Archive | August 2020

QUOTE FOR MONDAY:

“Of the more than 72,000 preventable drug overdoses in the country in 2017, more than 47,000 involved opioids. International Overdose Awareness Day (IOAD) is a global event held Aug. 31 each year to remember those gone too soon from overdose deaths.”

The National Safety Council (https://www.nsc.org)

QUOTE FOR THE WEEKEND:

“Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you’re taking certain medications that also depress the brain’s function.”
 
MAYO CLINIC

Part II Alcoholism Awareness

Complications

Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you’re taking certain medications that also depress the brain’s function.

Impact on your safety

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

  • Motor vehicle accidents and other types of accidental injury, such as drowning
  • Relationship problems
  • Poor performance at work or school
  • Increased likelihood of committing violent crimes or being the victim of a crime
  • Legal problems or problems with employment or finances
  • Problems with other substance use
  • Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape
  • Increased risk of attempted or completed suicide

Impact on your health

Drinking too much alcohol on a single occasion or over time can cause health problems, including:

  • Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis).
  • Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
  • Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation.
  • Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
  • Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation.
  • Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated.
  • Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime.
  • Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
  • Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
  • Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
  • Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer.
  • Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.

If you want to stop drinking, there is help. Start by talking to your health care provider. Treatment may include medicines, counseling, and support groups.

What to expect to report to your doctor.

Consider your drinking habits, taking an honest look at how often and how much you drink. Be prepared to discuss any problems that alcohol may be causing. You may want to take a family member or friend along, if possible.

Before your appointment, make a list of:

  • Any symptoms you’ve had, including any that may seem unrelated to your drinking
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins or other supplements that you’re taking, and their doses
  • Questions to ask your doctor

Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal.

Treatment for alcohol use disorder may include:

  • Detox and withdrawal. Treatment may begin with a program of detoxification or detox — withdrawal that’s medically managed — which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.
  • Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
  • Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy — family support can be an important part of the recovery process.
  • Oral medications. A drug called disulfiram (Antabuse) may help to prevent you from drinking, although it won’t cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate don’t make you feel sick after taking a drink.
  • Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently.
  • Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group.
  • Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment.
  • Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up.
  • Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.

 

 

 

QUOTE FOR THURSDAY:

“Sexually transmitted infections (STIs) are infections that are spread by sexual contact. STIs can cause severe damage to your body—even death. Except for colds and flu, STIs are the most common contagious (easily spread) infections in the United States, with millions of new cases each year. Although some STIs can be treated and cured, others cannot.”

ACOG – American College of Obstetricians and Gynecologists

STDs stop the fun; so play it safe with protection! from day one!

Sexually transmitted diseases (STDs) have been known to mankind for centuries. Before the advent of modern medicine, people’s lack of awareness and understanding of STDs contributed to the widespread transmission of the infections while few or no treatments were available to treat the conditions.

In medieval times, syphilis and gonorrhoea were two of the most prevalent STDs in Europe.

Some STDs can have severe, life-changing consequences; syphilis, for example, can eventually cause progressive destruction of the brain and spinal cord, leading to mental dysfunction and hallucinations, speech problems and general paresis.

It’s kind of puzzling that sexually transmitted diseases are so prevalent—particularly when you consider that you have to get pretty up close and personal to contract one. An STD is characterized by any disease that is spread by one partner to another via sexual contact, and that can be orally, vaginally, anally, or via hand to genital contact. Regardless, they are spread when one partner passes the disease-causing organism on to the other. Obviously, preventing STD transmission is first and foremost by practicing safe sex (PREVENTION) and not enough do it in America for some crazy reason hurting themselves and other people. However, if you think you might have contracted one of the most common STDs, recognizing the disease is imperative for swift treatment and preventing further spreading.

Top venereal diseases in the USA:

1-Gonorrhea

The Centers for Disease Control estimate that 700,000 new cases of Gonorrhea, or the “clap”, crop up every year. This long-term STD that is spread bacterially, affecting a female’s cervix, a male’s urethra, or the throat in both sexes, which means that it’s transmitted by vaginal, oral, and anal sex. The symptoms of gonorrhea are pretty subtle; the most noticeable being burning when urinating or a yellowish penile discharge in men.

