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4 A SPECIAL ADVERTISING SECTION OF BALTIMORE SUN MEDIA GROUP • WEDNESDAY,SEPTEMBER 20, 2017

JOINT REPLACEMENT

Casing the When is it necessary to have ?

By Margit B. Weisgal, Contributing Writer

hen the Advil and the Chardonnay stop working, it’s time to have your answers, “The general rule is once you’re identified as having , hip replaced,” says J.M. Wolfe, an avid tennis player, four years after his loss or pain with motions, we stick with non-surgical treatments as long as pos- “W surgery. “For two years, I literally had to lift my leg into the car to drive. sible. When you cry, ‘Uncle!’ we plan your surgery.” My X-rays showed on bone, and it had atrophied. Having the surgery was a great relief.” Manson adds, “Consider surgery If you ask around, you’ll find lots of no reason to even think about surgery. when the pain begins to change your people who have had a joint replaced and, And since it’s elective, we make sure life, especially for those who have left sometimes, two or more. Over seven mil- you’re as healthy as possible before their homes, can’t do steps, become lion people are living with artificial operating so that your outcome will be as reclusive, have pain that wakes them and hips with an expected increase of 188 good as possible.” up and are dependent on devices (a Healing is percent in replacements and 123 Marc W. Hungerford, M.D., chief of cane or walker) to get around. Then, percent in hip replacements for patients orthopedics at Mercy Medical Center, surgery is needed to improve the qual- a matter of age 45-64, according to research pre- concurs. “Symptoms can be managed ity of life.” time, but it is sented at the 2014 Annual Meeting of using anti-inflammatories, exercise, For those with hip problems, the first the American Academy of Orthopaedic braces, canes and/or hint of an issue will sometimes feel like sometimes also Surgeons (AAOS: www.aaos.org). “There (PT). Then we move on to corticosteroid a pulled muscle that doesn’t heal or the a matter of are roughly one and a half times as many shots to control pain and delay surgery. pain doesn’t go away, or you’re having people living with a hip or knee replace- Patients think we’re stalling, but medi- trouble walking. With your knees, there’s opportunity. ment in the United States as people living cations are the least risky despite the some pain when you’re walking or using —Hippocrates with heart failure,” the research states. high success rate of joint replacement stairs. Prospective patients will go one of Surgery is not the first option, though, .” several different routes to identify their if you have pain in your knee or hip. The question most people ask is, problem. Theodore Manson, M.D., associate pro- “When do you have the surgery?” Robert Some start with a visit to their internist fessor of orthopaedics at the University of Sterling, M.D., director, adult hip and to assess pain. Some go directly, or are Maryland Medical Center, says, “Always knee replacement fellowship and asso- referred by their primary care doctor, to start with conservative treatments. As ciate professor of orthopaedic surgery long as you can control the pain, there’s at Johns Hopkins School of Medicine, Joint continued on page 20 20 A SPECIAL ADVERTISING SECTION OF BALTIMORE SUN MEDIA GROUP • WEDNESDAY,SEPTEMBER 20, 2017

