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In the United States, hundreds of thousands of total
joint replacements are performed each year. The obvious
reason for this is the patients have arthritic joints and no
longer can tolerate their pain.
National statistics indicate that 90 percent of patients
undergoing joint replacement surgery should expect good to
excellent results. These are defined as little pain or no
pain and return to normal activities. The problem is that 10
percent of patients do not achieve these results.
When counseling patients regarding joint replacement
surgery, one key factor is always present. Each patient
should understand that there is a realistic expectation with
regard to their surgery. Surgery is performed to improve the
quality of their life, to improve their range of motion, to
decrease their pain, and to allow them to return to normal
activities consistent with a joint replacement.
Individuals must understand that a total joint
replacement has its limitations. The new joint will never be
a normal joint and a new joint will never function like a
normal joint. The trade-off is that in 90 percent of the
people, their lifestyle will be improved. Accepting the fact
that hundreds of thousands of total joint replacements are
performed each year, they must admit. that this is a
successful operation. They also must accept that this
success is based on the criteria as outlined previously and
not on a perfect result and return to a perfectly normal
joint that the patient was born with. They also must expect
that in order to achieve maximum success following joint
replacement surgery, a certain time interval is inevitable.
Tissues heal at a predictable rate. We know that tissues
heal at 90 percent of normal strength at 3 months. We also
know that it takes a full year to recover from any operation
as we are not dealing with a localized situation involving a
hip or knee, but rather the whole body. It is interesting
that patients undergoing hip replacement surgery will
uniformly reach their maximum improvement between 1-2 years.
Equally interesting is the fact that patients undergoing
total knee replacement do not achieve their maximum
improvement until 2-4 years. This fact is probably due to
the soft tissue structures surrounding each individual
joint. For hip replacement surgery, the buttock and thigh
muscles substantially protect the hip and, therefore, allow
the patients to return to normal activities earlier. For
knee replacement surgery, there are essentially no muscular
structures surrounding the knee other than ligaments,
capsule, and tendon. For this reason, the surrounding soft
tissue structures must gradually stretch and adapt to the
new artificial joint. This procedure does indeed take 2-4
years.
Artificial joints are enormously successful and do indeed
enable people to improve their lifestyle and increase 'their
quality of life. But the bottom line is artificial joints
are artificial joints and they never will be normal joints.
The funny thing is that the majority of people undergoing
joint replacement surgery will readily admit that their hips
appear to be normal and feel normal, but that their knees,
while they are enormously better, never appear to be normal.
There is nothing new on the horizon that is going to change
this. Joint replacement surgery will continue to improve the
quality of patients' lives, but everybody must keep in mind
that realistic expectations is the name of the game.
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