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Upper Body Joint Replacement

By MARILYN SOLTIS
Injuries, arthritis and other diseases can cause damage to the joints. Years of use may simply cause the joint to wear away. This can cause pain, stiffness, and swelling. Bones are alive, and they need blood to be healthy, to grow and repair themselves. Diseases and damage inside a joint can limit blood flow, causing problems.
   
Arthritis is the leading cause of disability in the U.S., according to the American Academy of Orthopedic Surgeons (AAOS). It is estimated that one out of five people has at least one joint affected by arthritis with half of those affected under 50.
   
Researchers are now exploring other causes that can contribute to disease and the pain and discomfort of damaged joints.
   
Osteoarthritis has often been attributed to the “wear and tear” of obese patients whose increased weight load may result in cartilage breakdown. However, studies have shown that osteoarthritis occurs in joints such as the hand in obese patients, where loading would not be a factor.
   
Dr. Bravman and coauthor Ryan C. Koonce, MD of the department of orthopedic surgery at Skagit Regional Clinics in Mount Vernon, WA wrote in the March Issue of the Journal of the AAOS that the link between obesity and osteoarthritis has a hormonal factor as well as a biomechanical one.
  
Adipose, or fat, tissue is “known to secrete adipokines—proinflammatory cytokines that target different organs. One of the targets seems to be articular cartilage,” according to the doctors. They see adipose tissue as a “freely functioning endocrine organ, one that’s acting at the cellular level in concert with mechanical, alignment-based factors.”  
  
Since excess fat increases the symptoms of arthritis, the doctors argue that weight loss should be offered at the primary treatment for osteoarthritis and musculoskeletal pain.
  
Researchers found that low Vitamin D levels are found in all adult orthopedic trauma patients, not just in elderly patients. Although research is sparse, low levels of Vitamin D have been linked with fracture and fragility fractures.
   
The National Institutes of Health reports that most Americans have blood levels of Vitamin D lower than 30 ng/mL; almost no one has levels that are too high. Low levels of Vitamin D have been associated with decreased dietary calcium consumption, increased bone absorption and increased parathyroid hormone expression.
   
Whatever the cause, replacing upper body joints is becoming more common. A new joint, or prosthesis, can be made of plastic, metal, or both. It may be cemented into place or not cemented, so that your bone will grow into it. Both methods may be combined to keep the new joint in place. Here are some of the most common upper body procedures:

 Shoulder joint replacement
    
About 53,000 people in the U.S. have shoulder replacement surgery each year according to the Agency for Healthcare Research and Quality. Shoulder replacement surgery relieves pain and stiffness for most people. It even allows many people to return to sports such as golf, swimming, bowling, and others.
   
MedlinePlus describes the procedure as: For total shoulder replacement, the round end of your arm bone will be replaced with an artificial stem that has a rounded metal head. The socket part (glenoid) of your shoulder blade will be replaced with a smooth plastic shell (lining) that will be held in place with a special cement. If only 1 of these 2 bones needs to be replaced, the surgery is called a partial shoulder replacement, or a hemiarthroplasty.
   
For shoulder joint replacement, your surgeon will make an incision (cut) over your shoulder joint to open up the area. 
     Then your surgeon will:
  •  Remove the head (top) of your upper arm bone (humerus)
  • Cement the new metal head and stem into place
  •  Smooth the surface of the old socket and cement the new one in place
  • Close your incision with staples or sutures
  • Place a dressing (bandage) over your wound. Your arm will be in a sling for up to six weeks with no active movement. 

Elbow Joint Replacement
   
The elbow joint connects the humerus in the upper arm and the ulna in the lower arm.  The artificial joint consists of two metal stems connected by a metal and plastic hinge.
   
Elbow replacement surgery works to ease pain in most cases. A cut is made in the back of the arm and the damaged tissue and parts of the arm bone are removed. A hole is drilled in the center of the two arm bones and the end of the artificial elbow joint are placed into each bone and connected with a hinge. The tissue around the elbow is repaired.
   
Surgery is done under general anesthesia and the hospital stay may be two or three days. Some people can use their elbow as soon as 12 weeks after surgery but full recovery can take up to a year. In some cases there may be limits on the amount of weight you can lift.

Wrist Joint Replacement
   
OrthoInfo on the AAOS website describes the procedure: Wrist joint replacement can be done as an outpatient procedure, unlike a hip or knee replacement. Wrist replacement surgery is often combined with other procedures to correct deformities or disorders in the tendons, nerves, and small joints of the fingers, and thumb.
   
An incision is made on the back of the wrist. The damaged ends of the lower arm bones are removed and the first row of carpal bones may also be removed. The radial component of the prosthesis is inserted into the center of the radius bone on the outside of the lower arm. It is held in place with bone cement.
   
Depending on the component design, the carpal component is then inserted into the center hand bone (third metacarpal) or screwed into the remaining row of carpal bones. Bone cement may be used to hold the component in place. The carpal bones may be linked or fused together to better secure this component. Wrist replacements may last 10 to 15 years.

Stem Cell Research
   
Research is advancing in the field of stem cells for regeneration of joint cartilage and for the repair of arthritis damage. This may eventually greatly reduce the need for joint replacement surgery or postpone the need for it. 












Published: April 15, 2013
Issue: Spring 2013 Issue