2-Hepatitis

Sexually transmitted hepatitis is hepatitis B (or HBV), which afflicts more than 1.25 million individuals in the U.S. even though there is a vaccine. If left untreated, a Hep B infection will scar and damage the liver, causing cirrhosis and liver cancer. Unfortunately, over half of those affected show no symptoms, but those who do suffer muscle pain and fatigue, yellowing of the eyes (or jaundice), nausea, and a distended stomach.

3-Syphilis

Syphilis is a particularly sneaky STD that caused by a type bacterial infection of the genital tract, known as Treponema Pallidum. Syphilis is transmitted when direct contact is made between the small, painless sores on the mouth, rectum, vagina, or around the genitals in areas not protected by latex condoms. It can also be transmitted via infected mother to her baby during pregnancy. When there are no sores, the disease is still present. Syphilis symptoms are rare , however, the most telling are sores or lesions on and around the genitals, as well as hair loss, sore throat, fever; headache; and a white patchy skin rash.

4- Chlamydia

Like Gonorrhea, Chlamydia affects a man’s penile urethra and a woman’s cervix. However, oftentimes those who’ve contracted Chlamydia don’t show symptoms for months or even years, which explains why it’s the most common and rampant STD. If you do show symptoms, you’ll feel pain during intercourse and have a discolored, thick discharge from the vagina or penis. Transmitted via sexual penetration with an affected partner, using latex condoms can prevent transmission of this curable STD.

 5. Crabs

If you feel a creepy-crawly, itchy sensation in your genitals, you may have crabs (or public lice). They show themselves as visible eggs or lice in the coarse hair of the genital region (even if you shave it off), and they can spread to the armpits and eyebrows if left untreated. Typically transmitted via sexual contact, crabs can also be passed via contact with infested linens or clothing .

6. Human Papilloma Virus

Human Papilloma Virus (or HPV) is currently the most wide spread STD. It affects roughly three-quarters of the sexually active population and a staggering one-quarter of sexually active women, which is why there is a North American vaccine to protect young women from certain types of HPV that are linked to genital warts and cervical cancer. HPV is transmitted through genital contact—via vaginal and anal sex, and also oral sex and genital-to-genital contact. Most times HPV doesn’t show any symptoms until it’s far advanced, but genital warts as well as RRP, a condition where warts grow in the throat and eventually cause breathing difficulties are common.

7. Bacterial Vaginosis

Bacterial Vaginosis, or BV, is not always considered an STD even though it typically afflicts those of child-bearing age with multiple or new sex partners. BV occurs when healthy bacteria in the vagina overgrow and become imbalanced, causing burning and itching around the vagina and a thick, grey discharge with a strong fishy odor. Antibiotics will quickly clear up bouts of BV, but it can reoccur, leaving the victim prone to pelvic inflammatory disease, other STDs, and premature births (if pregnant).

 8. Herpes

Painful sores or lesions on your mouth or genitals may indicate herpes, a viral STD that comes in two forms HSV1 (herpes of the mouth) and HSV2 (herpes of the genitals). Herpes is transmitted skin-to-skin—for instance, from genital to genital, mouth to genital, or mouth to mouth contact with an infected individual, even when they don’t have visible sores. Even though herpes symptoms be treated with antibiotics, the virus never goes away and reoccurs typically 2 to 4 times per year.

9. Trichomoniasis

Trichomoniasis, or “trich”, often masks itself as a yeast infection or bacterial vaginosis (BV) in women with similar symptoms—including a thick, grey discharge, offensive vaginal odor, pain or burning intercourse, and itchiness. A parasitic trichomonas vaginalis infection affects the urethra and the vagina in women. It can be transmitted back and forth between sex partners (man to woman and woman to woman) via vaginal intercourse and contact. However, most men typically don’t have any symptoms.

10. HIV

HIV is transmitted via the exchange of body fluids—such as semen, vaginal secretions, blood, or breast milk. Within a month or 2 of contracting HIV, about 40 to 90-percent of those afflicted suffer from flu-like symptoms including fever, fatigue, achy muscles, swollen lymph glands, sore throat, headache, skin rash, dry cough, nausea, rapid weight loss, night sweats, frequent yeast infections (for women), cold sores, and eventually, pneumonia. Luckily, many individuals who are diagnosed early can live a long, productive life with HIV thanks to a combination of highly active anti-retroviral drug therapy, which prevents to progression to AIDS.

