Last Saturday morning I attended a study morning, dedicated to the topic of knee replacements, hosted by the New Zealand Orthopaedic Nurses Association. I learned a lot!
Prof Gary Hooper, Orthopaedic Surgeon, spoke about the history of knee replacements and the complex functional problems which arise when the alignment of the prosthetic parts is faulty. He also stated that the incidence of joint replacements is increasing in New Zealand, and is expected to reach epidemic proportions due to:
- Our aging population
- The increasing numbers of healthy retired people
- The greater expectation of the population to access free health funded procedures
He also reported that statistics for the USA predict that by 2030
- Total hip replacements will increase by 157%
- Total knee replacements will increase by 673%.
New Zealand statistics show that we model similar trends.
The NZ Orthopaedic Association has established a NZ Joint Registry which collates information about joint arthroplasty outcomes. Using data gathered between the years 1999-2012:
- The incidence of Total Knee Replacements has increased by 157%
- The incidence of Total Knee Replacements is 57% higher than Total Hip Replacements
These statistics are attributed to the physically orientated population, high levels of obesity, ethnicity, and favour females between the ages of 70-79 years of age.
By 2018, it is predicted that the number of Total Knee Replacements will exceed the number of Total Hip Replacements.
The Survival Rate of the prosthesis has been found to be 95%, for a period of approximately 14 years – after which a revision of the procedure may be necessary. This is the main reason why people under the age of 55 years are discouraged from having the surgery as their chances for requiring a revision are greater.
Reasons for requiring revision can include:
- Prosthesis in the Tibia loosening
- Patellar problems
- Deep infection
Prof Hooper was very clear in stating that any person who has had any form of joint replacement could be at risk of deep tissue infection for the rest of their lives. Any haematological infection (carried in the blood) such as a respiratory tract or urinary tract infection, could cause a “seed to plant” in the replacement area. Any such infection must be treated by prophylactic antibiotics.
By far the commonest cause for revision is PAIN. Even after revision, which is usually cementless, the person will probably still experience PAIN.
With my background in Pain Management, this is not at all surprising, as numerous people return to surgery to “investigate the source of pain” after “failed” procedures, leaving the person worse off than before, as the pain pathways have yet again been excited / assaulted.
According to Chris Scott, Physiotherapist, scar tissue management to reduce pain is one of the vital postoperative goals in order to return to full functional activities. This was covered in a later presentation.
Take Home Message:
- The incidence of joint replacement is reaching epidemic proportions
- Be Proactive – ensure that you remain physically healthy and active
- Do not depend on the public health system to automatically be able to cater to your health needs
Have you received a joint replacement?
How has it influenced your life?
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