Articles filed under 'Degenerative'
The artificial hip is indeed a medical miracle, but the joint replacement surgery usually lasts only 20 years or so. Each year about 300,000 Americans undergo hip joint replacement surgery. As younger patients avail themselves of this type of hip surgery, the problem of “outliving” the joint replacement must be faced.
Middle-aged or younger people with hips damaged by disease or injury are often cautioned to put the surgery off as long as possible. In the meantime, many are plagued with pain and disability.
Now, an alternative surgical procedure may make the waiting game a thing of the past. Because extracting and replacing a worn-out or defective artificial hip is difficult, more surgeons are turning to hip resurfacing. Surgeons using this procedure preserve enough of the healthy bone to allow for a future total hip implant when benefits of hip resurfacing wear out.
In the past decade, tens of thousand of patients worldwide have undergone hip resurfacing. Many U.S. “medical tourists” had the procedure done overseas, where doctors are experienced in the technique and costs are lower. Popular destinations are Britain, Belgium or India, where costs may be half what they are in the U.S.
Hip resurfacing surgery is no easier for the patient or physician than hip replacement, and the incision is usually larger than with a total joint replacement. Complete healing can take six months or longer. The advantage is that the patient will still be eligible for a total hip replacement using an entirely new artificial joint rather than having a revision of the old one.
Hip resurfacing and total hip replacements both involve implanting a metal cup in the pelvic socket. The difference is mainly the way each procedure treats the top of the femur, the long thigh bone that fits into the socket. In resurfacing, the femur is shaved to a rounded shape and covered with a metal cap, with a spike that is cemented into a small hole drilled into the center of the femur.
With total hip replacement, surgeons saw off the entire head of the femur and replace it with a larger, hemispherical device that is anchored with a much longer spike and driven deeper into the femur. This procedure leaves too little strong bone to allow for follow-up with an entirely new total hip replacement if this joint wears out.
Hip resurfacing is not minor surgery. It requires a highly skilled surgeon, and the operation usually takes a bit longer than the three or four hours of total hip replacement. In addition, patients lose more blood, although transfusions are rarely needed.
With either procedure, problems can occur, but they are unlikely. Complications that are possible with either surgery include infections or fractures. Since hip resurfacing is so new, we are unlikely to know how durable the resurfaced hips are until the 20-year mark is reached in the earliest patients.
Doctors advise patients, especially younger ones, not to even think about either procedure unless they are in pain every day. Most people won’t want to take on the risks of either type of surgery, and the complications that could arise, just to improve their golf game or to be able to resume jogging.
Source: New York Times
April 16th, 2007
If you’ve ever experienced chronic pain (lasting more than six months), you were probably depressed. Pain and depression can form a vicious cycle, with one fueling the other. When your quality of life takes a big nosedive, you generally get depressed. If a significant disability is also involved, your chances of depression are even greater.
Most physicians who treat patients with chronic pain also treat the depression that usually accompanies it. Your internist may wish to give you a prescription or refer you to a psychiatrist. Sometimes you may be referred to a licensed “behavioral medicine” specialist. So-called “cognitive therapy” classes may be especially useful in helping you find new ways of thinking and thus reduce your pain levels.
Talk therapy usually takes a back seat to prescription antidepressants these days. In fact, sometimes talking about your pain can actually make it worse because you focus on it more. Antidepressant medications are often a primary treatment for depression, especially when chronic pain syndromes or nerve-related disorders are involved.
The earlier your depression is treated, the better the outcome can be. Early diagnosis and appropriate medications can reduce distress and even prevent suicide, in many cases. Those receiving treatment for depression that takes place while experiencing chronic pain often have an improvement in their overall medical condition.
Antidepressants work by altering certain chemical levels in the brain. It may take a while to find a particular antidepressant with minimal side-effects that works well for you. Every person experiences pain and reacts to medications differently. Among the antidepressants which are commonly prescribed today are the following:
• Celexa
• Prozac
• Zoloft
• Elavil
• Norpramin
• Effexor
• Serzone
• Wellbutrin
• Cymbalta
• Paxil
• Remeron
If you are depressed about a serious, life-changing event or due to severe, unremitting pain and disability, you should consult a physician about treating your depression.
Source: WebMD
March 11th, 2007
A new study is assessing whether back and neck pain from degenerative disk disease can be helped using fish oil supplements. The supplements containing omega-3 fatty acids might be a safer treatment than nonsteroidal anti-inflammatory drugs (NSAIDs) for some individuals with nonsurgical back or neck pain.
Researchers are Joseph Maroon, MD, and Jeffrey Bost, PAC, whose study at the University of Pittsburgh Medical Center’s neurological surgery department was published in the medical journal Surgical Neurology.
One in four U.S. adults will be affected by degenerative disc disease at some time in their lives. This condition in which shock-absorbing disks in the spine wear down is one of the largest causes of pain and disability in this country.
Although NSAIDs and Cox-2 inhibitors are potent painkillers, their long-term use can lead to stomach ulcers or increased risk of heart attack or stroke. The Cox-2 inhibitors Vioxx and Bextra were removed from the market in 2004 and 2005 due to suspected heart risks.
Researchers studied 250 people seen by a neurosurgeon for nonsurgical neck or back pain. Patients were asked to take daily fish oil supplements while gradually phasing off their NSAIDs over a two week period.
Patients initially took 2.4 grams of omega-3 EFAs, after which most cut their dose to 1.2 grams daily of fish oil supplements. After taking fish oil for 75 days, patients returned surveys. Three-quarters of them reported taking 1.2 grams daily of omega-three EFAs, while the rest took 2.4 grams daily. More than half had stopped taking any NSAIDs for pain (59%).
Study finding showed the following:
• 60% of patients noted overall improvement in their pain
• 60% specifically reported less joint pain
• 80% were satisfied with their improvement
• 85% noted they would keep taking fish oil supplements
Researchers understand that patient expectations of pain relief (placebo effect) may have played a role in their reported results. However, past research on arthritis has also shown less inflammation and joint pain with omega-3 EFAs.
Maroon and Bost have called for additional appropriately designed studies to confirm the effectiveness of omega-3 EFAs for spine-related pain.
Source: WebMD
April 19th, 2006