Nov. 24--PLATTSBURGH -- Advances in the use of prosthetic hips and knees have helped surgeons fine-tune the replacement process for these joints, but doctors continue looking at all options before turning to surgery.

Plattsburgh orthopedic surgeons Pamela Reinhardt and C. Phillip Volk presented updated information on osteoarthritis and the damage it causes to knees, hips and other joints, speaking during a monthly CVPH Community Lecture Series on health care sponsored by The Foundation of CVPH.

"As we age, many of us are affected by osteoarthritis," Reinhardt said as she reviewed some of the basic differences between osteoarthritis and rheumatoid arthritis. "We don't know specifically what causes it, but do know that many things contribute to it."

ALTERNATIVES FIRST

Osteoarthritis, also called degenerative joint disease, is the most common type of arthritis, affecting 21 million Americans. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body.

The major concern with osteoarthritis is the often-debilitating pain that accompanies the worsening condition.

Rheumatoid arthritis, affecting 2 million Americans, is a type of chronic arthritis that typically occurs in joints on both sides of the body (such as hands, wrists or knees). This symmetry helps distinguish rheumatoid arthritis from other types.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood or nerves.

Age is a major contributor in osteoarthritis, but the disease does not affect all people as they age, Reinhardt noted. Obesity, especially with osteoarthritis of the knees, is another contributing factor.

Fractures and other injuries to the joint can also promote osteoarthritis.

When examining a new patient, orthopedic surgeons will look at the alternatives to surgery first.

"A relatively small weight loss can make a big difference," Reinhardt noted, though she acknowledged that pain caused by the disease can impact a person's ability to exercise properly for successful weight loss.

"Options may include low- or no-impact exercises."

Pain medicines can be beneficial as well, though Reinhardt warned of the problems associated with treating a chronic problem with narcotic pain relievers, which can turn into a issue themselves.

CUSTOM JOINTS

Volk took some time to look at the differences between healthy and diseased joints, explaining how cartilage lying between bones in the joints wears down, eventually causing bone to rub against bone and sometimes intense pain.

"We are surgeons," he said. "Our job is to get you pain free. We will try all the options available to us before surgery, but when surgery becomes an option, we have a lot of new technology available to us."

Patients undergoing knee-replacement surgery 20 years ago received the same knee, regardless of problem, age or sex. Today, doctors can choose specific knees or parts of the knee to correct the problem each individual patient may face, Volk noted.

"With custom-made joint replacement, we can provide the best function with the best protection of the joint while relieving the pain."

New procedures allow physicians to preserve healthy bone and cartilage and protect the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which are key to stability and natural motion in the leg.

With smaller incisions, there is less pain following the operation and a faster recovery time as well, Volk added.

New materials also allow for longer duration of the replacement parts, which can now last up to 30 years or more, improving the options for younger people with joint problems and reducing the number of repeat surgeries needed.

New processes also allow for computer-assisted techniques, eliminating several steps in the process and reducing the amount of time in surgery by at least a half hour.

E-mail Jeff Meyers at: jmeyers@pressrepublican.com

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