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Frequently Asked Questions- Conditions & Procedures

What is a hip replacement?

A hip replacement involves a surgical procedure to replace part or all of a
diseased or damaged hip joint with an artificial substitute—a prosthetic hip joint.
The operation to replace or mend a joint is known as 'arthroplasty'. The aim of a
hip replacement is to alleviate pain and restore function in the hip joint.

When is a hip replacement necessary?

A hip replacement may become necessary to prevent pain and increase mobility
if your hip joint is damaged as a result of disease or injury. The most common
cause of hip replacements is osteoarthritis, but the procedure may also be
necessary for people with rheumatoid arthritis, osteoporosis, bone tumours or a fractured femur (thigh bone).

Hip replacements may not be recommended for people who have a high likelihood
of injury, such as people with Parkinson’s disease or a significant weakness of the muscles.

What is the difference between standard hip replacement and
resurfacing hip replacement?

The traditional treatment of a patient that required a hip replacement has been
a stem-type replacement. The decision to perform a hip resurfacing is determined
by diagnosis, the age of the patient, the patient’s level of activity and expectations.
The resurfacing hip replacement offers a long-term outcome for young and active patients while saving bone for later revision when necessary. This conservative approach to hip replacement accounts for the popularity of the procedure.

How is my new hip different?

You may feel some numbness in the skin around your incision. You also may
feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain
and limited function they experienced prior to surgery.

Your new hip may activate metal detectors required for security in airports and
some buildings. Tell the security agent about your hip replacement if the alarm is activated.

What is the length of expectancy of the resurfaced hip?

The average expectancy ranges from five to twenty years depending upon the
activity level of the patient.

What causes arthritis in the knee?

Osteoarthritis or Degenerative Joint Disease - the most common type of
arthritis. Osteoarthritis is also known as “wear and tear arthritis” since the
cartilage simply wears out. When cartilage wears away, bone rubs on bone
causing severe pain and disability. The most frequent reason for osteoarthritis is genetic, since the durability of each individual’s cartilage is based on genetics.

Trauma - can also lead to osteoarthritis. A bad fall or blow to the knee can
injure the joint. If the injury does not heal properly, extra force may be placed
on the joint, which over time can cause the cartilage to wear away.

Inflammatory Arthritis - swelling and heat (inflammation) of the joint lining
causes a release of enzymes which soften and eventually destroy the cartilage. Rheumatoid arthritis, Lupus and psoriatic arthritis are inflammatory in nature.

What is the difference between total knee replacement and unicompartmental knee resurfacing?

Knee replacement is removing the edges of the joint that have been diseased
by degeneration or trauma. Knee resurfacing is like a retread. The only part of
the joint that is resurfaced is the side of the joint that is diseased.

What is revision knee surgery? how is it different to the knee
replacement?

Revision surgery is different in that the original components are removed and
new components are implanted. The technical aspects of the surgery are more
complex than the original total knee replacement. However, the preparation for
surgery and hospital experience tend to be very similar to the primary knee replacement.

What happens if my knee gets infected?

If a knee is infected the patient is first given antibiotics. If the infection does not
clear up, the implant will have to be taken out and the patient is scheduled for
revision surgery. The original components are removed and a block of
polyethylene cement treated with antibiotics (known as a “spacer block”) is
inserted into the knee joint for six weeks. During this time the patient is also
treated with intravenous (I.V.) antibiotics. After a minimum of six weeks, new
knee components are implanted.

How is my new knee different?

You may feel some numbness in the skin around your incision. You also may feel
some stiffness, particularly with excessive bending activities. Improvement of
knee motion is a goal of total knee replacement, but restoration of full motion is
uncommon. The motion of your knee replacement after surgery is predicted
by the motion of your knee prior to surgery. Most patients can expect to nearly
fully straighten the replaced knee and to bend the knee sufficiently to go up and
down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it
is not harmful. Occasionally, you may feel some soft clicking of the metal and
plastic with knee bending or walking. These differences often diminish with time
and most patients find these are minor, compared to the pain and limited
function they experienced prior to surgery.

Your new knee may activate metal detectors required for security in airports and
some buildings. Tell the security agent about your knee replacement if the alarm
is activated. Find out more from your doctor on Special precautions and special exercise programs.

What are common causes for back pain?

Back pain afflicts 80% of the population at some point in their lives. Back pain
is not always the result of an accident or injury, but often times back pain is due
to long-term repetitive faulty habits such as poor posture, improper body mechanics and decline in physical fitness. Other common causes include degeneration of the
discs, as well as disc herniations or other causes of pinched nerves, such as spinal stenosis. Not only the discs themselves, however, can be a source of pain. The
facet joint, muscles and ligaments can also be involved in creating pain.

What is sciatica?

Sciatica is a condition caused by the sciatic nerves in the body becoming inflamed.
The sciatic nerves (largest nerve in the body) begin from your lower spine and
continue down the buttock area, back of the leg, and into the foot. Symptoms can range from a light tingling feeling, burning sensation to a full blown shooting pain radiating from your lower back, buttock area or leg. Sciatica usually affects only
one side, although it is possible to also run down both legs.

How do disc injuries cause back pain?

Injury to the disc can cause pain in three different ways. First, the injured disc
can itself be painful. The damage results in development of pain coming directly
from the disc. Second, the injured disc may be weakened to the point that it no
longer functions as it should. Normally, the discs allow for normal movement of
the spine by acting as "shock absorbers" between the blocks of bone of the spine (vertebra). When the disc fails to do its job, the other parts of the spine, such as
the joints known as facet joints, may suffer.
This can generate secondary pain arising from the other structures. Finally, an
injured disc may be displaced from its normal position and pinch (compress) a
nerve, causing pain. If the displaced disc compresses or inflames a nerve, there
may be back pain, leg pain or a combination of both.

What is spinal stenosis?

Spinal stenosis is a condition where the space available for the nerves becomes
very small and the nerves become pinched and inflamed which leads to significant nerve pain. The typical cause of the narrowing of the spinal canal is arthritis of the spine, which gradually narrows the space for the nerves. This condition typically
takes years to develop, although it can become debilitating

What are the risks associated with spinal surgery?

Any surgery has risks. There are many risks associated with spinal surgery.
However, in the hands of a well-trained, dedicated spine surgeon, these risks
should be quite low. The risks include paralysis, weakness, numbness, bleeding,
spinal fluid leakage, wound healing problems, infection, spinal hardware breakage,
and failure to fuse. There is also a risk that the pain may not be fully relieved. All
of these risks should be discussed with your surgeon prior to surgery.

What is a laminectomy?

The bony arches behind the sac of nerves in the lower back are called laminae. Laminectomy is a procedure where the surgeon removes a small amount of bone
and tissue that is compressing the nerves.