hi this is a mcgregor from senior perspective today i have something very different to share with you one day last summer i was working in my garden and fell the doctor said my hip broke causing me to fall which led to a hip replacement thanks to my guests and their staff i am able to day to rock and now i live a normal life my guests are familiar with cases such as this they are doctor much to learn from southwestern orthopedic association antoni from keystone rehabilitation system i have a few simple questions i would like to ask you could you tell me what is arthritis or what or where it is basically is wearing the joint surface cartilage is a very smooth and slippery substance  don't have materials as slippery as cartilage young cartilage and what happens is the cartilage the actual running surface to the joint becomes damaged originally it looks very shiny or alike as it starts to become  it then becomes fuzzy and then it starts to look like little pieces of crabmeat as it starts to flake off or fall off once that surfaces go on the bone and starts to rub on the bone that whole process  swelling is what causes the pain then is when that we are seeing this sort of pain is caused by the particles flaking off they irritate the lining to the joint and the joint cords a lot of fluid and that's what you see is those are the people you'll see where their fingers tend to drift in the form that is rather terry can happen at some very young ages osteoarthritis can also be hereditary but it's not as strongly linked and what we think is that a portion maybe about six percent of osteoarthritis is familial or read a terrier and what that osteoarthritis is is a wear and tear type of arthritis that's why we tend to think about it then also be like some of the symptoms of getting as your finger joints or your knee joint you might notice it's a little more swollen then the other side you know a quote you try to move it sometimes if you try to walk on and you find you can't it's just sort of do that in sometimes in case of the rim of the riddick as the day story how can you prevent a joint from deteriorating well in the case of rheumatoid arthritis there's various medications that tend to quiet down the process the room toward earth ri the actual problem starts not with the cartilage surface but with the lining to the knee that lying tends to overgrow the cartilage and kills the cartilage in an osteoarthritic situation it's a fraying away of the cartilage and you really can't do anything about that process it's progressive it's degenerative there is recently in the news media like cartilage transplantation and there is some research going on both in england and in the united states to see if we can regroup hardly trouble with cartilage is probably one of the slowest rowing materials or horse tissues in the body and once damaged if the wear process is faster than the repair process you have arthritis so basically the ability of cartilage to repair itself is limited and the research into transplantation along those lines is trying to find ways to help  repair itself that's cutting edge that's not something you can do now basically the approach to arthritis now is controlling the symptoms if we can help the process then we try to control the symptoms there are some things that a patient can do to help one of the things is if you're enjoying impact activities if you like to run or play tennis and you notice that after you do these things you need swells and it's a pain for you limping and maybe you ought to say away from those activities there are other there are other can do to help themselves out local things like cane they can use ice there's numerous anti inflammatory medications the latest on the market or aleve and or you the numerous brand names they're all basically about the equivalent of some work better than others and some people so you have to find the one that works best for yourself that be something like an aspirin or something or that something a little more stronger well there's two different ways to fight inflammation there are what we call monster wardle anti inflammatory drugs you may have seen the word and sets yeah and then there are steroids everybody has a bad feeling about still the truth of the matter drugs work by a different pathway in the body to relieve inflammation their side effects are mostly gastritis upset stomach and if you're on them for prolonged periods of time months and years you have to be concerned about any sort of kidney damage steroids medications on the other hand were by a different pathway and because of the abuse of athletes and that with steroids people tend to shy away from but they are much stronger than they had than the non steroid inflammatory medications you tend not to stay on the for a long time in addition sometimes you can locally inject the steroids sometimes when you come into the doctor's office or your knee is puffed up and sworn he'll tap your knee and then inject your knee with cortisone and that can work very effectively fairly quickly in two or three days your pain can be settling down if it's in excess of a joint like the knee you know i know you've had that experience then you have to consider joint replacement as an option what happens during a hip replacement i mean let me show you what arthritis looks like to a surgeon when he's evaluating you to determine if you look at this side of the x ray just limit to the side see this gap right here now from here to here that's the cartilage space halfway between that space is the imaginary line we can't see on x ray but where those two quarterly surfaces rubbing against each other this half is lined with cartilage and the ball half of federal or europe i'm sorry federal headed half is lined with cartilage so that makes a very smooth slippery ball joint which is centuries what your hip joint is now let's look over to the right side you notice the difference that space is gone entirely in addition we can see that this is really white to me here compared to the other side that's what we call an x ray sclerosis what it means is that the bone because the card leech is worn is seeing stress and even now in bone reacts to stress so it's growing up it's building itself up trying to fight off its increased stress the other thing is i don't know if you can see what was his little blackened areas and yeah those are bone cis ok there are cysts that form in the bone is it some of the load and also see how this is round now you see how this is flattened out across here and is water severe arthritis i would call this a severe arthritis if all conservative measures fail and this patient is having pain that it can't control they can't live with then the patient's only option is a joint replacement operation the main thing to realize if you have arthritis is i told my patients this there's three reasons to have a joint replacement number one is pain number two is pain number three is pain because one can h some people decide to live within their restrictions if the if a decrease their activities if they decide all they want to do is go to church go to the shopping center for groceries and come home and they have an x ray to looks like this but they're not having that much pain you don't do it replacement if there's somebody that likes to walk them all they've been doing three miles a day in the earth right is so bad now that they can't do it anymore and they really want to do it that's an excellent candidate for a  they will get pain relief and it will restore them to the activity level that they're used to well the longer they wait though the more damage they do to that is a progressive process so it's really the more pain they're living through not more damage because we could reverse the process anyway so what they're doing is actually the wisest thing nothing beats mother nature to ride it out for as long as you can if you can't stand it any more than that's a good time to ever placement parisian let me show you i have a x ray of a hip that's been replaced ok we can compare the two side by side right this would