QUOTE FOR WEDNESDAY:

“A person with active TB will have symptoms. A person with latent, or inactive, TB will have no symptoms.

You may still have a TB infection, but the bacteria in your body is not yet causing harm. You may experience other symptoms related to the function of a specific organ or system that is affected. Coughing up blood or mucus (sputum) is a sign of in TB of the lungs. Bone pain may mean that the bacteria have invaded your bones.

These symptoms can also occur with other diseases, so it is important to see a healthcare provider and to let them find out if you have TB. If you think you have been exposed to TB, get a TB test.”

American Lung Association (https://www.lung.org/lung-health-diseases/lung-disease-lookup/tuberculosis/symptoms-diagnosis)

Part II Tuberculosis – The symptoms, how its diagnosed and treatment.

Symptoms of active TB include a cough that contains thick, cloudy, and sometimes bloody mucus from the lungs, called sputum, for more than two weeks, tiredness and weight loss, night sweats and a fever, a rapid heartbeat, swelling of the lymph nodes, and shortness of breath and chest pain.

DIAGNOSIS:

There are numerous ways for a doctor to diagnose a patient with tuberculosis. Doctors can typically find latent, or not active, TB by doing a tuberculin skin test, where TB antigens are injected under the skin. If the patient has TB bacteria within their body, a red bump will appear at the injection spot in two days. A blood test can also be performed to detect if a patient has TB. For doctors to discover pulmonary TB, they will often test a sample of mucus from the lungs to see if the TB bacteria are present there. Other tests may include further testing on sputum, or mucus from the lungs, other blood tests, or a chest X-ray to find pulmonary TB. To diagnose extrapulmonary TB, a doctor may take a sample of tissue, or a biopsy, to test as well as a CT scan or an MRI to get a clear visual of the inside of the patient’s body.

TREATMENT:

In the majority of cases, doctors will combine four antibiotics to treat active TB, and it is essential for patients to take this medicine for a minimum of six months.

RIPE regimen
A six-month regimen that includes rifapentine, isoniazid, pyrazinamide, and ethambutol.

A majority of patients are cured of the TB bacteria if they take all the required medicine necessary to destroy the infection. If tests performed by a doctor reveal active TB is still present in the body after six months, treatment will continue for another two or three months. In the worst case scenario, if the TB bacteria is still resistant to multiple antibiotics, called multidrug-resistant TB, treatment will be necessary for one year or longer. Patients with latent TB may be treated with one antibiotic they consume daily for nine months or with a combination of antibiotics taken once a week for twelve weeks. Ensuring every dose is taken reduces the risk of a patient with latent TB to develop active TB.

Patients should be aware that if they miss a dose of their medication or if they stop taking it too soon, the treatment may fail or have to continue for an extensive period. Some patients may even have to start their treatment all over again. This can result in the infection becoming worse or even lead to an infection resistant to antibiotics, which is much more difficult to treat.

There is no guaranteed way for an individual to prevent TB from happening to them or a loved one, but there are some helpful tips individuals can implement if they are at risk or around someone with active TB. As previously stated, latent TB is not contagious and extrapulmonary TB is much more challenging to spread compared to active pulmonary TB. One thing everybody can do to stop the spread of this infection is to get vaccinated, whether as a child or as an adult.

Individuals who are at risk of developing TB or who work with patients who have active TB should always wash and sanitize their hands after they have come into contact with the patient. If an individual is visiting a loved one with TB or taking care of a patient, due to the airborne nature of this infection, uninfected individuals should also keep a healthy distance and wear a mask to prevent them from coming into contact with TB bacteria. Patients who have severe TB should also be quarantined for a time to reduce the risk of spreading the disease as well.

Despite the stigma surrounding this curable disease, with the proper treatment and a bit of patience, individuals infected with tuberculosis can get onto the road to recovery and be healthy sooner rather than later!

Despite the stigma surrounding this curable disease, with the proper treatment and a bit of patience, individuals infected with tuberculosis can get onto the road to recovery and be healthy sooner rather than later!

QUOTE FOR TUESDAY:

“A total of 1.3 million people died from TB in 2022 (including 167 000 people with HIV). Worldwide, TB is the second leading infectious killer after COVID-19 (above HIV and AIDS).

In 2022, an estimated 10.6 million people fell ill with tuberculosis (TB) worldwide, including 5.8 million men, 3.5 million women and 1.3 million children. TB is present in all countries and age groups. TB is curable and preventable.

Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. Only about 2 in 5 people with drug resistant TB accessed treatment in 2022.”

World Health Organization – WHO  (https://www.who.int/news-room/fact-sheets/detail/tuberculosis)

Part I Tuberculosis What it is and risk factors that prone you in getting TB.

  TB commonly affects lungs.

 

Spreads via coughing and talking near someone so in active TB the patient is put in droplet isolation.  A restricted room and anyone who visits the pt in the room wears a mask.

Tuberculosis is an infectious disease usually caused by Mycobacterium tuberculosis bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body.

Approximately 8.6 million individuals are diagnosed with tuberculosis (TB), and 1.3 million will die of the disease globally, but it is commonly found in the developing world. TB is a highly contagious but treatable infection that predominantly affects the lungs and throat, but can also spread to the kidney, bones, and brain. So what is tuberculosis exactly? Find out what causes this highly contagious infection, who is most at risk for developing it, and how to treat the different kinds and prevent the spreading of this old world disease.

Tuberculosis, commonly abbreviated to TB, is an infection caused by slow-growing bacteria that festers in areas of the body containing an abundant amount of blood and oxygen, hence why it is commonly found in the lungs. TB found in the lungs is known as pulmonary TB and tuberculosis that spreads to other organs is called extrapulmonary TB. TB is highly contagious, but treatment is often effective and can take between six to nine months to treat, or in severe cases, can take up to two years to treat an infected patient. TB can also be either latent or active. Latent TB is when the immune system is defending the body against TB bacteria and keeping it from becoming active, with no visible symptoms. Active TB is when the TB bacteria are growing inside of the body and symptoms have become noticeable in the patient, and it is easy to spread the disease to others= CONTAGIOUS.

Pulmonary TB is contagious, however extrapulmonary TB does not spread as easily as it is usually contained within another part of the body. TB spreads when an individual has active TB breathes out air that has the TB bacteria in it and another individual breathes in the bacteria from the air. Even more bacteria can become airborne when an infected person coughs or laughs as well.

RISK FACTORS IN DEVELOPING TUBERCULOSIS:

1-Those at risk of developing TB are individuals who have HIV or another illness that weakens the immune system, individuals who have close contact with a patient with active TB such as living in the same house as an infected patient, and those caring for a patient with active TB, such as doctors and nurses.

2-Other risk factors include individuals who live or work in crowded places such as prisons, nursing homes, homeless shelters or wherever individuals may have active TB, as well as individuals who abuse drugs and alcohol.

3- Individuals with poor access to health care, where it is commonly seen in the developing world, as well as homeless individuals and migrant farm workers.

4-As well, traveling to places where untreated TB is common puts an individual at risk, such as Latin America, Africa, Asia, Eastern Europe, and Russia. It is important to note individuals who are at a high risk for developing TB should get tested once or twice a year.

5-As well, traveling to places where untreated TB is common puts an individual at risk, such as Latin America, Africa, Asia, Eastern Europe, and Russia. It is important to note individuals who are at a high risk for developing TB should get tested once or twice a year.  So people who make it in the United States via customs with this disease or left here to another country picking up TB bringing it in America passing customs put many at risk and pick up the TB and continue spreading it till treated and healed.  Just like the others who pick it up in or out of America but spread it in the U.S.  There needs to be closer checking on visitors coming in or citizens that leave home and come back in America to be checked for TB.  This will help decrease the amount of people in America with TB by getting diagnosed immediately with treatment.

 

 

QUOTE FOR MONDAY:

“According to the Centers for Disease Control and Prevention, Health Literacy is the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.

Health literacy is important for everyone because, at some point in our lives, we all need to be able to find, understand, and use health information and services.

Studies consistently show that a significant number of people have problems reading, understanding, and acting on health information.

This is an issue because health information is complex and can be hard to understand, and health providers are not necessarily skilled communicators. When organizations or people create and give others health information that is too difficult for them to understand, or we expect them to figure out health services with many unfamiliar, confusing or even conflicting steps, a health literacy problem is created.

Patients also bring a wide range of learning needs to the healthcare experience.

Basic literacy skills, language, age, disability, cultural context, and emotional responses can all affect the way people receive and process information — and the way people process information, in turn, has a direct impact on health outcomes and cost.”