Joint from page 4

an orthopedist, a physician specializing in “injuries and diseases of your body’s musculoskeletal system,” explains the AAOS. “This complex system includes your , , ligaments, tendons, muscles and nerves, and allows you to move, work and be active.” Another referral source is a rheuma- tologist, a physician who receives further training in the diagnosis and treatment of musculoskeletal disease and sys- temic autoimmune conditions commonly referred to as rheumatic diseases. These diseases, such as rheumatism and arthri- tis, can affect the joints, muscles and bones causing pain, swelling, stiffness Theodore Manson, M.D., Marc W. Hungerford, M.D., Robert Sterling, M.D., director, adult hip and and deformity. associate professor of orthopaedics at the chief of orthopedics at Mercy knee replacement fellowship and associate Others see a physiatrist, defined by the University of Maryland Medical Center Medical Center professor of orthopaedic surgery at American Academy of Physical Medicine Johns Hopkins School of Medicine and Rehabilitation (www.aapmr.org) as a “Physical Medicine and Rehabilitation (PM&R) physician, who treats a wide vari- ing physical and occupational therapy, hip and knee. And I was determined. OK, as possible. You should figure that it ety of medical conditions affecting the so you’re completely prepared. Those stubborn. So now I’m back to playing will take around six months to be fully brain, spinal cord, nerves, bones, joints, who take the class are more engaged, singles as I did before.” healed.” ligaments, muscles and tendons.” The more mentally prepared and have more The length of your hospital stay is “You get out of rehab what you put AAPMR recommends seeing a physiat- reasonable expectations. This mitigates dependent on your surgeon and the into it,” says Wolfe. “I did it religiously. rist to assess a chronic condition, limited fear and anxiety, which drives pain. We hospital in which you have the surgery. My therapist would tell me to ‘move your function, diminished energy, ability to discuss what they’ll be able to do – and Contingent on whether you have a partial leg a half inch’ and ‘that’s really good.’ move easily or chronic pain from arthritis. what they can’t. After all, we’re not replacement or a complete one, your Baloney. It took a long time to get better.” Normally, an X-ray will be taken to help implanting a time machine. It’s what is surgery may be done as an outpatient “The average age for a joint replace- with a diagnosis. The National Institute of best for each individual.” surgery. The norm is two to three days, ment is 64,” says Hungerford. “With Arthritis and Musculoskeletal and Skin These reviews (check out the Joint although 60 percent go home the day some chronic diseases, like arthritis, you Diseases (NIAMS: www.niams.nih.gov), Journey Program at Mercy) include after surgery. Manson says his patients can’t get rid of them. Once you have a part of the National Institutes of Health, everything from what you can do before must be able to walk stairs before they replacement, you get your life back. The describes why you may need to have a the surgery, what happens during the are released. younger a person is – and that’s anyone joint replaced. “Joints can be damaged surgery, the type of anesthesia (spinal After you leave the hospital, you usu- my age or less – the more varied the by arthritis and other diseases, injuries versus general), time in the recovery ally go home, but a small percentage of expectations. A 40-year-old will probably or other causes. Arthritis or simply years room and the post-operative procedures patients go to a rehabilitation facility that need a second replacement. Once you’re of use may cause the joint to wear away. and expectations. Physical therapists will includes PT to recover. You will need to past 60, you can expect your prosthesis This can cause pain, stiffness and swell- actually work with patients the same day manage your pain, manage swelling and to last as long as you do, but you’ll prob- ing. Diseases and damage inside a joint they have the replacement, getting them keep moving, using a cane or walker ably not be able to play basketball.” can limit blood flow, causing problems moving immediately. at first. Ideally, you’ll have someone to Does it matter what type of new in the bones, which need blood to be “But, says Manson, “There are times help you with meals, but many patients joint you get? “The variances in differ- healthy, grow and repair themselves,” the when you shouldn’t have surgery. If prepare food prior to surgery and freeze ent prostheses are not that great,” says organization states on its website. you’re ill, if you have medical conditions it so they can manage on their own. And, Manson. “It’s usually whatever the sur- Any of these doctors can treat you like heart disease and diabetes, or even being home, you heal better and are geon prefers. The materials we use today up to the point when you need a joint infections, these need to be optimized exposed to fewer pathogens. – they include titanium, high-strength replacement. Then you need an ortho- prior to surgery because they can cause “Everyone is different, and every- plastic, ceramics and combined cobalt pedic surgeon. Once you’re identified as complications. And the healthier you are one heals differently,” says Sterling. and chrome – are far better