How you can prevent all these STDs are the following and its easy!

1.) Practice Abstinence 2.) Condoms 3.) The pill for women 4.) Fewer partners or one partner only and be checked prior to having sex through the doctor or clinic to make it safe for BOTH.  5.) Get Vaccinated.

Dogs are more than great pets; its National Dog Day!!

    

  

Goldsmiths College released a study that showed more dogs will approach someone who’s crying or in distress than someone who is not. This shows that dogs are empathetic and are eager to help comfort humans in pain.

Their sense of smell can do even more than we think; dogs can also detect low blood sugar in their master. They will either alert the person that the sugar has dropped or, if a diabetic attack has already occurred, will bark and bark and bark in an attempt to alert somebody to come help, thus working to save the diabetic’s life.

Some dogs are also able to detect seizures in humans.  Recent research has shown certain dogs are able to warn seizure patients that they’re going to experience an attack, sometimes hours before it happens. Nobody yet knows how they do it, or why only certain dogs can do it. They also can’t be trained to do it, so if you feel you need a seizure-sniffing dog, you need to make sure you have yourself a natural.

Due to their incredible sense of smell, dogs have shown anywhere from 70 to 99% accuracy (depending on the study) when tasked with detecting lung cancer in a nearby patient.

Fibromyalgia is a debilitating disease that can leave its victim in constant pain. Studies have shown that the Xolo dog’s body temperature can be used as a kind of therapeutic heating pad, due to it being a hairless species. Of course, unlike heating pads, a Xolo will bond with you, snuggle with you and keep you warm as long as you need, leading to both external comfort and internal happiness.

In a surprising twist, it might actually be beneficial to get a dog for your baby, even if they’re allergic. Studies have shown that children under the age of one who live with a dog are much less likely to develop the chronic, and annoying, skin condition called eczema.

Dogs can highly make humans more social.  The British Medical Journal has concluded that dogs act as “social catalysts,” who help people get out more, approach others more easily, and overall reduce isolation. This is actually just as important as the basic companionship that dogs provide, as human social support is beneficial to human health and the dog.

Simply by being themselves, dogs have been shown to help reduce PTSD among soldiers. In addition to providing the usual doggie companionship, they have been shown to help sufferers come out of their shells, be less numb and angry, and improve their social life as well.

A dog kissing you obviously feels wonderful, but it might actually have physical benefits too. Studies have shown that saliva, both the human and doggie variety, can help stimulate nerves and muscles, and get oxygen moving again, which is the secret ingredient in helping wounds to heal. In short, “licking your wounds” is not just a cliché after all.

Almost certainly due to the positive vibes and good feelings that dogs bring out of their masters, even in the worst of times, studies have found that older people who own dogs average at least one less doctor appointment per year than those who do not.

Not that they are the cure but preliminary studies by the American Heart Association are revealing that dog owners have less risk of heart disease than those without dogs. The reasons given are the exercise that owners get when walking their dogs, plus the presence of the dog helps the owner deal with stress better. The evidence is mostly anecdotal right now, but dog owners know that it’s all true.

Day-to-day depression, or even more serious chronic depression, is easier to handle with the love of a dog, studies show. Simply by having them around, and knowing that even at our worst, somebody loves us unconditionally and is eager to see us happy again, we’re given a reason to get up and keep going.

Autistic children often find the world very stressful, in ways that the non-autistic can’t understand. Luckily, a dog can. Studies are showing that bringing a therapy dog into an autistic household helps to reduce the amount of cortisol (a stress hormone) in the autistic child’s body. This both calms the child down and shows him that he has a friend.

Bullying has been a huge problem for a long time, and people are finally doing something about it. Dogs, too. Experimental programs have been launched that bring dogs into schools to promote empathy, with the lesson that you shouldn’t treat people badly, because you wouldn’t do it to a dog. Thus far, kids have been able to make the connection, which will hopefully continue to be the case.

Dogs have shown that they can help keep dementia sufferers on schedule, reminding them when its time for medicine and when to see the doctor. In addition, when the owner experiences frustration over the state of their mind, the “dementia dog” is right there to support them, comfort them, and remind them that someone’s always there for them.

AREN’T DOGS AMAZING!!