District Health Department (https://www.dhd10.org/healthy-literacy-month/)

Health Literacy Month!

During the month of October, Health Literacy Month encourages everyone working to provide easy access to understandable health information. For more than 20 years, October has been recognized as Health Literacy Month. Health Literacy Month is a time of international observance when hospitals, health centers, literacy programs, libraries, social service agencies, businesses, professional associations, govern­ment agencies, consumer alliances, and many other groups work collaboratively to integrate and expand the mission of health literacy.

Low health literacy is more prevalent among:

  • Older adults
  • Minority populations
  • Those who have low socioeconomic status
  • Medically underserved people”

What Are the Consequences of Low Health Literacy? – The two major areas that are impacted by low health literacy are “economic costs to society and the health-care system, and costs in terms of the human burden of disease” (Institute of Medicine, 2004). There is also considerable psychological suffering created by low health suffering. Within those overarching categories, the results of low health literacy (as measured by reading and numeracy skills) can include:

  • Shame and stigma, which can create barriers to health and behavioral health care and to improving low health literacy;
  • Reduced knowledge and understanding of a person’s own medical conditions and treatment;
  • Reduced knowledge and understanding of health-promoting behaviors and preventive care and services;
  • Increased rates of hospitalization and use of emergency services;
  • Increased rates of poor health status;
  • Entry of sicker patients into healthcare systems;
  • Increased health care costs and spending (Institute of Medicine, 2004).

During this time, organizations and individuals promote the importance of understandable health information along with bringing awareness to breaking down the barriers of understanding. According to health experts, there is a large gap between the way health care issues are communicated by professionals, and the ability of the average person to understand them. Most people have limited health literacy… Not just those with limited reading or writing skills. If someone struggles to understand health literacy, statistically, they are more likely to skip important medical tests, have a harder time living with conditions, and visit the emergency room more often. This is why understanding health literacy is so important for everyone.

The good news is, that many health care facilities are trying to improve the way they communicate with patients to make sure everything is clear before the patient leaves. They are doing things like simplifying their written materials, using video and photos to teach patients, and more to help doctors clearly get their message across.

There are a few things you can do to improve your own health literacy individually or as a organization:

1. Improve your communication with health professionals. Make a list of your symptoms before you go in, have questions written down, and take a few notes when your doctor is explaining things to you.

2. Make sure you know who to call with any questions when you leave.

3. Attend health education programs at a library, community center, or anywhere you can find them in your community.

4. Talk to local schools and request that kids are taught about health literacy and education so they are prepared as they get older.

5. Hold a staff training to teach staff to use simple language, short sentences, and explain medical terms.   Some useful tools for measuring individual.

6. Update materials for your organization to include similar resources in the primary language for Limited English Proficiency.

 

 

QUOTE FOR THE WEEKEND:

“Domestic Violence Awareness Month (DVAM) is a national campaign dedicated to raising awareness about domestic violence. Every October, organizations and individuals unite across the country for a national effort to uplift the needs, voices, and experiences of survivors. Congress declared the month of October to be Domestic Violence Awareness Month in 1989.”

Domestic Violence Awareness Project (https://www.dvawareness.org/HealHoldCenter)

 

Domestic Violence Month Awareness.

photodune-4439753-domestic-violence-l-1920x714

   

We live in a scary world and for reasons society inflicted on itself; regarding the thought process or how our mind works.  Domestic Violence is violent or aggressive behavior within the home, typically involving the violent abuse of a spouse or partner.

People are often confronted with feelings of disappointment, frustration and anger as they interact with government officials, co-workers, family and even fellow commuters; which is people just in society. Most can control their actions to the extent that relatively few of these interactions end in a radical action like being racist to violence.

What help build a individuals feelings to turn out in a negative result (like bullying someone to protesting to worse rioting to violence or killing) is factors.

