Arthritis is a common and potentially disabling condition.
Relief of the pain and stiffness has been a long-term goal for physicians. This
effort dates to 1821 when Anthony White of London performed the first
arthroplasty. In this procedure the arthritic part was replaced. While pain was
eased, joint stability was a failure. Several others made attempts at surgeries
designed to repair or improve the arthritic joint; none of this proved useful.
Professor Glück led the way in development of implanting
artificial material to replace arthritic hips.
He developed an artificial joint consisting of an ivory ball and socket
joint that he fixed with screws. He also used a mixture of plaster of Paris,
pumice, and resin to achieve further fixation. He realized that the materials
implanted needed to have biocompatibility and be well tolerated by the patient.
About 500,000 knee replacements and more than 175,000 hip
replacements are performed annually according to WebMD. No doubt these numbers
are low as this is from a study done several years ago. The National Center for
Biotechnology Information reported that the demand for hip replacements was
estimated to grow by 174% by 2030. Total knee arthroplasty is projected to
increase by 673% to 3.48 million operations. The need for revisions of previous
operations is projected to double by 2026 for hips, and to double in 2015 for
knees.
Most of these procedures are for osteoarthritis, not some other
disease like rheumatoid arthritis. What
are the factors causing this increase? People are heavier and more active these
days. They live longer; perhaps the life expectancy of the person exceeds that
of their joints. There is a greater desire to remain active into older age than
in the past. Many people simply don't accept that most things, including
themselves, deteriorate with age.
There are both opportunities and problems associated with
this explosive growth. It is likely that the device manufacturers can make
enough artificial joints to meet the demand.
It is less likely that there will be enough orthopedists to implant
them. Training programs need to expand and this area of orthopedics needs to be
promoted.
There is great opportunity for biomedical engineers and
centers in this expansion of the need for and the use of artificial joints.
Certainly there are other joints also amenable to replacement. Finger joints,
elbows, shoulders and ankles can also be replaced.
There is an excellent patient
information folder on the National Institute of Arthritis and Musculoskeletal
Diseases website with much useful information. Many areas are being researched,
evaluated, and improved:
- Surgical technique
- Materials, surfacing, and lubrication substances
- The diseases that lead to the arthritis being
severe enough to require surgery
- The response of the body to the implantation of
a foreign substance (Professor Glück was absolutely right in the early 19th
century when he realized that biocompatibility was a huge issue)
Another area of research is learning more about why people
with severe arthritis refuse to have surgery. Is it ignorance of the
availability? Are they afraid? Do they not have adequate insurance? Learning
more about the decision to have surgery, recovery from surgery, and how well
people eventually feel is all of interest. Certainly putting it off for a long
time is not the best course of action.
Once symptoms are significant and are limiting life style,
surgery can and should be undertaken. Recovery of younger patients is shorter
and easier than in those who tough it out into their 60s or 70s. I have one grandchild who asks me each time I
see her, "How are your robo-knees doing?" I am pleased that I have been able to
answer now for ten years, "Never better!"
Image - wikipedia
| 
Re: Artificial Joints
