AMHE Newsletter spring 2020 april 27 Haitian Medical Association Abroad Association Medicale Haïtienne à l'Étranger Newsletter # 276 AMHE NEWSLETTER Editor in Chief: Maxime J-M Coles, MD Editorial Board: Rony Jean Mary, MD Reynald Altema, MD Technical Adviser: Jacques Arpin The Longevity of a Total Hip Replacement Maxime Coles MD In this number - Words of the Editor, Maxime Coles,MD - You need to know the difference in symptoms: - La chronique de Rony Jean-Mary,M.D. - From The New York Times: - La chronique de Reynald Altéma,M.D. - Décès - Chronicle of Slave rebellions in the Americas. - And more... 2 In face of a patient presenting with a painful hip other causing stiffness and later pain and joint enabling him to ambulate and forcing the inability to bear weight and ambulate. use of external supports or a wheelchair, one 2- Autoimmune diseases like Rheumatoid can understand how daily living activities can arthritis in which the synovial membrane affect life. The hip become stiff and painful become diseased, inflamed or thickened, rendering any task requesting mobility, difficult. damaging the cartilage in allowing a loss The individual contemplating such procedure of joint surface. This kind of process often report difficulties in wearing socks represents a group of disorders called because of inability to cross their legs. Medications which have in the past relieved the inflammatory arthritis. symptoms, ceased to benefit the patient. A hip 3- Injuries to the hip joint following a replacement become the best option to restore traumatic event like a fracture dislocation, functionality. can damage the articular cartilage of the Anecdotally, the first total hip replacement was hip joint and lead to stiffness, pain and performed in the mid-20th century. This is a loss of motion. The blood supply to the successful procedure which over the years has femoral head can become deficient after allowed us to perfect the way of approaching the the dislocation limiting the blood supply joint to minimize the destruction of the anatomy to the femoral head and causing an and to restore the function. Improvements in the Avascular Necrosis. With time, the techniques and technology have greatly increase avascular portion of the femoral head the effectiveness of the hip joint. The Agency collapse resulting in arthritis. Many for Health Research and Quality reports more than 300,000 total hip reconstructions by total diseases like sickle cell and other hip replacement each year are performed in the hemoglobinopaties, like Gaucher’s United States of America. disease can present with the same lack of The hip joint is the largest joint of the human blood supply to the femoral head. We body. It consists in a ball-and-socket articulation have seen this complication in IV drug where the ball represents the head of the femur abusers and infections around the hip joint and the socket being a part of the pelvic bone as well. called acetabulum. An articulate cartilage 4- Many pathologies during infanthood or covered the joint surface allowing a smooth adolescence can also present with such motion. The joint is enveloped by a synovial problem. Kids with Developmental Hip membrane responsible for the lubrication of the Dysplasia called in the past Congenital joint eliminating any friction during motion. A hip dysplasia have shown a loss of massive musculature supported by ligaments is congruity at the hip joint leading to re-enforcing the capsule of the joint. The most common cause of pain and disability degenerative process. Slipped capital in a hip joint is degenerative arthritis. Many femoral epiphysis will also present with arthritic process due to osteoarthritis, Traumatic stiffness and loss of range of motion but arthritis or rheumatoid arthritis can involve this with time, osteoarthritis and chondrolysis joint and interfere with the range of motion: may set in. 1- Osteoarthritis is the becoming of all joint with time. It is aged-related and The Total Hip Replacement consists in the represents the “tear and wear” of the removal of damaged cartilage and bone joint. Any patient older than 50 years of including the femoral head with their age or older will manifest pain or replacement by prosthetic components. stiffness in relation to this type of They are replaced by a metallic stem inserted into the medullary canal of the arthritis. Some may develop the proximal femur. This stem can be degeneration earlier than others because cemented in people with poor bone stock of familial predispositions. The cushion or pressed fitted in younger individuals provided by the cartilage wears away with healthy bone. The orthopedic allowing the bones to rub against each surgeon will have also the choice to 3 replace the head with a metallic or the expected changes. In discussing with ceramic head over the tip of the his/her patient, expectation for daily component. The damaged cartilage of living activities should be