Factors being:

  • Feel powerless
  • Suffer from insecurity
  • Need to control others
  • Enjoy the rewards they get from bullying
  • YOUR CHILDHOOD UPBRINGING. Your childhood builds the foundation of how you turn out as an adult. If you have good upbringing where there are good morals, values, ethics with limitations or rules and regulations in what you can and cannot do with mommy and daddy overlooking from a distance in watching the child’s actions/interests/who they play with/what they’re doing on the computer or watching on T.V or even listening to music will help give direction for their child to be effective in society. Including, as the child shows good choices than more independence in getting older with still guidance and direction as needed. Remember your a young adult at 17 and a full fledged adult at 21 years of age to make all decisions in your life.
  1. BEING AN ADULT.   This includes accepting the turn outs of how a situation finally results; before the final result if you did everything you could legally try to reach your hope of a turn out and did reach it great, it makes you a stronger person. Now let’s say you didn’t than acceptance is necessary of what the result turned out as which also makes you a stronger person with being an asset in the community. Than your next step whether it be alone or in society overall move on without being an insult to the community where it effects the society in a negative way (like killing 2 innocent police officers just for wearing the color blue in uniform, prejudice=a radical action).   Being able to allow acceptance in your life which doesn’t always turn out the way you want it to helps you move on in life making you less out to be radical in your behavior. Take the riots (which they call protesting a radical approach from Missouri to New York) and see what their results turned out to be. Stopping people from getting to a destination point who had nothing to do with what the protestors were protesting about, to damage of property of innocent people’s business to the worse DEATH. Like this radical move did anything productive for humans in society. It obviously didn’t.

First let’s look at what turns anger into action?

The answer to this is mostly cognitive control or to use a less technical term, self-control.   University of Michigan professor of social psychology, Richard Nisbett, the world’s greatest authority on intelligence, plainly said that he’d rather have his son being high in self-control than intelligence, one year ago. Self-control is the key to a well-functioning life, because our brain makes us easily [susceptible] to all sorts of influences. Watching a movie showing violent acts predisposes us to act violently. Even just listening to violent rhetoric makes us prone or more inclined to be violent. Ironically, the same mirror neurons that make us empathic make us also very vulnerable to all sorts of influences. This is why control mechanisms are so important. If you think about it, there must be control mechanisms for mirror neurons. Mirror neurons are cells that fire when you grab a cup of coffee (to give you an example) as well as when you see someone else grabbing a cup of coffee. So, how come you don’t imitate all the time? The idea is that there are systems in the brain that help us by imitating only “internally”—they dampen the activity of mirror neurons when we simply watch, so that we can still have the sort of “inner imitation” that allows us to empathize with others, without any overt imitation. The key issue is the balance of power between these control mechanisms that we call top-down—because they are all like executives that control from the top down to the employees—and bottom-up mechanisms, in the opposite direction, like mirror neurons. This is whereby perception—watching somebody making an action—influences decisions—making the same action ourselves.

Neuroscience uncovered why people behave so violently looking into the Virginia Tech Massacre in 2007 with many other like incidents also which were still a small percentage of people. What happens in these individuals is that their cognitive control mechanisms are deranged. Mind you, these individuals are not out-of-control, enraged people. They just use their cognitive control mechanisms in the service of a disturbed goal. There are probably a multitude of factors at play here. The subject is exposed to influences that lead him or her to violent acts—including, unfortunately, not only the violent political rhetoric but also the media coverage of similar acts, as we are doing here. A variety of issues, especially mental health problems that lead to social isolation, lead the subject to a mental state that alters his or her ability to exercise cognitive control in a healthy manner. Again also childhood plays a big role.   The cognitive control capacities of the subject get somewhat redirected—we don’t quite understand how—toward goals and activities that are violent in a very specific way. Not the violent outburst of somebody who has “lost it” in a bar, punching people right and left. The violence is channeled in a very specific plan, with a very specific target—generally fed by the media (like take the protesting that has gone on from Missouri to New York for a month or more with media showing every news flash each day)through some sort of rhetoric, political or otherwise—with very specific tools, in the Giffords case, a 9-millimeter Glock.

Now lets look at what are the signs of a person who is disturbed enough to take some form of action to killing.   The signs are quite visible, although difficult to interpret without a context—and unfortunately they unfold very quickly , and people can rarely witness them before the action is taken (which happened with Brinsley in New York killing officers in Brooklyn on duty just doing their job), . The action itself is a sign, a desperate form of communication from a disturbed individual (Brinsley did put on the internet a warning the day it was going to be done, Sat 12/20/14. Unfortunately, nobody was chatting with the guy when he left his final messages on Internet before getting into action. But I bet that if somebody was communicating with him before the act and saw those signs and read those messages on social network he was using, that person could have done something, could have engaged him in a sort of conversation that might have redirected his deranged plans. Indeed, by connecting with the subject, that person might have redirected some of the activity of mirror neurons toward a truly empathic behavior, rather than in the service of the deranged imitative violence leading to action.

