Osteoarthritis by definition is loss of cartilage within a joint. The sequelae of this occurrence are progressive development of bone spurs and cysts, which further the symptoms of degeneration. Once bone-on-bone arthritis has set-in, there are no treatments to date that can restore lost cartilage and the lost joint space.
Hip Arthroscopy Indications
Hip arthroscopy was first performed in 1931, but its utility has been limited until recent advances in optics and instrumentation. Over the past decade or so, there has been a rapid increase in the proposed indications, and subsequently, in the number of providers offering this service.
The concern with dental work after joint replacement is a possibility of inducing infection. Bacteria from your mouth can enter your blood stream and settle onto your implant. Approximately 6-13% of total joint infections involve bacteria primarily found in your mouth. The highest rate of infection is within the first 2 years after surgery. While this does not directly mean that bacteria from the mouth cause joint infections, the association is strong and concerning if you happen to be unlucky!
In 2003, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) first published guidelines regarding antibiotic use for dental procedures following hip and knee replacement. These recommendations have been addressed twice by this joint panel since that time, with the latest publication in 2012 suggesting that the data is not strongly for or against antibiotics before dental work. Ultimately, the decision to use antibiotics for dental procedures should be made with consideration of each patient’s health and surgery.
When do we recommend antibiotics?
Last week, Tiger Woods was pulled over for driving under the influence…of opioid medications. He is not an IV drug user and he was not drunk behind the wheel. Instead, his judgement was clouded, at least in part, by very strong pain medications. His picture was plastered over every major news outlet, and for better or worse, he is becoming today’s face for an epidemic.
A 2016 Washington Post/Kaiser Family Foundation survey found that 1 in 3 patients who took opioids for at least two months reported feeling addicted or dependent on the drugs. In addition, patients taking opioids prior to surgery have greater post-surgical pain, and face a higher risk of pneumonia, over-sedation and even death. It is not uncommon to have post-surgical patients report they felt symptoms of “withdrawal” after they stopped taking their pain medications only a few weeks following surgery.
According to the U.S. Department of Health and Human Services, more people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid. Since 1999, the rate of overdose deaths involving opioids (including prescription pain relievers and heroin) nearly quadrupled. On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed, 3,900 people initiate nonmedical use of prescription opioids, and 78 people die from an opioid-related overdose. According to the CDC, in 2015 alone, more than 22,000 people died from prescription opioid overdoses, and countless more have had their lives influenced by dependence.
What is Metal Sensitivity?
Metal sensitivity (or metal hypersensitivity) is an allergic reaction triggered by the body’s immune system. Unlike the clear and immediate reaction one might experience to pollen and dust, allergies to metal present in a more delayed fashion. Basically, your body develops a negative memory regarding a specific antigen (i.e. metal) and overreacts when that metal shows up again. It’s not usually an immediate response like a bee sting, but rather, it can take several days or more before the signs begin to appear.
A common question we as surgeons, and you as the consumer, are faced with is: “How long will my hip replacement last?” It’s easy to rattle off a number, but the reality is not so cut-and-dry.
According to CDC data, in 2010 alone >310,000 hip replacements were performed in patients age 45 and older. Recent projections expect that number may reach almost 600,000 by 2030. We are seeing a significant increase in hip replacements for younger patients. From 2000-2010, the population with the largest volume increase was age 45-54. Additionally, by 2010, hip replacements in patients age 55-64 accounted for a higher percentage than those >75.
SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000 and 2010.
In the past few years, there has been a debate among physicians and patients regarding the “optimal” approach for hip replacement. If fact, considerable marketing has been deployed to attract patients to a surgical approach, citing rapid recovery, minimal or no pain, muscle-sparing exposure, and return to unrestricted activity. The frank reality is that these outcomes are possible with almost any of the common approaches today. The American Academy of Hip and Knee Surgeons (AAHKS), which is the largest collection of fellowship-trained specialists in total joint replacement, has concluded that “the best approach is the one your doctor is most comfortable with to allow safe and precise implantation of your hip replacement components.” As a patient, you should choose the surgeon and trust on their decision regarding the approach.