Lots to consider with joints

Medication, activity modification and surgery are options

Published: Sunday, Aug. 10 2008 1:09 a.m. MDT

There's a lot to think about when you're trying to decide if it's time to replace a hip or knee. What an X-ray shows, how active you are, your lifestyle and overall health all have to be part of the equation, according to a pair of orthopedic surgeons from LDS Hospital who staffed the Deseret News/Intermountain Healthcare Hotline on Saturday.

"You need to get in and see a specialist if you're having trouble," said Dr. Kent Samuelson, chairman of the Division of Orthopedic Surgery at LDS Hospital. "You need to get in and get a proper diagnosis. The majority of new patients we see don't need surgery," but can be helped in other ways, including medication and activity modification. "For patients who are surgical candidates — nothing else has worked or will — we discuss the pros and cons."

Samuelson and Dr. Josh Hickman, orthopedic surgeon at the Joint Center at LDS Hospital, answered more than 60 calls during an extraordinarily hectic hotline, which had some callers holding for 10 minutes or more. Callers ranged from their 40s to a 91-year-old woman and came from as far away as Texas and Georgia.

A few callers were experiencing problems after having hip or knee replacement. They wondered if their experience was normal or if there was relief available.

"It's hard to know," Samuelson said. "We have to look and see if it's something with the prosthesis. Usually, it's a need for more therapy."

Both Hickman and Samuelson said that implanting a new hip or knee gets a patient just partway to better. The rest of the journey is theirs and it involves following the rehabilitation plan, keeping up on prescribed exercises and avoiding movements that can injure them.

Even so, a small percentage of patients after five years need the prosthesis revised in another surgery — fewer, quipped Samuelson, than the percentage of luxury autos that need fixing after five years.

Patients who cooperate with their post-surgery treatment plan are less likely to need further help. Often, when he questions patients who are suddenly experiencing pain after years of relief from a replaced joint, Samuelson said he finds the patient has recently decided to stop doing exercises that keep the muscles strong.

Hickman said keeping strength is critical for the health of cartilage. For instance, exercise helps lubricate the knee joint with synovial fluid.

Among nonsurgical treatments are injections of corticosteroids or hyaluronic acid, he said, although the latter is somewhat controversial.

The hotline tackles a different topic the second Saturday of each month.


E-mail: lois@desnews.com

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