Now we have Ukraine vs Israel War with now Former President Trump having attempted assassinations not once but THREE times because people did not agree to want him as President of the U.S.  What is this world coming to.

My readers I could go on with more examples of people killing but I am sure you listen to the news or read it somehow but I tell you this information not to persecute a person, not even a race or politician but to LEARN HOW THE BRAIN WORKS.   Most importantly to PARENTS bring your children up AS A CHILD not as an adult until they reach adulthood with giving good direction and guidance as their primary mentor. You the parents make our next generation who are now children and even for future parents learn so they will have a more productive working society. For now the society in America works as a   nonproductive unit of people to all races, creeds, genders, sex preferences, & nationalities of all kinds. Especially in being compared to the 1980’s; yes they had their problems but not like today’s with people treating each other with more respect even if things didn’t go their way. Our nation didn’t go off the deep end  where  it was allowing us to have freedom of everything without limitations or better rules/regulations legally in place not followed which we are paying a good price for today for allowing this behaviour and will take a very long time to fix. Remember when someone or now a group of people get hurt you can forgive but healing is like a wound it takes time to heal. Example: Look at Hitler, people who haven’t forgiven him, those that did have not forgotten it and they shouldn’t since he caused such a disaster to the human race. Protesting can be effective where its peaceful, quiet, and not bothering other people in the area who aren’t involved. Look at Missouri and New York City this past 15  years, MUCH DAMAGE due to not thinking first but acting out first.

Take A Stand is a call to action meant to bring attention to the issue of domestic violence for Domestic Violence Awareness Month (DVAM) and throughout the year.  By taking a stand we intend to remind the nation that there are still countless people–victims and survivors, their children and families, their friends and family, their communities–impacted by domestic violence.  We, all of us, should not stop until society has zero tolerance for domestic violence and until all victims and survivors can be heard.

Take A Stand is a call to action meant to bring attention to the issue of domestic violence for Domestic Violence Awareness Month (DVAM) and throughout the year.  By taking a stand we intend to remind the nation that there are still countless people–victims and survivors, their children and families, their friends and family, their communities–impacted by domestic violence.  We, all of us, should not stop until society has zero tolerance for domestic violence and until all victims and survivors can be heard.

Taking a stand against domestic violence means speaking up when we see or hear behaviors that contribute to a culture where violence lives. This could mean trying to stop violence before it starts by promoting healthy relationships and attitudes, supporting survivors of violence when they come forward, or intervening if you see someone acting violently toward another person. Before you intervene in a situation, think about your personal safety, the safety of others, your relationship with the people involved, and what your options are for intervening.

Strategies on how to take a stand:

1) Refocus the Conversation

This is the least direct approach to intervening as a bystander, by refocusing the conversation away from the offensive comment or person.  The goal is to not give an audience to the comment or person by changing the situation.  This approach can work especially well if you are uncomfortable confronting the offender directly for any reason, like someone in a position of power.  You could ask for the time, ask for directions, make a joke, tell a story, or even spill your drink.  If the comment is toward a specific person, you could take a more direct approach and verbally support the target without addressing the offender.

2) Engage Others in Intervention

In this approach, the goal is to use the situation to promote a new positive perspective for all the bystanders. You can do this by asking the group a question that challenges the idea you think is problematic without directly refuting it.  For example, if a friend or family member makes a victim blaming comment about someone returning to a relationship where there is domestic violence, you could say, “I know it’s easy to ask why victims go back when we hear about domestic violence, but maybe a better question would be why someone would think it’s okay to harm or control someone they love.”

3) A Direct Confrontation

In this case, the bystander approaches the person who made the offending comment and explains why what they said is a problem, or how the comment made the bystander feel. You could choose to confront the situation right away or wait for a moment of privacy with this person. It could also be good to seek the support of another friend, especially if you worry that your approach will not be taken seriously.

Your goal is to make whoever you’re approaching consider, even briefly, why their behavior is problematic with the hope of influencing future behavior.

QUOTE FOR FRIDAY:

“During hip replacement, a surgeon removes the damaged sections of the hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.

Also called total hip arthroplasty, hip replacement surgery might be an option if hip pain interferes with daily activities and nonsurgical treatments haven’t helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement.”

MAYO CLINIC (https://www.mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042)

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.