Better Material Make Earlier Hip & knee Replacement possible

I've had two operations on my right knee, the last to replace the knee in 1980 - a 23 year old prothesis. Next week, my 47 year old son will have his third surgery on his right knee to remove torn cartilege. It's an attempt to save his knee until he is old enough to safely have the knee replaced. ---BumbleBeeBoogie

URL: http://www.abqjournal.com/health/90840health09-29-03.htm
Monday, September 29, 2003
Better Materials Make Earlier Hip Replacement More Practical
By Jackie Jadrnak - Albuquerque Journal Staff Writer

It may sound like an advertising cliché, but Nina Ashley really would like to go to Disney World after her hip replacement surgery.
Marmi Barron simply savors the thought of a life without pain. "I'm just looking to take my life back?- and have a life," she said.
The two are in the vanguard of baby boomers who are facing longer lives with deteriorating joints. But while people in the past were urged to put off hip replacement surgery for as long as possible, new materials are making it practical to transplant hips at younger ages.
"Doctors wouldn't do them (for younger patients) because they would need two or three replacements," said Dr. Keith Harvie, an orthopedic surgeon in Albuquerque. "Now, you can do it when someone is 45, and it may last for 40 years."
In the standard hip replacements, a metal pin and ball put into the thigh bone end up rubbing against a plastic liner in a metal cup nestled into the pelvic bone. The friction shaves off small particles that create irritation in tissues around the joint, he said. In turn, the irritation creates enzymes that, over time, destroy the connections between the artificial joint and bone.
Overall, doctors expect those replacements to last 15 to 25 years, Harvie said.
Dr. Alan Altman, another orthopedic surgeon in Albuquerque, said he sees those joints last only 10 to 15 years in an older person and seven to 10 years in a younger, more active one.
One of the newest models, which has a ceramic ball rubbing against a ceramic cup in the hip, is expected to last at least 25 years, and perhaps as many as 40, Harvie said. That contact creates 10,000 times fewer of those tiny wear particles than the model with plastic, he said.
Both Albuquerque women?- Ashley, 59, and Barron, 52?- had the ceramic model implanted recently.
Altman, who did both surgeries, said the artificial joint should last a lifetime. "It's primarily indicated for younger, active individuals. "I may use it in an active individual who is 65 or 70."
The drawback is that it costs more than the standard hip hardware: $4,800 compared to $2,800, according to Harvie. That's why the older model is still often used in older people.
Because the ceramic model causes less wear, surgeons can choose one with a bigger ball, which gives a better range of motion with less chance for dislocation, Altman said.
Other treatments can be tried before surgery. Some people may feel better if they limit their activity, lose weight, use walking aids (a cane or walker, for instance), and take anti-inflammatory drugs, he said. "When all else fails, hip replacement is a very satisfying option," Altman said.
He doesn't have to convince Barron. She's almost giddy with the fact that she no longer has pain in either hip?- she had her other hip replaced in 2001.
"The pain was incredible," she said of the effects of osteoarthritis. "It was at the point where I didn't have anything resembling a hip joint?- it was bone on bone."
Barron said she always has been active. Although she had to give away her skis and in-line skates, her new hips will allow her to resume walking and hiking.
Barron, a legal assistant, feels as if she is getting her life back. "I'm so happy, so excited about it," she said. "This whole veil has just lifted from me."
Ashley said osteoarthritis meant climbing the stairs in her two-story home was a struggle?- her husband, Bob, put a chair on the landing so she could rest half-way up.
The two are retired and enjoy traveling, but Ashley said her hip problems limited how much she could walk. Giving herself a pedicure, fixing dinner, even putting on her underwear became difficult.
She was telling her story just before her surgery at Presbyterian Kaseman Hospital earlier this month. Altman had written a black "yes" on her left hip?- a safety measure to make sure the doctor replaced the correct one.
By 3:40 p.m., she was in the operating room with a spinal block to eliminate the pain, as well as drugs to keep her drifting in and out of sleep. The surgical team rolled her onto her side, braced her into position, slathered her leg with antiseptic, and draped her with sheets and blankets so that only her hip and the immediate area were exposed.
Altman and Jan Baca, his surgical assistant and nurse, had scrubbed and been covered in gowns and hoods. A few minutes before 4 p.m., Altman made the first cut.
The incision wasn't much longer than the span of a hand. The surgery has been refined in recent years to reduce the cut from 6 inches or more down to 3 or 4 inches. Patients lose less blood and recover more quickly, Altman said.
In describing the implantation of the artificial hip, he often used the word "carpentry." The operating table edged by two long tables was crowded with various sizes and shapes of metal tools.
Nine minutes after he made the incision, Altman took the toothed blade of a power saw and cut off the head of Ashley's thigh bone. He used drills with round, ridged heads to shape the spot in the pelvis for the metal, ceramic-lined cup that would hold the new joint. He used a wooden mallet to pound materials into place, using models of the artificial pieces to make sure which size would work the best.
By 4:45 p.m., all the pieces were in place and Altman soon started sewing the wound shut, with stitches pulling the tissue together in three layers. By 5:10 p.m., he had taken the final stitch and stripped off his gown and hood. Ashley blinked dazedly from under the drapings.
Ashley expects to use a walker for four to six weeks after the surgery, putting only 50 percent of the normal amount of weight on her left leg. Within four to six months, she may be back to normal.
Hip replacement patients are told not to do activities that involve running or jumping, Altman said.
Ashley said she would just like to get back to her treadmill, some aerobics and Pilates.
She and her husband are looking forward to going to Disney World and Epcot Center, as well as Hawaii, where they have a time-share, and Newport, R.I., to explore the mansions.

Copyright 2003 Albuquerque Journal