be the situation before the operation and this pristine to the public bone after it's prepared during the operation you can see but inside it here is a plastic liner then there is a cobol cromer of ceramic head fitted on a titanium step so this goes down into your fiber her femur this part goes into your pelvis and then what holds it together the muscle forces these two one attached i actually have some components we can look at  we see them now sure this part is the stem and that's that long this part make this into your bone is the part right here now their stories a little bigger ok it's magnified some of this is this component this goes down into your thought well they implant that i tend to use as a coating on here it actually has a blue mineral called hydroxy appetite it's the mineral base that your bone transforms into and what this implant does is the bone sees that and grabs onto it fairly quickly chemically in about six weeks so it goes in my experience a good fit with the bone right on to that and this is a ceramic we place this ball right and that composes your five bone if you will have total hip replacement right now on the other side we have this cup which is titanium you can see we have the inside polished in that's because you're trying to prevent where debris inside of that snaps this plastic liner so surgically after this isn't bedded in helpless what we do is a line this in this will snap into place ok now you can see this is the plastic the rides on the ceramic in this case so now you have a joint that moves about c neither piece other than these two components once these two are assembled the only thing that keeps this pushed together like this is the muscle forces so it allows you to walk and move your hip about without pain because margolin surfaces are now gone so the white part there is what takes place in the current then yes that cartilage and this ceramic are now the new bearing surfaces and this is basically where the weak spot is a joint replacement these days this plastic wears and your body doesn't know how to handle the wear degree and when your body doesn't know how to handle something be it tuberculosis polyethylene plastic it creates inflammation and tries to wall it off and that inflammation ok actually starts getting to the bone the interfaces here will loosen them and after years you'll start to have pain again basically you can expect probably somewhere between ten and fifteen years out of a hip replacement so the older you are actually the better it is for you because number one your demands are a little lower if we put these in young patients they're basically the worst flu to put them in if you  will we just don't have the technology to date that we can replace a hip and a young patient have it last a lifetime would like to get there we're just not there yet dr winter could you tell me where are these parts they're going to recall i made a call strengthen the muscles begins to deteriorate so after the surgery that there's just the patient needs to recover the strength the flexibility in the joints not only be affected joint but also after surgery most of the time how are these depends on the search and but most of that they will begin the day after the surgery with a physical therapist in the hospital in the patient's room assisting flexibility str the ability of the patient to be able to see it to stand to walk and then determine what kind of treatment they will be requiring i remember that is for sure you do as you have the two of them already right in that again that will depend mostly on the surgeons after the surgery and also india but if you have the patient to surgery some patient may have been using a cane or a walker for years before and he would be difficult for them to go from using a walker for years to not using any assisted devices so again the that would be depending on the assessment by the surgeon by the physical therapist after the surgery  the joint is sustained to only by the muscles sustaining place only by the muscles so what do you get with the hip joint there are certain mormons that should not be performed by the patient following the surgery and there are three main activities that the patient should avoid the first one they should never banned the hip more than ninety degrees so therefore they should not go beyond beneath a level with the hip bending it which means they should also not squat because that would bend them more than the ninety degrees that are accepted bending will be more than ninety degrees in other words they need should never be higher than the hip when you are sitting a would you do it any activity another view that should also be avoided is crossing the good leg on top or behind the other one or later to get too close to the other one when you're lining bed if you're lying on your side you should always put a pillow between your legs between your knees to prevent them from falling and crossing over the other one so basically don't bend the big hip more than ninety degrees don't do it in squatting activities and don't cross your legs those are the main restrictions ye area to improve flexibility and then progressing to strength balance and conditioning to send them to their functional activities but i think the best thing we can do now is maybe show with  model couple of the exercises that are done with the patients ok let's see what we can do one of the first exercises we teach the patient is this is usually done in the hospital is exercise to promote circulation to lots of developing in the leg and what we show the patient is to do was c in the beginning especially then other exercises there will also be that in the beginning our flexibility exercises to start gently more in the joint to stimulate the l of the joint in the joints in the leg and at the same time to begin more movement of the muscles and this will be done with assistance in the beginning because the patient will be unable to do it in most case by themselves in addition to the flexibility in the circulation exercises will also start with some strengthening exercises to regain the strengthen the muscles that are the condition or affected and one of the ways that we do that is just using the progressive lean creasing weights in this case we have her with a two pound weight where she is going just are doing  exercises with her knee to strengthen their quota system which is the muscle in the front of your thighs which is very important for walking as well as for balancing the stability of the hip and  with some conditioning of your body some part of the vascular exercises to improve also your insurance and in this case we're having her do some squats in a position therefore there's also there's only a percentage of her body weight being lifted back and forth can you do that for me and here we can see how she works the hips and the another aspect that we need to also work on is balance ok many patients with little joint replacement have the physics of balance and we need to work also to regain that in one of the exercises that we do we have used our stand on an unstable surface in first with assistance of both hands you start trying to balance yourself going back and forth in going around make in circles and that w stimulate the sensors in the joints that tell your brain where the joint is and therefore you can improve your balance then as you improving get better it will take one and often you will do the same and eventually you will to do it without holding you just supervising ok you can a step down now another aspect that is important in the rehabilitation is your cardiovascular endure your ability to do activities for a sustained period of time and for that we put jewels on the treadmill or in the bicycle to make you continue for at least three months with a homicide program but it would not be a bad idea if they would keep doing exercises for a lifetime not only exercises to regain  strength and flexibility but also to maintain it and exercises to improve their cardiovascular activities we think is the walking on a treadmill or a bicycle