than those a candidate, the surgeon will begin the beforehand, the better your outcome and “Hips usually recover faster than knees. from just 20 years ago and only deterio- pre-operative screening process. recovery.” Healthier, fitter patients are capable of rate about one percent a year, so most “That includes a dental check to lower Wolfe, who plays tennis several times doing more, faster. It’s not about age. people won’t need another surgery.” the risk of infection and, for diabetics, a week, laughs about his expectations. That’s just anumber.Your physiolo- How do you choose a surgeon? “The to ensure your sugar in under control,” “I was told playing singles would be out, gy contributes a lot. Those with health ideal surgeon,” says Manson, “is fel- explains Sterling. “Most hospitals and that I would have to play doubles the issues – overweight, high body mass lowship trained, which means he or she surgeons have a class beforehand to rest of my life. But I went into surgery in index (BMI), or heart issues – will take had an additional year of training after inform you about what to expect. We go great physical condition. When you keep longer, but our goal is to get you back residency. A fellow will do more surgeries over what happens afterwards, includ- the pounds off, it’s much easier on the to functionality as quickly and safely than their teachers. And look for some A SPECIAL ADVERTISING SECTION OF BALTIMORE SUN MEDIA GROUP • WEDNESDAY,SEPTEMBER 20, 2017 21 who does replacements primarily.” Interview from page 18 of European History,’ written by New Sterling adds, “There are nine sub- York attorney and amateur anthropolo- specialties in orthopedics. Those with fel- manufacturer provides a third-party writ- gist Madison Grant. Grant was of Puritan lowships in joint replacements have a far “Once you have a ten guarantee that the product is made descent and believed the U.S. was being better understanding of the procedures. under the F. D.A.’s “good manufacturing invaded by inferior (non-Nordic) races, Ask about the scope of the practice and replacement, you get practice” (G.M.P.) conditions, as well as then took eugenics one step further, how long they’ve been doing surgeries. your life back. a Certificate of Analysis (C.O.A.) assuring saying traits such as loyalty, bravery or Get recommendations from your primary that what is written on the label is what’s criminality, could be passed on. Grant care physician and ask friends who did – Marc W. Hungerford, in the bottle.” said, ‘We need to make America America their replacements. This surgery has a M.D., Mercy Medical The impetus for his most recent book, again.’ Sound familiar?” he says. high success rate, over 97 percent, no “Pandora’s Lab,” was an exhibition hosted In 1925, the book was translated into matter whom you go to. Most people Center by the Franklin Institute in Philadelphia, of German. Hitler plagiarized much of it for will have good outcomes, but you want Grande’s 101 Inventions That Changed his opus, “Mein Kampf.” Stefan Kuhl, in ‘outstanding.’” The World. “From the carving of stone tools “Nazi Connection: Eugenics, American Much research is being done in this to the birth of the internet, 101 Inventions Racism, and German National Socialism,” area. “Studies of the various forms of That Changed the World chronicles this documented a letter from Hitler to Grant arthritis, the most common reason for tory response to the artificial joint compo- journey. Some inventions were driven by to personally thank him for writing it, refer- joint replacement surgery, are helping nents, and are trying to learn why some necessity, while others were discovered ring to the book as “my Bible.” doctors better understand these dis- types of prostheses are more successful purely by accident, but what they all share Offit is a mixture of curiosity, vision, a eases and develop treatments to stop than others.” is a significant and lasting impact on the desire to improve the lives of his fellow or slow their progression and damage to Wolfe is completely satisfied with his course of history,” according to www.gran- man and staunch ethics. By taking on joints,” says NIAMS. . “Six months later, you’re deexhibitions.com. industries and ill-conceived beliefs that “Scientists are studying replacement a 110 percent better because, before the Two stood out to Offit – gunpowder warrant investigation, he makes us safer joints to find out which are best to surgery, you couldn’t even lift your leg. and atomic energy – but it got him think- and healthier and more aware of the dan- improve movement and flexibility. They It’s so much better now.” His reaction is ing about the reverse – what inventions gers we face. If you’re ever looking for a are also looking at new joint materi- echoed by many people who’ve had a changed the world for the worst. thought provoking read, pick up one of his als and other ways to improve surgery. joint replaced. There is a light at the end “The one that scared me the most was books. We need more champions – more For example, researchers are looking of the tunnel and that’s getting your life a treatise published in 1916, ‘The Passing crusaders – like Paul Offit. With him in the for ways to reduce the body’s inflamma- back to normal. • of the Great Race: or, The Racial Basis world, we are all far better off. •

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