Published: May 24, 2009 11:37 pm      

Surgery restores life quality for many arthritis sufferers

Jim Johns of Maplewood Drive got himself a new Brittany spaniel last year and was looking forward to going after some pheasant.

But he and Zip hardly made it out last fall. Pain in Johns’ hip was getting worse.

“I only went out two or three times,” Johns said. “I couldn’t take it anymore. Well, I could, but the pain outweighed the fun.”

Johns is not alone. An estimated 46 million Americans have been diagnosed with arthritis or similar condition affecting muscles, joints and related tissues.

Arthritis is the most common cause of disability in the nation, limiting activity for 19 million people, the National Center for Chronic Disease Prevention and Health Promotion reports.

Forty-six million Americans report that a doctor told them they have arthritis or other rheumatic conditions. Arthritis is the most common cause of disability in the United States, limiting the activities of nearly 19 million adults.

“Osteoarthritis is the most common type,” Dr. Ian Katz said from Western Pennsylvania Orthopedic and Sports Medicine in Southmont.

Also called degenerative joint disease, osteoarthritis affects the cartilage, or the smooth covering of the bones at the joints, Katz continued.

It wears away cartilage slowly, until the joint becomes a grinding of bone on bone with no cartilage “shock absorber.”

Bone spurs can develop to compensate for the lost cartilage, reshaping the joints. Arthritis in the knee, for example, can lead to knock knees or bow legs.

“Deformity can become progressive as the arthritis progresses,” Katz said.

Nonsurgical treatment begins with pain and inflammation control from analgesics like Tylenol, Dr. Brian E. Gunnlaugson said from his orthopedic surgery practice at 321 Main St., Johns-town.

Physical therapy and directed exercise can improve mobility in the affected joints, and acupuncture and massage therapy available in Windber Medical Center’s integrative medicine program have helped some patients in the early stages, Gunnlaugson said.

But because osteoarthritis is a degenerative disease, nonsurgical treatments are limited, he said.

“It just keeps you less symptomatic for a while,” Gunnlaugson said.

Fortunately for knee and hip patients, surgery has proven to be a godsend.

Less than six weeks after his total hip replacement, 80-year-old Johns says he’s back to normal. He’s even been mowing grass at his Maplewood Drive home in Richland Township.

“Now I have no pain at all, anyplace,” Johns said.

His results are typical, doctors say.

“Hip and knee replacement are the most successful orthopedic surgeries in terms of quality of life improvement,” Katz said.

“It is a marked improvement in the quality of life,” Gunnlaugson said. “With the increased activity level, they can do so much more in day-to-day life.”

Nine orthopedic surgeons combine for more than 700 joint-replacement surgeries each year at Memorial Medical Center, with smaller programs at Windber Medical Center and Somerset Hospital.

Although complications are always possible, the prognosis is good with joint replacement, doctors say.

Surgery initially requires about three days in the hospital, followed by six weeks of monitored recovery at home.

“After six months, they absolutely forget that they had anything done,” Gunnlaugson said. “It’s as close as you can come to being 18 again.”

Technology is helping speed recovery, Katz said.

“Technology makes small incremental improvements,” Katz said. “There is not one great discovery that revolutionizes knee-replacement surgery.”

Mobile bearing knee replacement and computer-assisted navigation are among the latest advances being offered locally.

In the mobile bearing knee, a flexible spacer used in place of cartilage in the joint is not as tightly attached to the upper “bone.” Allowing it to slide or rotate on a metal section provides a more natural range of motion.

Computer-assisted navigation is being introduced at all three hospitals for select patients, Gunnlaugson said.

The process begins with a pre-operative magnetic resonance imaging scan or computer tomography scan to show the exact location and shape of the joint.

The surgical team uses the three-dimensional image to map out incision location and joint placement, constructing special tools and spacers to customize the operation.

“It makes the surgery potentially more accurate and more personalized,” Gunnlaugson said. “It takes out some of the guesswork and can save time.”

But the computer-aided option is also very expensive, Gunnlaugson noted. He recently completed his first surgery using Windber’s Signature Personalized Patient Care System, manufactured by Biomet. Somerset uses the same system and Memorial uses the TruMatch Custom Patient Instrumentation system.

Hospitals are still studying the new options to determine which patients would benefit from the more exact placement.

Perhaps the most important ongoing change in joint replacement is illustrated by the incision size. While some surgeons have introduced minimally-invasive techniques to joint replacement, local physicians note the technique is still controversial.

“There are pros and cons to minimally invasive surgery,” Katz said. “Recovery can be faster, but there can be more complications.”

Instead, local surgeons concentrate on minimizing damage to surrounding tissue.

“In general, we are using smaller incisions and paying closer attention to preserving soft tissue,” Katz said. “The main reason people are recovering faster is because of pain control preoperatively and postoperatively. It helps them get up and get around sooner.”