger people are excellent candidates for joint replacement surgery.

People affected with joint-damaging conditions such as lupus, those who have sustained significant sports injuries and those who deal with congenital issues may find joint replacement is exactly right for them. White noted a "20-something" female patient affected with lupus who experienced dual knee replacement and Whittum said that younger people have had hip replacement surgeries.

Getting Physical

Obesity can cause joint deterioration, which in turn can generate significant pain levels. The situation often brings about a "catch-22" scenario, said White, who noted that weight loss could ease the joint pain. But successful weight loss usually means exercise, and those with painful, damaged joints may be unwilling or unable to do so.

Physical rehabilitation is key to the success of all joint replacement surgeries and must be part of recovery, White and Whittum said.

"Rehab is definitely important," Whittum said. "You can't expect anything is going to magically get better without the rehab."

Some Cautions And Concerns

Those with new joints must advise their dentist prior to undergoing any dental procedures. Both the American Dental Association and the American Academy of Orthopaedic Surgeons concur that for the first two years after joint replacement surgery, people undergoing dental procedures may need to follow a preventive antibiotic therapy prior to the work.

There are other medical conditions which may require antibiotic treatment prior to dental work. Anyone with a diagnosed medical condition should advise their dentists prior to beginning dental treatments or therapies.

Joint replacement surgery is not without risk and as with any surgery, complications may arise. Anyone contemplating surgery is strongly advised to discuss the procedure thoroughly with their physician and/or surgeon.

While there are numerous treatments and therapies that may help reduce joint pain and improve mobility, and while many people report much pain relief after recovering from joint replacement surgery, people should be aware that existing interventions do not restore joints to a completely unaffected state.

"Everybody is looking for the Holy Grail [for joint repair]," Whittum said. "That is what everyone is looking for."

Additional information about joint replacement is available at a www.kneereplacement.com , www.hipreplacement.com , www.globalshoulder.com , www.agilityankle.com , and www.aaos.org Internet web sites.

Susan Bush may be contacted via e-mail at suebush@iberkshires.com or at 802-823-9367.