raised. the acetabulum (socket) is also grounded - One has to understand that material used out and replaced with another metallic in the components are subject to wear. component which can be stabilized with So patient’s weight needs to be discussed cement, or screws alone. A spacer is then with exercises programs to minimize inserted into the socket to fit the femoral wear and loosening of the components. metallic head. This spacer can be of This can be manifested by a painful joint plastic, ceramic or metallic forming a replacement. Avoidance of high impact smooth gliding surface. activities such as jogging, jumping, hiking and even dancing is strongly When a surgical option is finally chosen suggested. by a patient to become a recipient of a Total Hip Replacement, it will require a - A dental evaluation to minimize cooperative effort between the patient bacteremia from any infection is and his family, the primary care recommended. If needed, the dental physician and the orthopedic surgeon. procedures should be carried prior to the Many factors will be analyzed during a planned replacement. Even routine consultation once a patient is ready for cleaning procedure should be delayed to the replacement: decrease any risk. - Urinary problems like an inflamed - Pain and disability rather than age prostate, should be resolved prior to any should be considered. We believe that 50 surgical treatment. Infections anywhere to 80 years of age-group have been in the body need to be treated. considered as typical ages for a hip replacement but recipient should be - Proper social planning with home chosen on an individual basis. Total joint therapy will be arranged at discharge arthroplasty has been performed from the hospital, after a short stay in successfully on teenagers and elderly hospital first and maybe also a stay in an who have demonstrated pain with every extended care facility providing help day activities, unrelieved by anti- with cooking, bathing, laundry etc. inflammatory medication. Often, Proper equipment will be also delivered stiffness and inability to ambulate after at home like high toilet seat, pillow, failed attempts at rehabilitation and dressing etc. ambulation with external support. Radiologic images may show extensive It is important also for the one who become a damage or deformity to the hip joint. recipient of a Total Hip Replacement to know Occasionally an MRI or a CT scan study about the possibility of failure of the component may be needed to determine the quality of the prosthetic device through different of the bone stock. processes like dislocation, infection, fracture, Other considerations for an evaluation prior mechanical failure with wear of polyethylene, to such procedure, should include: breakage or loosening in the cement fixation etc. Infections are seen in less than 2% of Total hip - The orthopedic consultant to decide replacements. Blood clots are common whether a hip replacement surgery is the complications especially in the pelvic veins and best method to relieve the pain and can be life-threatening. Prophylaxis with improve the mobility. He will need to anticoagulation therapy and sequential explain the potential risks and compressive devices or ankle pump will complications of such procedure in facilitate the vascular flow. Early mobilization is opening a true dialogue with the patient. always enforced with precautions when sitting, The more the patient know, the better bending and even sleeping. One has always to he/she will be able to accept and manage discuss those eventualities and the life 4 expectancy of such procedure. The conception that all hip replacements provide a normal pain- Failure in arthroplasty can be measured in free function for the remaining of their life many ways and patients who report failure in needs to be discouraged fully. A recipient one setting may also report success in another. should be also told about the possibility of a Revision surgery has an uncertain outcome leg-length discrepancy. seeing patients and clinicians deciding on the risks and benefits. We need to remember that Studies in the United Kingdom in 2014 have the goal for the revision surgery is as well to advertised Hip replacement were for people relieve pain. Studies have shown that less than with advanced degenerative arthritis and then a 20% of such patients in need of a revision revision was expected in the next 10 years. have not taken the choice. Women were found Nowadays, it is difficult to hear about the to have better construct survivorship at all ages longevity of a revised hip replacement’s than men. Data contributing to a 15-year surgery. The new hip replacement may activate survival are also available from the Australian metal detectors at the airports security stand and and Finnish Registries. a special identification card confirming the existence of an artificial hip, is generally To all who ask so often the pro’s and the cons provided.