 

QUOTE FOR TUESDAY:

Presently the Top 3 Hospitals in America by U.S. News for glioblastoma are:

#1 – John Hopkins Hospital in Baltimore, MA
#2 – UCSF Medical Center SanFrancisco, CA
#3 – Columbia Presbyterian Hospital Manhattan, NY.”
 
usnews.com

Glioblastoma

Glioblastoma is an aggressive type of cancer that can occur in the brain or spinal cord. Glioblastoma forms from cells called astrocytes that support nerve cells.  The tumor only grows in brain tissue this means the cancer only spreads in the brain and spinal cord since the spinal cord is made out of brain tissue.

Glioblastoma can occur at any age, but tends to occur more often in older adults. It can cause worsening headaches, nausea, vomiting and seizures.

Glioblastoma, also known as glioblastoma multiforme, can be very difficult to treat and a cure is often not possible. Treatments may slow progression of the cancer and reduce signs and symptoms.

Survival rate is one to five years but some live longer; it varies from person to person.

Diagnosis

Tests and procedures used to diagnose glioblastoma include:

  • Neurological exam. During a neurological exam, your doctor will ask you about your signs and symptoms. He or she may check your vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas may provide clues about the part of your brain that could be affected by a brain tumor.
  • Imaging tests. Imaging tests can help your doctor determine the location and size of your brain tumor. MRI is often used to diagnose brain tumors, and it may be used along with specialized MRI imaging, such as functional MRI and magnetic resonance spectroscopy.Other imaging tests may include CT and positron emission tomography (PET).
  • Removing a sample of tissue for testing (biopsy). A biopsy can be done with a needle before surgery or during surgery to remove your glioblastoma, depending on your particular situation and the location of your tumor. The sample of suspicious tissue is analyzed in a laboratory to determine the types of cells and their level of aggressiveness.Specialized tests of the tumor cells can tell your doctor the types of mutations the cells have acquired. This gives your doctor clues about your prognosis and may guide your treatment options.

Treatment

Glioblastoma treatment options include:

  • Surgery to remove the glioblastoma. Your brain surgeon (neurosurgeon) will work to remove the glioblastoma. The goal is to remove as much of the tumor as possible. But because glioblastoma grows into the normal brain tissue, complete removal isn’t possible. For this reason, most people receive additional treatments after surgery to target the remaining cells.
  • Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing beams to precise points in your brain.Radiation therapy is usually recommended after surgery and may be combined with chemotherapy. For people who can’t undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.
  • Chemotherapy. Chemotherapy uses drugs to kill cancer cells. In some cases, thin, circular wafers containing chemotherapy medicine may be placed in your brain during surgery. The wafers dissolve slowly, releasing the medicine and killing cancer cells.After surgery, the chemotherapy drug temozolomide (Temodar) — taken as a pill — is often used during and after radiation therapy.Other types of chemotherapy may be recommended if your glioblastoma recurs. These other types of chemotherapy are often administered through a vein in your arm.
  • Tumor treating fields (TTF) therapy. TTF uses an electrical field to disrupt the tumor cells’ ability to multiply. TTF involves applying adhesive pads to your scalp. The pads are connected to a portable device that generates the electrical field.TTF is combined with chemotherapy and may be recommended after radiation therapy.
  • Targeted drug therapy. Targeted drugs focus on specific abnormalities in cancer cells that allow them to grow and thrive. The drugs attack those abnormalities, causing the cancer cells to die.Bevacizumab (Avastin) targets the signals that glioblastoma cells send to the body that cause new blood vessels to form and deliver blood and nutrients to cancer cells. Bevacizumab may be an option if your glioblastoma recurs or doesn’t respond to other treatments.
  • Clinical trials. Clinical trials are studies of new treatments. These studies give you a chance to try the latest treatment options, but the risk of side effects may not be known. Ask your doctor whether you might be eligible to participate in a clinical trial.
  • Supportive (palliative) care. Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

QUOTE FOR MONDAY:

“Hip replacement surgery is one of the most successful operations in all of medicine. Since the early 1960s, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed each year in the United States.”

Ortho Info (https://orthoinfo.aaos.org/)

Understanding Hip Surgery: Types of Hip surgeries & know the components involved.

