Military Officer - August 2007 - (Page 46)

askthedoctor Worn-Out Parts Joints such as knees and hips are critical to mobility. But over time, they can wear out, causing severe pain. Rear Adm. Joyce Johnson, D.O., discusses joint replacement surgery. J Head, Shoulders, Knees, and Toes? ■ More than a half mil- lion knees and hips are replaced annually, with more knees than hips replaced. Other joints — knuckles, ankles, elbows, and shoulders — also can be replaced. oint replacement is called arthroplasty (from the Greek for joint and repair). Chronic pain with decreased mobility is the most common reason to replace a joint. Fractures (especially hip fractures resulting from falls in older people or those with osteoporosis), ligament tears and other trauma, tumors, and diseases causing reduced blood supply to the joint contribute to the need for arthroplasty. The hip is a ball-and-socket joint, with cartilage covering bone surfaces. If the cartilage is damaged and bone rubs directly on bone, severe pain results. Surgically removing the bone and replacing it with a prosthesis reduces pain and helps restore function. Typically both the ball and socket are replaced, but in the case of a fracture often only the ball is replaced. The knee is basically a hinge joint (though with the knee cap and ligaments, it is more mechanically complex). Three parts of the joint can be replaced: the kneecap, the bottom part of the thigh bone, and the top part of the tibia (larger lower leg bone). Surgeons can choose from more than 150 prosthetic styles for knees alone. Prostheses are made of metal (titanium and other alloys), plastic (polyethylene), and ceramic. Hip and knee replacements generally last 15 to 20 years before they might need to be replaced. Technology is continuing to improve both prostheses and the surgical procedures used to insert them. Replacement of a hip or knee joint is major surgery. Patients receive either gen- eral anesthesia or a spinal anesthetic. A surgeon makes an incision in the skin, removes the troublesome bone, and replaces it with a prosthesis. The prosthesis can be glued in place, wedged into existing bone, or inserted so that the patient’s bone will grow around it to ﬁx it in place. Complications from joint replacement surgery are the same as from most other surgeries: infection, blood clots, pneumonia, and anesthetic complications. With hip replacements, there can be a difference in leg length after surgery. Dedicated effort is needed to regain ambulation after surgery. Patients begin physical therapy while they are still in the hospital. Hospitalization generally lasts three to ﬁve days; some patients might need to spend an additional week (or longer) in a rehabilitation facility afterward. Those who were active before surgery tend to recover quickly. Those with signiﬁcant mobility, mentation, or other problems before surgery, especially inﬁrm patients who fall and break a hip, might ﬁnd it difﬁcult to return to independent living afterward. (A fall and fracture often are a signal to family members that someone requires a more structured living environment.) Fortunately, most patients do very well after joint replacement surgery. MO — Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at www .moaa.org/wellness. For submission information, see page 20. PHOTO: STEVE BARRETT 46 MILITARY OFFICER AUGUST 2007 http://www.moaa.org/wellness http://www.moaa.org/wellness

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Military Officer - August 2007 Contents From the Editor From the President Your Views MOAA Directory Rapid Fire Washington Scene Financial Forum Ask the Doctor Chapter Activities Cover Story: No Longer in Reserve A Different Path Weird Science Charge? Pages of History Faces of MOAA Member Books Information Exchange Advertising Index MOAA Calendar MOAA Scholarship Donors Sounding Taps MOAA Member Services Encore

Military Officer - August 2007

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