Part One: Reconstruction Era

Joint Procedures

By Eileen Metheny Carlton

 

The numbers of those receiving total arthroplasty or joint replacement are increasing almost exponentially. According to The Journal of Arthroplasty’s website, arthroplasty can be performed for hips, knees, ankles, feet, shoulders, elbows, wrists and fingers, with knees and hips being treated the most frequently.

Dr. William Hamilton of Anderson Orthopaedic Clinic in Alexandria is among those surgeons performing these replacements. “I deal primarily with end-stage osteoarthritis. This is an incredibly common condition which affects one out of every three families in America. … The most common symptom would be pain leading to disability and stiffness. Patients have less ability to function. They can’t walk as far. They can’t do their household activities,” Hamilton says.

The causes of osteoarthritis are unclear. What is clear, Hamilton says, is that nothing will eliminate wear on cartilage in the joints, while the most common contributing factors include obesity, genetics and injury. “It was once the thought that a way to avoid it was to avoid running, but recent research has contradicted that notion. A study that followed runners for many years showed people who maintained constant running did not have an increased incidence of degeneration of knees in long-distance runners,” Hamilton says, adding that both knee and hip replacement are a little bit more prevalent in women.

Hamilton also cautions there is scant data to support the belief that nutritional supplements such as glucosamine or chondroitin help slow degeneration of cartilage.

One of Hamilton’s patients, Pamela O’Bryant of Alexandria, is a woman in her mid-forties and the manager of a real estate office. O’Bryant underwent a total hip arthroplasty.

The pain became severe two years ago.

“The first symptoms were non-localized pain, a lot of pain, not only in my hip, but also in my lower back and shooting down my left leg. I tried a little bit of everything—chiropractic, acupuncture. Pretty much, you name it, I tried it,” O’Bryant says.

An Army doctor referred O’Bryant to an orthopedic specialist. “That physician basically said, ‘You are kind of young to do this, so suck it up.’ But I wasn’t sleeping. It hurt to roll over at night. It was hard to walk,” O’Bryant says.

The suck-it-up approach was unacceptable to O’Bryant, who regularly ran marathons and played co-ed soccer.

“It’s exhausting. It’s absolutely exhausting to be constantly in pain. I got on the Internet. I had seen about the new technique of hip replacement. It’s a new anterior approach. They go in from the front of the hip instead of from the back or the side, and it’s a smaller incision. Once I read about it, I decided I really wanted someone who would do that procedure, and Dr. Hamilton was the first surgeon in Northern Virginia to do this.”

Her first appointment with Hamilton was last April.

“He told me, ‘Well, you’ve got bone on bone. No wonder you’re in pain.’ I told him, ‘Look, I really want to get this done. I’ve already talked to my boss.’ I asked for early June only because I’d worked it with my bosses to get a little bit of time off. He asked, ‘How about May 28?’ He was doing a teaching surgery, and he needed a really good candidate to teach this procedure. Doctors would be coming from all over the country, and they got to watch my surgery,” O’Bryant says.

Following Anderson Clinic’s procedure, O’Bryant attended a joint replacement class that met for a couple of hours in the evening. The next step was a pre-operation preparation day when she met with everyone who would be involved with the surgery, from the anesthesiologist to the general physician, the physical therapist and, of course, the surgeon. The staff also explained what kind of equipment she would need once she returned home after the surgery.

“The next morning, I got up and walked. … One day—eight after surgery—I walked a mile,” recalls O’Bryant. She says the fact that she did her physical therapy exercises religiously was a contributing factor to her rapid recovery. She cautions insurance may not pay for the optimum number of sessions.

“The doctors would love to send patients to physical therapy early, but insurance won’t cover but so many physical therapy sessions. … Find out what the exercises are, and do them on your own,” O’Bryant says.

O’Bryant returned to work part time June 15, less than a month after her surgery.

“There is a reason we invented modern medicine, and if someone tells you to suck it up, ask them, ‘Why?’”

(February 2010)