 

To understand hip replacement, you need to understand the structure of the hip joint, a ball-and-socket joint. The ball, at the top of the femur (thighbone) is called the femoral head. The socket, called the acetabulum, is a part of the pelvis. The ball rotates in the socket, allowing the leg to move forward, backward, and sideways.

Regarding the surgery its repairing the hip to do fixation like it use to without pain.  Fixation is simply the action of making something firm or stable.  Hopkins Medicine states in a hip surgical procedure ORIF (open reduction internal fixation),  for example, is a surgery used to treat a broken thigh bone. … In a “broken hip,” it is actually part of your femur that breaks, and not part of the hipbone itself. … Most people do very well after ORIF for their femur fracture. … you sleep through the operation, so that you won’t feel any pain or discomfort …

In a healthy hip, soft tissue called cartilage covers the ball and the socket to help them glide together smoothly. If this cartilage wears down or gets damaged, the bones scrape together and become rough. This causes pain and can make it difficult to walk.  Think of a car, our brake pads allow our car not to walk but drive, the pads (like cartilage) when thinning down to the point hitting metal (not bone) will scrape on the rotors and don’t repair like the cartilage gone hitting bone to bone the damage to the car will scrape on the rotors till they break and new rotors with brake pads needed.  Where in patient hitting bone to bone, pain results, limitation of the movement takes place at that area (example Hip) and become immobile.  Repair it with surgery and mobilization reoccurs so you can move around like you use to and do regular of activities you previously did.

TYPES OF HIP SURGERY:

The most common type of hip replacement surgery is called a total hip replacement (THR). In this surgery, worn-out or damaged sections of the hip are replaced with artificial implants. The socket is replaced with durable plastic or polyethylene cup with or without a metal titanium shell. The femoral head is removed and replaced with a ball made from ceramic or a metal alloy. The new ball is attached to a metal stem that is inserted into the top of the femur.

Information hip replacements is more easily available than ever before. But direct-to-consumer advertising, online articles and other reports in the media may make it more difficult for people considering these surgeries to understand their options. Becoming familiar with the key considerations that go into selection of the implant that is used to replace the injured or damaged joint can make the process easier.

Total hip replacement surgery – in which the damaged joint is replaced with an implant – is associated with a high degree of successful and predictable outcomes.

Orthopedic surgeons may approach the surgery in one of three different ways:

  • the direct anterior approach in which the incision is made on the front of the hip; this approach may be less disruptive to the muscles and soft tissues surrounding the hip joint, however, surgeons who employ this approach usually use a custom operating table and fluoroscopy (a type of X-ray) to guide placement of the implant during surgery; fluoroscopy is not routinely used with the other two surgical approaches
  • the anterolateral approach in which the incision is made on the side of the hip, toward the front of the body
  • the posterolateral approach in which the incision is made on the side of the hip toward the back of the body

The majority of people who undergo hip replacement receive a traditional hip arthroplasty in which the surgeon uses a stemmed device and prosthetic head to replace the upper part of the femur (the head and neck of the bone) and a hemispherical shaped cup to replace the acetabulum. [Figure A, below]

However, some patients may be candidates for hip resurfacing in which the head and neck of the femur are not removed. In this procedure, the surgeon resurfaces or sculpts the femoral head to accept a metal cap with a short stem. Hip resurfacing is usually most successful in male patients under the age of 55, who are larger in stature There is little data to support functional benefit of one type of hip replacement over the other, although if revision surgery is needed, this may be easier after hip resurfacing.

Illustrations and X-ray imaging of a tradtional hip replaement implant at left and a hip resurfacing implant at right.
Figure A: Illustrations and X-ray images of a traditional hip replacement versus a hip resurfacing implant (Hip resurfacing images courtesy of Smith and Nephew)

It should be noted that while the procedure has vastly improved the ability to treat certain hip disorders with minimal surgical trauma, it is not always an appropriate replacement for other larger operations. If the hip has severe degeneration, total hip replacement may be the only procedure that will provide long-term pain relief. Conversely, in younger patients with skeletal deformities ( i.e. dysplasia, impingement) hip arthroscopy will usually provide relief. But the relief may be short-lived because the underlying pathologic condition has not been corrected.

Total Hip Replacement – Total hip replacement is extremely effective at relieving pain and restoring function as well as range of motion. But, it is an artificial joint and should be performed only if other “joint saving” procedures are not appropriate.

Other forms of orthopedic surgery for the hip are:

Osteotomy – Osteotomy (cutting the bone) is a technique were the anatomy of the femur or socket is altered to relieve pain and prolong survival of the joint by reducing the abnormal loads on the cartilage.

Fusion – Fusion (arthrodesis) makes the hip permanently stiff by obliterated the joint via bone bridging across the joint. This procedure was performed much more frequently in the past and is still appropriate in certain conditions, such as severe arthritis of one hip in a young person.

Arthrotomy – Arthrotomy (opening the joint) is a procedure where the joint is opened to clean out bone spurs, loose bodies, tumors, or to repair fractures.

Know your components involved in the hip surgery:

Dr Padgett is a M.D. from 1987 a resident in orthopedic surgery at Hospital for Special Surgery (HSS) to chief of the Hip Service, and in 2008 to the present chief of the Adult Reconstruction and Joint Replacement Service at HSS.  Learn much more about him in tomorrow’s topic with an excellent hospital to go to if you need this in N.Y.C.   If not you can also find out where to go for help in finding excellent hospitals in hip surgery out on NY to California.

Knowing your components is very helpful.  Hip implants come in two primary types: the traditional single-piece implants and modular models, in which the stem and head of the implant portion that is placed in the femur can be matched independently. Although the single piece implants provide a good fit for many patients, “modular devices were developed to improve the fit of the implant to the patient’s specific anatomy,” explains Dr. Padgett.   However, he adds, some modular implants have recently been found to be associated with problems related to the linkage between the various parts.

Some degree of corrosion and fretting has been seen with these metal on metal components, a process that can result in the creation of metallic debris that is destructive to the soft tissue surrounding the joint. As a result, some of these implants have been recalled.

Implants may be made of a variety of materials including metal (usually titanium), ceramic or polyethylene (a type of hard plastic). Ongoing research and enabling technology will determine new directions in materials used in hip replacement surgery. At present, bearing surfaces – where the femoral component of the implant meets the acetabulum – may combine in three different ways:

  • Metal or ceramic on polyethylene, in which the metal or ceramic head meets a medical-grade polyethylene socket or acetabulum in the pelvis. This combination is now generally regarded to be the “gold standard” for hip replacement. The polyethylene components currently in use are significantly more wear-resistant and resistant to degradation than earlier generations of these plastics.
  • Metal-on-metal, in which a large metal ball at the top of the femur articulates with a metal socket or acetabulum in the pelvis. This combination was originally developed to offer the benefits of increased stability – related to the size of the head – and the ability to create a very thin, but durable metal shell. Owing to the creation of metal fragments or metallic debris that is destructive to the soft tissue surrounding the joint, use of some of these total hip replacement implants has been discontinued in the United States. Metal-on-metal bearing surfaces continue to be used for hip resurfacing.
  • Ceramic on ceramic, in which both components are made of the same material; this combination has been shown to have good durability, but there is a risk of the ceramic breaking and ceramic on ceramic hips can produce an audible squeak.

Placement of the hip implant components involves an additional consideration: how the implants are bonded to the bones. This can be accomplished either through the use of acrylic cement or with uncemented fixation, in which the surface of the implant is composed of a porous, honeycomb-like surface that allows for the in-growth of new bone tissue to help hold the component in place.

“On the cup portion of the implant, uncemented fixation is clearly superior,” Dr. Padgett a orthopedic M.D. and from 2008  says. “However, cemented fixation may be preferable in older patients or others with compromised bone quality.” With regard to fixation of the stem, Dr. Padgett notes, available data shows no advantage of one type of fixation over the other, and the decision to use one over the other is left to the surgeon’s discretion.

With a history of excellent surgical technique and outcomes, the focus of new development in this area is on the use of enabling technology to improve preparation and component positioning in hip and knee replacement surgery. These tools include navigation devices that provide three-dimensional spatial orientation and robotics which can also provide tactile feedback during surgery. “The role of these emerging technologies is still evolving,” Dr. Padgett notes.

Much of the important early work in the development of successful hip implants took place in the late 1960s and early 1970s, including that of British surgeon John Charnley, MD and introduced at HSS by Philip D. Wilson, Jr. MD.